Objective: Adolescent girls represent the fastest growing group of persons with HIV. In the year 2000, persons age 13-19 were the only age category where the number of females infected with HIV or AIDS outnumbered the number of males. Girls 15-19 years also have higher reported rates of gonorrhea and chlamydia than adolescent males or older persons of either gender; these STDs are known to facilitate the transmission of HIV. As a result, the highest priority on the National AIDS agenda and a critical Healthy People 2010 objective is to reduce the rate of HIV in adolescent girls. The overall purpose of this study was to develop and pilot test an HIV-prevention intervention in at-risk adolescent girls. This paper presents the pre-intervention data on the 129 girls enrolled in the study.
Design: A randomized controlled trial comparing a manualized HIV-prevention intervention to a structurally equivalent health promotion control group. Participants completed self-administered questionnaires on their knowledge about HIV/AIDS, various measures of motivation to reduce risk, and sexual behaviors.
Population, Sample, Setting, Years: Pre-intervention data were collected from 129 single, sexually active girls ages 15-19 from an inner-city family planning site in New York State from 11/99-7/00. Approximately one-half of the sample were young adolescents of color (44%) with one-third residing in homes below the poverty level (34%). The highest grade completed by most the adolescents was 10th grade.
Concepts/Variables: Guided by the Information-Motivation-Behavioral Skills Model data on constructs of information, motivation, behavioral skills, and HIV risk-related behaviors were collected.
Methods: Following individual private consent administration by trained research team members, pre-intervention data were collected via self-administered questionnaires.
Findings: HIV-related information was incomplete; many misconceptions regarding transmission and prevention appeared commonplace. Despite history of STDs in many participants and their partners having multiple sex partners or being bisexual, low assessments of vulnerability to HIV were common. This sense of invulnerability may be related to a decreased motivation to practice HIV-preventive behaviors. Overall assessments by participants suggest that they are easily able to practice safer sexual behaviors, particularly condom use.However, despite these behavioral intentions,serial monogamy and erratic condom use were widespread among these girls. Two-thirds of the girls did not use condoms consistently or at all and one-quarter never talked to their sexual partner(s) about condom use or safer sex behaviors. Confidence in condom use and negotiation with partners was also negated by the common use of alcohol and drugs during sex; 41% used alcohol and 23% used drugs concurrently with sex.
Conclusions: Adolescent girls ages 15-19 remain a group at increased risk for HIV and other STDs. Incomplete knowledge regarding HIV transmission and prevention coupled with a lack of motivation to reduce risk that is fueled by perceptions of invulnerability and concomitant substance use decreases the likelihood of condom use and other less risky behaviors. Despite what these girls intend to do to decrease their risk for HIV, few in reality follow through in their actual day-to-day behaviors. The common pattern of serial monogamy often leads to these adolescents having many sexual partners over a brief period of time. This can lead these girls to a feeling of complacency regarding HIV-preventive behaviors and encourage low perceptions of vulnerability yet ultimately this behavior increases their risk for HIV.
Implications: Randomized controlled trials are urgently needed to assess the effect of interventions in this at-risk population. Eliciting pre-intervention levels of information, motivation, behavioral skills, and risk behaviors facilitates the development of targeted interventions that are gender- and culturally-specific, as well as developmentally appropriate.Interventions that address the importance of motivation as well as knowledge and behavioral skills are likely to be more effective in reducing HIV in this population.
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