Psychosocial correlates of HIV risk behavior in adolescent girls

HIV Knowledge of Middle Eastern and North Africans 18-35 Residing in the U.S.: A Cross Sectional Study

The current body of literature on the HIV knowledge related to young adult Middle Eastern and North African (MENA) individuals residing in the United States is substantially underdeveloped. As the number of MENA individuals residing in the US continues to rise, there remains a need for research investigating the levels of general HIV knowledge for this unique group. An exploratory cross-sectional design was used for an anonymous online survey of MENA adults ages 18-35 (n = 198) residing in the United States concerning their levels of HIV knowledge. Results showed that less than fifty percent (46.40%) of the sample reported adequate knowledge of HIV transmission and prevention methods. Multiple regression analyses indicate that prior sexual health education, prior HIV testing, a four-year college degree and identification as a Muslim predicted higher HIV knowledge. These findings may assist with the development of MENA specific HIV prevention and education programs.

A "Triple Threat" to Research Protocols and Logistics: Adolescents, Sexual Health, and Poverty

The purpose of this article is to discuss lessons learned from conducting research with urban communities. A brief overview of the Health Improvement Project for Teens (HIPTeens) will be provided. It will be followed by several suggestions concerning recruitment and retention of participants, challenges related to working in impoverished environments, hiring and training of research teams, interacting with administration and community, and strategies for doing research in diverse settings.

Assessing girls' HIV vulnerability: evidence from Botswana, Malawi and Mozambique

Past research documents multiple factors associated with girls' susceptibility to human immunodeficiency virus transmission; yet a literature review found no systematic approach to measure vulnerability. This study characterized, developed and tested a set of indicators to measure girls' vulnerability, resulting in the vulnerable girls index (VGI). A quasi- experimental, separate-sample pre-/post-test design was used to test the index. Adolescent girls were randomly drawn for the pre-test (2277 respondents) and post-test (1418 respondents) from 16 purposively selected communities in Botswana, Malawi and Mozambique. The higher the VGI score-or the more vulnerable the girl-the more likely she was to report premarital sexual experience across the three countries and the more likely she was to report low agency to insist upon condom use in Botswana and Mozambique. The VGI can be used to assess girls' vulnerability levels across time and space for policy and programme planning purposes, and as part of programme evaluations.

Self-determination and gender-power relations as predictors of condom use self-efficacy among South African women

This article identifies correlates of condom use self-efficacy using concepts from self-determination theory and gender–power measures. A cross-section of Xhosa-speaking women (n = 238) from Eastern Cape, South Africa, was used to conduct bivariate correlations and multivariate linear regression analyses. Gender equality beliefs and HIV knowledge were positively associated with condom use self-efficacy generally and in risky situations. Condom use self-efficacy generally was also positively associated with power balance attitudes, negative beliefs about intimate partner violence, and positive growth perspective, while the association with hopeless personal perspective was negative. Surprisingly, lack of social support was positively associated with condom use self-efficacy in risky situations. The predictors of condom use self-efficacy identified in this study that may serve as change objectives for future sexual health promotion interventions.

The Association of HIV Stigma and HIV/STD Knowledge With Sexual Risk Behaviors Among Adolescent and Adult Men Who Have Sex With Men in Ghana, West Africa

Ghanaian men who have sex with men (MSM) have a high HIV seroprevalence, but despite a critical need to address this public health concern, research evidence has been extremely limited on influences on sexual risk behavior among MSM in Ghana. To investigate associations between HIV/STD knowledge, HIV stigma, and sexual behaviors in a sample of MSM in Ghana, we conducted a secondary data analysis of cross-sectional survey data from a non-probability sample of Ghanaian MSM (N = 137). Nearly all the men (93%) had more than one current sex partner (M = 5.11, SD = 7.4). Of those reported partners, the average number of current female sexual partners was 1.1 (SD = 2.6). Overall, knowledge levels about HIV and STDs were low, and HIV stigma was high. There was no age-related difference in HIV stigma. Younger MSM (≤25 years) used condoms less often for anal and vaginal sex than did those over 25. Relative frequency of condom use for oral sex was lower in younger men who had higher STD knowledge and also was lower in older men who reported high HIV stigma. Knowledge and stigma were not associated with condom use for anal or vaginal sex in either age group. These descriptive data highlight the need for the development of intervention programs that address HIV/STD prevention knowledge gaps and reduce HIV stigma in Ghanaian communities. Intervention research in Ghana should address age-group-specific HIV prevention needs of MSM youth.

Associations Between Psychiatric Impairment and Sexual Risk Behavior Among Teens in Mental Health Treatment

AIMS

To assess the associations of sexual risk behavior with psychiatric impairment and individual, peer, and partner attitudes among adolescents receiving mental health treatment.

METHODS

Adolescents (N=893, 56% female, 67% African American) completed assessments of psychiatric impairment, rejection sensitivity, peer norms, HIV knowledge, perceived vulnerability, self-efficacy and condom use intentions. Two structural equation models were used to test the study hypotheses; one for sexually active youth and one for non-active youth.

RESULTS

For non-active youth, psychiatric impairment influenced self-efficacy and condom use intentions via peer norms, rejection sensitivity, and perceived vulnerability. Among the sexually active youth, sexual risk was related to impairment and previous condom use.

DISCUSSION

These results suggest that individual, peer, and partner factors are related to impairment and to sexual risk attitudes, but depend on previous sexual experience.

Condom use among young women: modeling the theory of gender and power

OBJECTIVE

This study sought to articulate pathways between constructs from the theory of gender and power and their associations with sexual behavior.

DESIGN

The data were collected preintervention during a randomized controlled HIV prevention trial. Participants were 701 sexually active, unmarried African American females, aged 14-20, who were not pregnant, and were recruited from three health clinics in a southeastern US city. Structural equation modeling was used for the analyses.

MAIN OUTCOME MEASURE

Self-reported condom use.

RESULTS

Theoretical associations yielded a well-fitting structural model across initial and cross-validation samples. A significant amount of variance was explained for the variables of condom use (R2 = .31, .18), partner communication (R2 = .30, .26), substance use during sex (R2 = .32, .51), and negative personal affect (R2 = .36, .48). Partner communication (.35, .38) was the strongest predictor of condom use, negative personal affect (-.41, -.37) was the strongest predictor of partner communication, and physical risk (.54, .54) was the strongest predictor of negative personal affect.

CONCLUSION

This model provides evidence to support both direct and indirect associations between social and behavioral risk factors and condom use. Associations between theory of gender and power constructs and condom use can facilitate future development and analyses of interventions based on this theory.

Prevalence and correlates of HIV unsafe sex and STIs among women working in China's entertainment industry

Female entertainment workers in China are at risk of sexually acquiring HIV, but risk factors of their unsafe sex remain understudied. Using information from a venue-based sample of 724 female entertainment workers in Shanghai, this paper examines the prevalence and risk factors of unsafe sex and STIs. While both measures of unsafe sex and history of common STIs suggest that participants in this study appear to have lower rates of unsafe sex and STIs than reported in the literature, venue-based female entertainment workers are at risk of sexually acquiring HIV. Risk factors of unsafe sex include both individual cognitive (information, motivation, and behavioral skills) and social factors. However, HIV-related information and most social factors are not directly and independently associated with unsafe sex. Behavioral intervention is needed for female entertainment workers in China. However, individual-based cognitive approach alone may be limited in effectiveness in reducing unsafe sex among female entertainment workers. Effective intervention needs to take a multi-level approach that addresses both individual cognitive and social risk factors and can particularly benefit from attention to empowering women in sexual relationships and creating a supportive social and working environment.

Always, never, or sometimes: examining variation in condom-use decision making among Black adolescent mothers

Our purpose in this study was to describe Black adolescent mothers' decisions regarding condom use and non-use with their male sex partners, including their children's fathers. Research on partner type and condom use has been insufficiently focused on understanding the specific influence that the biological father of the baby has on condom use among adolescent mothers. We conducted five focus groups and three interviews with 31 predominantly African-American mothers. We found that their decisions to use condoms always, never, or sometimes were based on partner type and on emotional and relationship factors. The "baby daddy" was the only partner with whom they never used condoms. HIV/STI prevention interventions for adolescent mothers must address risk taking with their children's biological fathers.

Elementos de vulnerabilidade individual de adolescentes ao HIV/AIDS

A adolescência é caracterizada pela experimentação e descoberta, pelo desenvolvimento da autonomia e pela sexualidade. O objetivo desse estudo foi identificar as evidências científicas da literatura sobre os elementos da dimensão individual da vulnerabilidade de adolescentes ao HIV/AIDS. Através da revisão sistemática integrativa, em bases e bancos de dados eletrônicos (Cinahl PubMed, Scopus, LILACS, Adolec, Dedalus, BDTD e Portal de Teses da Universidade de São Paulo) rastrearam-se trabalhos publicados entre 1996 e 2006. Compuseram a amostra final 41 estudos. O elemento da vulnerabilidade individual mais freqUente nos estudos foi o grau e qualidade do conhecimento sobre HIV/AIDS. A revisão permitiu identificar evidências científicas da vulnerabilidade individual relevantes para o planejamento das ações de prevenção à infecção pelo HIV em adolescentes.

Risk behaviors among adolescent girls in an HIV prevention trial

Adolescent girls remain vulnerable to HIV and other sexually transmitted infections. Understanding their sexual and substance use behaviors is essential to designing effective interventions to reduce their risk. In this study, baseline data were analyzed from 738 adolescent girls ages 15 to 19 years in Rochester, New York. Data on sexual behavior and substance use (lifetime, past 3 months, and most recent sexual experience) were collected. Nearly one half of recent vaginal (42%) and anal (45%) sex acts were not condom protected; 39% had a prior sexually transmitted infection (STI) and 12% were currently infected with an STI. Approximately one third (31%) of girls had more than one sex partner in the past 3 months. Girls with multiple partners reported that their recent sexual experiences were more likely to involve drug and alcohol use by themselves and partners. Adolescent girls, particularly those with multiple sexual partners, continue to report high-risk sexual behaviors and need focused risk-reduction interventions.

Social influence and individual risk factors of HIV unsafe sex among female entertainment workers in China

Female entertainment workers in China are at increased sexual risk of HIV, but causes of their unprotected sex remain poorly understood. We develop a model that integrates information-motivation-behavioral skills (IMB) with social influences and test the model in a venue-based sample of 732 female entertainment workers in Shanghai. Most IMB and social influence measures are statistically significant in bivariate relationships to condom use; only HIV prevention motivation and behavioral self-efficacy remain significant in the multiple regressions. Self-efficacy in condom use is the most proximate correlate, mediating the relationship between information and motivation and condom use. Both peer and venue supports are important, but their influences over condom use are indirect and mediated through prevention motivation and/or self-efficacy. Behavioral intervention is urgently needed and should take a multilevel approach, emphasizing behavioral skills training and promoting a supportive social/working environment.

Predicting sexual risk behaviors among adolescent and young women using a prospective diary method

We describe the sexual risk behaviors, psychological distress, and substance use of 102 late adolescent girls and identify predictors of protected and unprotected vaginal sex. Participants completed questionnaires assessing hypothesized predictors and then daily behavioral diaries for 12 weeks. Protected intercourse was predicted by baseline sexual behavior, greater knowledge, positive condom attitudes, lower perceived condom-use difficulty, greater condom-use intentions, more drinking days, less binge drinking, less Ecstasy use, and lower psychological distress. Unprotected intercourse was predicted by baseline sexual behavior, binge drinking, Ecstasy and opiate use, fewer drinking days, and fewer daily drinks. These findings suggest that psychological distress, substance use, and sexual risk behavior are interconnected and should be considered collectively in interventions for adolescent females.

Understanding sexual abstinence in urban adolescent girls

OBJECTIVES

To gain insight into the context of sexual abstinence and identify potential determinants of abstinence in this population.

DESIGN

Four focus groups.

PARTICIPANTS AND SETTING

Twenty-four, predominantly African American (88%) girls aged 14 to 19 years were recruited from urban health centers and youth development programs in Rochester, New York, between September and December 2006.

DATA ANALYSIS

Content analysis was used to analyze the four verbatim transcripts. Using analytic induction, groups were compared and contrasted at the micro (within-group) and macro (between-group) levels to identify themes.

RESULTS

Four themes were identified that provided insight into how and why these girls remain abstinent despite being in sexually active social climates. They focused on the following: self-respect (I'm worth it), impact of mothers (Mama says ... think before you let it go), influence of boys and other peers (Boys will be boys), and potential negative consequences of sex (Hold on, there's a catch).

CONCLUSIONS

Developing interventions to maintain abstinence, delay onset of sexual activity, and promote protected first and subsequent sexual contact in abstinent girls are key to decreasing future sexual risk. These findings suggest opportunities to develop HIV prevention strategies tailored to the needs of abstinent girls.

Adaptation and refinement of the HIV knowledge questionnaire for use with adolescent girls

The number of adolescent girls becoming infected with HIV has dramatically escalated to the point where they now represent one of the groups most at risk for this infection. As a component of addressing this pandemic, there is a need for psychometrically sound, tailored measures to assess an adolescent girl's level of knowledge regarding transmission and prevention of HIV. The purpose of this research was to modify an existing HIV knowledge measure used in the general adult population (brief HIV Knowledge Questionnaire [HIV-KQ]) and increase its utility by making it developmentally- and gender-specific for adolescent girls. The revised version with additional items underwent item and scale analysis to confirm psychometric properties with a sample of 62 adolescent girls. HIV-related knowledge is assessed extensively in clinical practice and educational settings and is an important component for monitoring change in successful HIV risk-reduction interventions. The final HIV-KQ for adolescent girls is a practical, specific, and appropriate instrument for use with adolescent girls in these settings.

Alcohol use severity and HIV sexual risk among juvenile offenders

Guided by the Information Motivation Behavioral Skills (IMB) model, we examine the alcohol severity/sexual risk relationship for juvenile offenders who are at extreme risk for HIV/AIDS due to situational vulnerabilities, substance abuse,1 and personality factors. Sexual risk behavior was analyzed by levels of alcohol use among 634 ethnically diverse adolescents in Miami between 1998 and 2002. Adolescents with the highest levels of alcohol use reported significantly higher levels of total and unprotected sexual activity and sex acts proximate to drinking. Alcohol use related problems require more attention by HIV interventionists. Alcohol severity may reduce the effectiveness of HIV interventions that do not address concurrent substance use.

Youths and HIV/AIDS: psychiatry's role in a changing epidemic

OBJECTIVE

To review the past 10 years of published research on human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the United States, including psychosocial and psychiatric risk factors, epidemiology, biology, neurocognitive and psychiatric sequelae, disclosure issues, prevention strategies, and biological and behavioral treatments.

METHOD

Researchers reviewed the English-language literature with a focus on child and adolescent risk factors associated with HIV/AIDS, prevention, and treatment.

RESULTS

Substantial scientific advances have occurred over the past two decades leading to decreased morbidity and mortality in the United States from AIDS-related opportunistic infections. At the same time, rates of HIV infection are increasing in teenagers, young women, and minorities, and growing numbers of youths are living with an infected family member. Understanding HIV risk behavior requires a broad theoretical framework. Comprehensive HIV prevention programs have led to reduced risk behavior among HIV-affected youths and teens at risk of infection. Biological and behavioral treatments of HIV infection continue to evolve and have led to longer life span, improved quality of life, and fewer psychiatric problems.

CONCLUSIONS

HIV/AIDS has significant mental health implications, and psychiatry can play a critical role in curbing the epidemic. With minimal effort, mental health professionals can adapt and apply the strategies that they use to treat psychiatric symptoms to prevent HIV transmission behaviors.

Group-based HIV risk reduction intervention for adolescent girls: evidence of feasibility and efficacy

The purposes of this pilot study were (a) to assess the feasibility of a community-based, small group HIV risk reduction intervention with adolescent girls, and (b) to obtain preliminary evidence of the efficacy of this theoretically-guided intervention using a controlled design. The feasibility of the intervention was demonstrated by successfully implementing it with 33 sexually-active, single girls. Preliminary evidence of the efficacy of the intervention was obtained using a randomized trial with 62 sexually-active, single girls. Data obtained at a 3-month follow-up assessment showed that girls who received the HIV-related intervention improved their HIV-related knowledge and enhanced their motivation for risk reduction compared to girls who received a control (health promotion) intervention. Effect sizes suggest that the HIV intervention also reduced several risk behaviors (e.g., vaginal sex without a condom, giving oral sex, and alcohol and drug use before sex). Challenges to implementation and suggestions for intervention enhancement are discussed.