Original Article

Annals of Behavioral Medicine

, Volume 44, Issue 2, pp 181-191

First online:

Moderation and Mediation of an Effective HIV Risk-Reduction Intervention for South African Adolescents

  • Ann O’LearyAffiliated withPrevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention Email author 
  • , John B. JemmottIIIAffiliated withUniversity of Pennsylvania
  • , Loretta Sweet JemmottAffiliated withUniversity of Pennsylvania
  • , Scarlett BellamyAffiliated withUniversity of Pennsylvania
  • , Zolani NgwaneAffiliated withHaverford College
  • , Larry IcardAffiliated withTemple University
  • , Lynnette GueitsAffiliated withUniversity of Pennsylvania

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“Let Us Protect Our Future” is a sexual risk-reduction intervention for sixth-grade adolescents in South Africa. Tested in a cluster-randomized controlled trial, the intervention significantly reduced self-reported intercourse and unprotected intercourse during a 12-month follow-up period.


The present analyses were conducted to identify moderators of the intervention’s efficacy as well as, which theory-based variables mediated the intervention’s effects.


Intervention efficacy over the 3-, 6-, and 12-month follow-up was tested using generalized estimating equation models.


Living with their father in the home, parental strictness, and religiosity moderated the efficacy of the intervention in reducing unprotected intercourse. Self-efficacy to avoid risky situations and expected parental disapproval of their having intercourse, derived from Social Cognitive Theory, significantly mediated the intervention’s effect on abstinence.


This is the first study to demonstrate that Social Cognitive variables mediate the efficacy of a sexual risk-reduction intervention among South African adolescents.


HIV prevention Behavioral intervention Adolescents South Africa Moderation Mediation