Trends in HIV prevention outcomes among Northern and Indigenous adolescents: A repeated cross-sectional study of arts-based sexual health workshops in the Northwest Territories, Canada

BACKGROUND: Arts-based sexual health workshops may improve adolescent sexual health, yet limited studies have evaluated outcome trends over time. This study examined HIV prevention outcomes before and after school-based workshop participation among adolescents in the Northwest Territories (NWT), Canada. METHODS: We analyzed seven waves of pretest and immediate posttest data from adolescents aged 13-18 years in 17 NWT communities from 2018-2019 to 2024-2025. Surveys assessed sociodemographic characteristics, HIV knowledge, and condom use self-efficacy (CUSE). Paired-samples t-tests examined pretest to posttest differences. Mixed-effects linear regression models examined trends in change scores across school years and adjusted for the number of previously completed arts-based sexual health workshops. RESULTS: The pretest sample included 1,936 workshop observations; 1,579 had paired outcome data. Mean age was 13.64 years (SD=1.47); 48.86% were cisgender girls, 19.62% identified as lesbian, gay, bisexual, or queer, 70.05% identified as Indigenous, and 68.16% lived outside of Yellowknife in rural settings. HIV knowledge increased from 2.74 (SD=3.13) to 8.05 (SD=4.18), with a large effect size (Cohen's dz=1.30). CUSE increased from 19.59 (SD=4.40) to 20.32 (SD=4.70), with a small effect size (Cohen's dz=0.15). HIV knowledge gains increased across school years, particularly among older adolescents and cisgender girls. CUSE gains also increased; no sociodemographic interaction was statistically significant. CONCLUSION: Arts-based sexual health workshop participation was associated with immediate improvements in HIV knowledge and CUSE across seven school years among Northern and Indigenous adolescents in the NWT. Findings support continued evaluation of culturally responsive, arts-based HIV prevention in Northern and remote settings.