Annals of Behavioral Medicine

, Volume 44, Issue 2, pp 181–191 | Cite as

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

  • Ann O’Leary
  • John B. JemmottIII
  • Loretta Sweet Jemmott
  • Scarlett Bellamy
  • Zolani Ngwane
  • Larry Icard
  • Lynnette Gueits
Original Article



“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 


The authors appreciate the contributions of Sonya Coombs, Costa Gazi, MD, Nicole Hewitt, Ph.D., Janet Hsu, BA, Shasta Jones, Ph.D., Xoliswa Mtose, MEd, Pretty Ndyebi, Mwezeni Nela, Ph.D., Robert Shell, Ph.D., Lulama Sidloyi, Gladys Thomas, MSW, MBA, Dalena White, MBA, and Tukufu Zuberi, Ph.D. This study was supported by research grant R01 MH065867 from the National Institute of Mental Health to John B. Jemmott III. Some of these data were presented at the XVII International AIDS Conference, Mexico City, August 2008. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Conflict of interest statement

The authors have no conflict of interest to disclose.


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Copyright information

© The Society of Behavioral Medicine (outside the USA) 2012

Authors and Affiliations

  • Ann O’Leary
    • 1
  • John B. JemmottIII
    • 2
  • Loretta Sweet Jemmott
    • 2
  • Scarlett Bellamy
    • 2
  • Zolani Ngwane
    • 3
  • Larry Icard
    • 4
  • Lynnette Gueits
    • 2
  1. 1.Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD, and TB PreventionCenters for Disease Control and PreventionAtlantaUSA
  2. 2.University of PennsylvaniaPhiladelphiaUSA
  3. 3.Haverford CollegeHaverfordUSA
  4. 4.Temple UniversityPhiladelphiaUSA

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