“I feel like I'm carrying a weapon.” Information and motivations related to sexual risk among girls with perinatally acquired HIV

Abstract

Some adolescent girls perinatally infected with HIV (PIH) engage in sexual behavior that poses risks to their own well-being and that of sexual partners. Interventions to promote condom use among girls PIH may be most effective if provided prior to first sexual intercourse. With in-depth interviews, we explored gender-and HIV-specific informational and motivational factors that might be important for sexual risk reduction interventions designed to reach U.S. girls PIH before they first engage in sexual intercourse. Open-ended interview questions and vignettes were employed. The Information-Motivation-Behavioral Skills (IMB) Model guided descriptive qualitative analyses. Participants (20 girls PIH ages 12-16 years) had experienced kissing (n = 12), genital touching (n = 6), and oral (n = 3), vaginal (n = 2), and anal sex (n = 1). Most knew sex poses transmission risks but not all knew anal sex is risky. Motivations for and against condom use included concerns about: sexual transmission, psychological barriers, and partners' awareness of the girl's HIV+ status. Girls were highly motivated to prevent transmission, but challenged by lack of condom negotiation skills as well as negative potential consequences of unsafe sex refusal and HIV status disclosure. Perhaps most critical for intervention development is the finding that some girls believe disclosing one's HIV status to a male partner shifts the responsibility of preventing transmission to that partner. These results suggest a modified IMB model that highlights the role of disclosure in affecting condom use among girls PIH and their partners. Implications for cognitive-behavioral interventions are discussed.

EVOLUTION—Taking Charge and Growing Stronger: The Design, Acceptability, and Feasibility of a Secondary Prevention Empowerment Intervention for Young Women Living with HIV

“…Adolescents, like adults, want to be loved and accepted, but due to their limited cognitive and behavioral skills, these desires may place them at risk for unfortunate consquences. 22 However, young women's sexual development differs from young men as young women struggle with traditional gender norms, power imbalances, and dynamics that can place them in risky situations. [22][23][24][25] As Marhefka and colleagues found, fear of stigma, rejection, and love among young women living with HIV, coupled with their limited sexual negation skills and the sexual power imbalances in their relationships, can provide a perfect scenario for unprotected sex and HIV transmission.…”

“…22 However, young women's sexual development differs from young men as young women struggle with traditional gender norms, power imbalances, and dynamics that can place them in risky situations. [22][23][24][25] As Marhefka and colleagues found, fear of stigma, rejection, and love among young women living with HIV, coupled with their limited sexual negation skills and the sexual power imbalances in their relationships, can provide a perfect scenario for unprotected sex and HIV transmission. 22 Therefore, secondary prevention interventions must not only increase HIV transmission knowledge but address the specific emotional and psychological barriers young women face.…”

“…[22][23][24][25] As Marhefka and colleagues found, fear of stigma, rejection, and love among young women living with HIV, coupled with their limited sexual negation skills and the sexual power imbalances in their relationships, can provide a perfect scenario for unprotected sex and HIV transmission. 22 Therefore, secondary prevention interventions must not only increase HIV transmission knowledge but address the specific emotional and psychological barriers young women face. 22,25 EVOLUTION aimed to reduce secondary transmission by enhancing social and behavioral skills and risk reduction knowledge pertaining to young women's physical, social, emotional, and sexual well-being and addressing moderating factors that increase women's vulnerability.…”

“…22 Therefore, secondary prevention interventions must not only increase HIV transmission knowledge but address the specific emotional and psychological barriers young women face. 22,25 EVOLUTION aimed to reduce secondary transmission by enhancing social and behavioral skills and risk reduction knowledge pertaining to young women's physical, social, emotional, and sexual well-being and addressing moderating factors that increase women's vulnerability. The process data presented here suggest that EVOLUTION is both an acceptable and feasible comprehensive secondary prevention intervention for YWLH.…”

Life Experiences of Youth Who Were Born with HIV Infection in Puerto Rico: The Voices of Young Survivors

“…Public health and prevention efforts regarding HIV need to include the general population. Several research studies have found that the pHIV-I population is very much aware of the transmissibility of infection and that the use of condom is an effective way to prevent HIV infection Fernet et al, 2007;Marhefka et al, 2011). If the general public were to attain the same sense of responsibility to themselves and to others that pHIV-I youth have achieved, HIV transmission could be lowered.…”