ABSTRACT
To assess whether pressuring others to use HIV self-tests is prevalent among US men who have sex with men (MSM), we analyzed data from a randomized controlled trial of HIV self-testing. Among 752 online-recruited MSM who received HIV self-tests and responded to a 12-month survey, 8.5% (60/709) reported pressuring someone to use an HIV self-test: 29 pressured a friend, 28 pressured a sexual partner, and 1 pressured a family member. Conversely, 2.1% (15/715) reported being pressured to self-test: 12 by a sexual partner and 3 by a friend. No physical harm was reported. HIV prevention programs that use HIV self-tests to reach populations at risk for HIV may be reassured by our findings because, despite reports of pressure to use HIV self-tests, no physical abuse was reported between sex partners. These programs should, however, include messages emphasizing the voluntary use of HIV self-tests and be prepared to address concerns of persons who have been pressured to use HIV self-tests. This trial is registered at www.clinicaltrials.gov (NCT02067039) and the date of registration is February 5, 2014.
RESUMEN: Analizamos los datos de un ensayo controlado aleatorio (ECA) de 12 meses para evaluar si presionar a alguien a que utilice la autoprueba del VIH es una ocurrencia frecuente entre hombres estadounidenses que tienen sexo con hombres (HSH) reclutados via el internet. Entre 752 HSH que recibieron por correo autopruebas del VIH y que respondieron a una encuesta a los 12 meses del ECA, el 8.5% (60/709) informó haber presionado a alguien a que usara una autoprueba del VIH: 29 presionaron a un amigo, 28 presionaron a una pareja sexual y uno presionó a un miembro de su familia. Por el contrario, el 2.1% (15/715) informó haber sido presionado a usar la autoprueba: 12 por una pareja sexual y 3 por un amigo. Ningun participante reporto daños físicos. Los programas de prevención del VIH que utilizan autopruebas del VIH para alcanzar a poblaciones a riesgo de contraer el VIH, pueden sentirse tranquilizados por nuestros hallazgos porque, a pesar de los reportes de presión para usar las autopruebas del VIH, no se reporto abuso físico entre parejas sexuales. Sin embargo, los programas deben incluir mensajes que enfaticen el uso voluntario de las autopruebas del VIH y estar preparados para calmar las preocupaciones de las personas que han sido presionadas a usar las autopruebas del VIH. El ensayo está registrado en www.clinicaltrials.gov (NCT02067039) y la fecha de registro es el 5 de febrero de 2014.
Subject(s)
HIV Infections , Sexual and Gender Minorities , HIV Infections/diagnosis , HIV Infections/epidemiology , HIV Infections/prevention & control , Homosexuality, Male , Humans , Male , Sexual Behavior , Sexual Partners , United States/epidemiologyABSTRACT
Adolescents need information about sex-related topics in order to reduce risk behavior and engage in healthy sexual decision-making. Parents have the potential to be an important source of this information. Using the 2006-2010 and 2011-2013 National Survey of Family Growth, we examined associations between parent-adolescent communication before age 18 about sex-related topics and HIV testing among respondents aged 18-24 that ever had sexual intercourse (women = 3893; men = 3359). Analyses showed that for both men and women, discussing how to prevent HIV/AIDS and how to use a condom with a parent before age 18 were positively associated with HIV testing. Among women only, discussions about methods of birth control, where to get birth control, and STDs were positively associated with HIV testing. Developing strategies and interventions to facilitate parent-adolescent communication about sex-related topics, particularly HIV prevention and condom use, may be important to increase HIV testing among young women and men.
Subject(s)
Adolescent Behavior , Communication , HIV Infections/prevention & control , Adolescent , Adolescent Health Services , Adult , Condoms/statistics & numerical data , Female , HIV Infections/diagnosis , Humans , Male , Parent-Child Relations , Risk-Taking , Safe Sex , Sexual Behavior , Sexually Transmitted Diseases/prevention & control , United States , Young AdultABSTRACT
HIV/sexually transmitted infection (STI) risk-reduction interventions are needed to address the complex risk behaviors among African-American female adolescents in disadvantaged communities in North Carolina. In a two-group randomized trial, we reached 237 sexually active, substance-using African-American female adolescents, to test a risk-reduction intervention, the Young Women's CoOp (YWC), relative to a nutrition control. In efficacy analyses adjusting for baseline condom use, at three-month follow-up participants in the YWC were significantly less likely to report sex without a condom at last sex relative to control. There were mixed findings for within-group differences over follow-up, underscoring the challenges for intervening with substance-using female youths.
ABSTRACT
This study examines the role of structural barriers experienced by a community-based sample of 63 HIV-positive and negative transgender women that may elevate HIV infection and transmission risks. Separate hierarchical linear multiple regression analyses tested the association between structural barriers (e.g., unemployment, lack of food, shelter) and condomless anal sex acts, abuse, and readiness to change risk behavior, while controlling for other related factors. Among this primarily Hispanic and African-American sample, HIV-positive and negative transgender women experienced a similar number of structural barriers and experiencing structural barriers was significantly associated with an increased number of condomless anal sex acts (p = .002), victimization (p = .000) and a decreased readiness to change HIV-related risk behavior (p = .014). Structural-level interventions are needed to address this elevated risk among this underserved and hard-to-reach population.
Subject(s)
Crime Victims/statistics & numerical data , HIV Infections/transmission , HIV Seropositivity , Health Services Accessibility , Healthcare Disparities , Risk-Taking , Transgender Persons/psychology , Adult , Black or African American/statistics & numerical data , Attitude of Health Personnel , Crime Victims/psychology , Discrimination, Psychological , Female , HIV Infections/epidemiology , HIV Seronegativity , Hispanic or Latino/statistics & numerical data , Humans , Middle Aged , Patient Acceptance of Health Care , Sexual Behavior , Social Stigma , Social Support , Substance-Related Disorders , Transgender Persons/statistics & numerical dataABSTRACT
Intimate partner violence (IPV) is associated with risky sexual behavior and STIs among diverse groups of women. IPV was examined as a moderator of efficacy for an HIV/STI intervention. 848 African American women, 18-29, were randomly assigned to an HIV/STI intervention or control condition. Participants completed measures on sociodemographics, IPV, risky sexual behavior and received STI testing. IPV predicted inconsistent condom use and a risky sexual partner over 12-month follow-up. A significant interaction indicated that among women who experienced IPV, those in the intervention were more likely to test positive for Trichomonas vaginalis (TV). Among intervention participants, those who experienced IPV were more likely to test TV-positive than those who did not. In an HIV intervention that did not specifically address IPV, women in the control condition were less likely to acquire TV than those in the intervention. Consideration of contextual/interpersonal factors is essential when developing HIV intervention programs.
Subject(s)
Black or African American/statistics & numerical data , Condoms/statistics & numerical data , HIV Infections/prevention & control , Intimate Partner Violence/ethnology , Risk-Taking , Sexually Transmitted Diseases/prevention & control , Adult , Black or African American/psychology , Female , Follow-Up Studies , HIV Infections/ethnology , HIV Infections/psychology , Heterosexuality , Humans , Interpersonal Relations , Intimate Partner Violence/psychology , Logistic Models , Male , Middle Aged , Multivariate Analysis , Prevalence , Risk Factors , Sexual Behavior , Sexually Transmitted Diseases/ethnology , Sexually Transmitted Diseases/psychology , Socioeconomic Factors , Unsafe Sex/statistics & numerical dataABSTRACT
Episodic drug use and binge drinking are associated with HIV risk among substance-using men who have sex with men (SUMSM), yet no evidence-based interventions exist for these men. We adapted personalized cognitive counseling (PCC) to address self-justifications for high-risk sex among HIV-negative, episodic SUMSM, then randomized men to PCC (n = 162) with HIV testing or control (n = 164) with HIV testing alone. No significant between-group differences were found in the three primary study outcomes: number of unprotected anal intercourse events (UAI), number of UAI partners, and UAI with three most recent non-primary partners. In a planned subgroup analysis of non-substance dependent men, there were significant reductions in UAI with most recent non-primary partners among PCC participants (RR = 0.56; 95 %CI 0.34-0.92; P = 0.02). We did not find evidence that PCC reduced sexual risk behaviors overall, but observed significant reductions in UAI events among non-dependent SUMSM. PCC may be beneficial among SUMSM screening negative for substance dependence.
Subject(s)
Binge Drinking , Cognition , Directive Counseling , HIV Infections/prevention & control , Homosexuality, Male , Sexual Behavior/psychology , Substance-Related Disorders , Adult , Binge Drinking/epidemiology , Binge Drinking/psychology , Follow-Up Studies , HIV Infections/epidemiology , HIV Infections/psychology , Homosexuality, Male/psychology , Humans , Male , Risk Reduction Behavior , Risk-Taking , Sexual Partners , Substance-Related Disorders/epidemiology , Substance-Related Disorders/psychology , Surveys and QuestionnairesABSTRACT
Episodic (less than weekly) drug use and binge drinking increase HIV-related sexual risk behaviors among men who have sex with men (MSM), yet no evidence-based interventions exist for these men. We describe an adaptation process of the Personalized Cognitive Counseling (PCC) intervention for utilization with high-risk, HIV-negative episodic, substance-using MSM. Participants (N = 59) were racially diverse, and reported unprotected anal intercourse and concurrent binge drinking (85%), use of poppers (36%), methamphetamine (20%) and cocaine (12%). Semi-structured interviews with 20 episodic, substance-using MSM elicited sexual narratives for engaging in unprotected anal intercourse while using alcohol or drugs. Emergent qualitative themes were translated into self-justifications and included in a revised PCC self-justification elicitation instrument (SJEI). The adapted SJEI was pretested with 19 episodic, substance-using MSM, and the final adapted PCC was pilot-tested for acceptability and feasibility with 20 episodic, substance-using MSM. This process can be used as a roadmap for adapting PCC for other high-risk populations of MSM.
Subject(s)
Cognitive Behavioral Therapy , Counseling , HIV Infections/prevention & control , Homosexuality, Male/psychology , Substance-Related Disorders/psychology , Adolescent , Adult , Coitus/psychology , Evidence-Based Medicine , HIV Infections/psychology , Humans , Male , Middle Aged , Risk Factors , San FranciscoABSTRACT
African American women at increased risk of HIV/sexually transmitted infection (STI) may engage in risky sex as a coping mechanism for depressed economic conditions. This study examines the association between high-risk sexual behavior and structural determinants of sexual health among a sample of young African American women. 237 young African American women (16-19 years old) from economically disadvantaged neighborhoods in North Carolina were enrolled into a randomized trial testing the efficacy of an adapted HIV/STI prevention intervention. Logistic regression analyses predicted the likelihood that young women reporting lack of food at home, homelessness and low future prospects would also report sexual risk behaviors. Young women reporting a lack of food at home (22 %), homelessness (27 %), and low perceived education/employment prospects (19 %) had between 2.2 and 4.7 times the odds as those not reporting these risk factors of reporting multiple sex partners, risky sex partners including older men and partners involved in gangs, substance use prior to sex, and exchange sex. Self-reported structural determinants of sexual health were associated with myriad sexual risk behaviors. Diminished economic conditions among these young women may lead to sexual risk due to hopelessness, the need for survival or other factors.
Subject(s)
Black or African American/statistics & numerical data , Food Supply/statistics & numerical data , Ill-Housed Persons/statistics & numerical data , Poverty Areas , Risk-Taking , Social Determinants of Health/statistics & numerical data , Unsafe Sex/statistics & numerical data , Adolescent , Educational Status , Employment/statistics & numerical data , Female , Humans , Logistic Models , North Carolina/epidemiology , Sexual Partners , Sexually Transmitted Diseases/prevention & control , Substance-Related Disorders/epidemiology , Young AdultABSTRACT
Data from the CDC's Medical Monitoring Project indicate that the United States is on track to meet one of five National HIV/AIDS Strategy (NHAS) Quality of Life goals among cisgender Black women, specifically, hunger/food insecurity. Substantial work needs to be done to improve self-rated health and to decrease unmet need for mental health services. Enhanced and coordinated action are necessary to reach all Quality of Life goals in this NHAS priority population.
Subject(s)
Black or African American , HIV Infections , Quality of Life , Humans , Female , HIV Infections/psychology , United States , Black or African American/psychology , Adult , Food InsecurityABSTRACT
To succeed in ending the HIV epidemic in the United States, the Centers for Disease Control and Prevention (CDC) focuses on delivering combinations of scientifically proven, cost-effective, and scalable interventions to priority populations. Systemic factors continue to contribute to persistent health disparities and disproportionately higher rates of HIV diagnosis in some communities. The National HIV/AIDS Strategy has designated cis-gender Black women (CgBW) as a priority population to address the racial and ethnic inequities in HIV. This report presents the portfolio of projects, programs, and initiatives funded by the CDC's Division of HIV Prevention (DHP) to address disparities in HIV and improve health and QOL among CgBW. These funded activities include the development, planning, and implementation of HIV prevention programs, mass media campaigns, and behavioral interventions focused on CgBW. This report also summarizes DHP's community engagement, capacity building, and partnership efforts, and highlights research and surveillance activities focusing on CgBW. Finally, this report outlines future directions for CDC's efforts to improve access to HIV testing, treatment, and prevention for CgBW in the United States.
Subject(s)
Black or African American , Centers for Disease Control and Prevention, U.S. , HIV Infections , Humans , Female , HIV Infections/prevention & control , HIV Infections/ethnology , HIV Infections/epidemiology , United States/epidemiology , Black or African American/statistics & numerical data , Healthcare Disparities/ethnology , Health Status Disparities , Health Services AccessibilityABSTRACT
BACKGROUND: Racial and ethnic disparities in antiretroviral therapy (ART) adherence and sustained viral suppression (SVS) have been documented among women with HIV. We examined factors that may account for these racial/ethnic differences among women to inform interventions that increase health equity. METHODS: We used data from the 2015-2019 cycles of the Medical Monitoring Project, a probability sample of U.S. adults with diagnosed HIV. Using logistic regression with predicted marginal means, we calculated weighted prevalence differences (PDs) of ART adherence and SVS among Black, Hispanic/Latina, and White women taking ART. Using modeling with forward stepwise selection, we adjusted PDs for selected variables, including social and structural determinants of health (SDOH) factors, to examine whether magnitude of PDs was attenuated by their inclusion. We assessed relative changes between unadjusted and adjusted PDs. RESULTS: After adjusting for poverty, transportation needs, health literacy, and gap in health insurance/coverage, the Black-White PD in adherence decreased by 11% (-16.0% to -14.2%). After adjusting for adherence, poverty, type of health insurance, and gap in health insurance/coverage, the Black-White PD in SVS reduced 37% (-7.9% to -5.0%) and was no longer statistically different. The Hispanic/Latina-White PD in adherence reduced 24% (-12.7% to -9.6%) after adjusting for poverty, health literacy, and transportation needs. The unadjusted Hispanic/Latina-White PD in SVS was not significantly different. CONCLUSION: Racial/ethnic disparities in HIV outcomes among women taking ART were substantially reduced after accounting for SDOH and other factors although differences remained. Structural interventions to improve SDOH are needed to improve health equity for women with HIV.
Subject(s)
HIV Infections , Medication Adherence , Adult , Female , Humans , Anti-Retroviral Agents/therapeutic use , Hispanic or Latino , HIV Infections/epidemiology , Sustained Virologic Response , United States/epidemiology , Viral Load , White , Black or African American , Social Determinants of Health , Health EquityABSTRACT
This article describes the development of a gender-specific and culturally tailored, theoretically derived, faith-based HIV intervention created to reduce HIV vulnerability among African American women. This innovative culturally congruent approach to HIV prevention involves one of the most influential social structures in the African American community-the African American church. Using the ADAPT-ITT model, and principles of community-based participatory research, this faith-based HIV intervention was adapted from a CDC-defined evidence-based HIV prevention intervention for young African American women. Results of data assessing the feasibility of implementing this faith-based HIV intervention suggests that young African American women are receptive and willing to participate in a faith-based HIV intervention. Results show that fidelity to intervention implementation (97%) and participant attendance to both sessions (92%) was high, and the HIV risk behaviors targeted in the faith-based intervention matched the participants' HIV behavioral risk profile. Given the vulnerability of young African American women to HIV sustainable efforts, in particular, the institutionalization of this intervention within the church structure could halt the persistent increase in HIV infections within this community.
Subject(s)
Christianity , Community Networks/organization & administration , HIV Infections/prevention & control , Health Promotion/organization & administration , Universities , Adult , Black or African American , Female , HIV Infections/ethnology , Humans , Program Development/methods , United StatesABSTRACT
OBJECTIVES: We examined the interactive effects of fear of abuse and knowledge of sexually transmitted infections (STIs) on sexual risk behaviors in a sample of young African American women. METHODS: We recruited 715 young African American women aged 15 to 21 years from a variety of health clinics and assessed them for fear of abuse because of negotiating condom use, knowledge of STIs, and several sexual risk behaviors. RESULTS: Overall, 75% of young African American women reported inconsistent condom use in the past 60 days. Surprisingly, under relatively higher levels of fear, young women with high STI knowledge were more likely than were those with low STI knowledge to exhibit inconsistent condom use in the past 60 days (89% vs 80%; chi(2) = 4.32; P < or = .04) and during the last sexual intercourse with a main sexual partner (76% vs 70%; chi(2) = 8.06; P < or = .01). CONCLUSIONS: Most HIV prevention interventions focus on increasing knowledge about the transmission of STIs. However, other contextual factors such as fear of abuse because of negotiating condom use may heighten the risk of HIV infection. Our findings highlight the need for combining dating violence prevention activities with STI and HIV prevention programs targeting young African American women.
Subject(s)
Black or African American/psychology , Health Knowledge, Attitudes, Practice , Sexual Behavior/ethnology , Sexually Transmitted Diseases/ethnology , Spouse Abuse/ethnology , Violence/ethnology , Adolescent , Condoms , Fear/psychology , Female , Humans , Logistic Models , Risk-Taking , Sexual Behavior/psychology , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/prevention & control , Sexually Transmitted Diseases/psychology , Spouse Abuse/psychology , Unsafe Sex/ethnology , Unsafe Sex/psychology , Urban Health , Vaginal Smears , Violence/psychology , Young AdultABSTRACT
BACKGROUND: Few longitudinal studies have examined predictors of dating violence, a public health issue that may be more prevalent among African Americans. Our objective was to examine the prevalence, incidence, and predictors of dating violence in an African American sample using the theory of gender and power. METHODS: A longitudinal design with a 1-year follow-up period was used. Recruiters screened adolescents from a variety of venues, including school health classes, county health department clinics, and adolescent health clinics. Study participants were 522 African American females 14-18 years of age. This study achieved an 85.7% participation rate. Dating violence was defined as ever having experienced verbal or physical abuse perpetrated by a boyfriend. RESULTS: At baseline, 28% of adolescents reported a history of dating violence. To calculate the 1-year incidence of dating violence, adolescents reporting a history of dating violence at baseline were excluded from subsequent longitudinal analyses. In longitudinal analyses, the 1-year incidence of dating violence was 12%. Logistic regression analyses identified four factors at baseline that were predictive of dating violence. This four-factor model correctly classified 87.6% of adolescents according to whether or not they experienced dating violence during the 1-year follow-up. Controlling for public financial assistance, relative to adolescents not experiencing dating violence, those who did were 2.0 times more likely to report less understanding of healthy relationships (CI = 1.1-3.9, p = 0.02), 2.0 times more likely to report using drugs (CI = 1.0-3.7, p = 0.02), and 1.9 times more likely to have viewed X-rated movies (CI = 1.0-3.7, p = 0.03). CONCLUSIONS: These findings suggest that secondary prevention of dating violence necessitates educating clinicians on the importance of screening and training practitioners in clinical settings on how to effectively screen adolescents for dating violence, including risk factors for victimization.
Subject(s)
Black or African American , Interpersonal Relations , Violence/statistics & numerical data , Adolescent , Adolescent Behavior , Female , Humans , Incidence , Longitudinal Studies , Prevalence , United States/epidemiology , Violence/prevention & controlABSTRACT
BACKGROUND: HIV and other sexually transmissible infections (HIV/STIs) are significant contributors to adolescent girls' morbidity in the US. Risks for HIV/STIs are increased among adolescent girls involved in the juvenile justice system, and African American adolescent girls comprise nearly 50% of adolescent girls in detention centres. Although HIV prevention programs focus on HIV/STI knowledge, increased knowledge may not be sufficient to reduce sexual risk. The present study examined the interactive effects of HIV/STI knowledge and the importance of being in a relationship (a relationship imperative) on sexual risk behaviours in a sample of detained African American adolescent girls. METHODS: In all, 188 African American adolescent girls, 13-17 years of age, were recruited from a short-term detention facility in Atlanta, Georgia, and completed assessments on sexual risk behaviours, relationship characteristics, HIV/STI knowledge and several psychosocial risk factors. RESULTS: When girls endorsed a relationship imperative, higher HIV/STI knowledge was associated with low partner communication self-efficacy, inconsistent condom use and unprotected sex, when controlling for demographics and self-esteem. CONCLUSIONS: Young girls with high HIV/STI knowledge may have placed themselves at risk for HIV/STIs given the importance and value they place on being in a relationship. Contextual factors should be considered when developing interventions.
Subject(s)
Black or African American , Criminal Law , HIV Infections/prevention & control , Health Knowledge, Attitudes, Practice , Interpersonal Relations , Sexual Partners , Unsafe Sex , Adolescent , Communication , Condoms/statistics & numerical data , Female , Georgia , Health Behavior , Humans , Self Concept , Self Efficacy , Sexual Behavior , Sexual HealthABSTRACT
CDC's high-impact human immunodeficiency virus (HIV) prevention approach calls for targeting the most cost-effective and scalable interventions to populations of greatest need to reduce HIV incidence. CDC has funded research to adapt and demonstrate the efficacy of Personalized Cognitive Counseling (PCC) as an HIV prevention intervention. Project ECHO, based in San Francisco, California, during 2010-2012, involved an adaptation of PCC for HIV-negative episodic substance-using men who have sex with men (SUMSM) and a randomized trial to test its efficacy in reducing sexual and substance-use risk behaviors. Episodic substance use is the use of substances recreationally and less than weekly. PCC is a 30-minute to 50-minute counseling session that involves addressing self-justifications men use for engaging in risky sexual behavior despite knowing the potential for HIV infection. By exploring these justifications, participants become aware of the ways they make sexual decisions, become better prepared to realistically assess their risk for HIV during future risky situations, and make decisions to decrease their HIV risk. The findings of Project ECHO demonstrated the efficacy of PCC for reducing HIV-related substance-use risk behaviors. The study also demonstrated efficacy of PCC for reducing sexual risk behaviors among SUMSM screened as nondependent on targeted drug substances. CDC has identified PCC as a "best evidence" HIV behavioral intervention and supports its national dissemination. Several features of PCC enhance its feasibility of implementation: it is brief, delivered with HIV testing, relatively inexpensive, allows flexibility in counselor qualifications and delivery settings, and is individualized to each client. The original PCC and its adapted versions can contribute to reducing HIV-related health disparities among high-risk MSM, including substance users, by raising awareness of and promoting reductions in personal risk behaviors.
Subject(s)
Cognitive Behavioral Therapy , Counseling/methods , Evidence-Based Practice , HIV Infections/prevention & control , Health Promotion/organization & administration , Homosexuality, Male/psychology , Psychotherapy, Brief , Adult , Centers for Disease Control and Prevention, U.S. , Feasibility Studies , HIV Infections/epidemiology , Health Status Disparities , Homosexuality, Male/statistics & numerical data , Humans , Male , Risk Assessment , Risk Reduction Behavior , Risk-Taking , San Francisco/epidemiology , Sexual Behavior/psychology , Substance-Related Disorders/epidemiology , Substance-Related Disorders/psychology , Treatment Outcome , United States/epidemiologyABSTRACT
OBJECTIVES: Guidelines for antiretroviral therapy (ART) initiation have evolved, but consistently note that adherence problems should be considered and addressed. Little is known regarding the reasons providers delay ART initiation in clinically eligible patients. METHODS: In 2009, we surveyed a probability sample of HIV care providers in 582 outpatient facilities in the United States and Puerto Rico with an open-ended question about nonclinical reasons for delaying ART initiation in otherwise clinically eligible patients. RESULTS: Very few providers (2%) reported never delaying ART. Reasons for delaying ART were concerns about patient adherence (68%), patient acceptance (60%), and structural barriers (33%). Provider and practice characteristics were associated with reasons for delaying ART. CONCLUSION: Reasons for delaying ART were consistent with clinical guidelines and were both patient level and structural. Providers may benefit from training and access to referrals for ancillary services to enhance their ability to monitor and address these issues with their patients.
Subject(s)
Anti-HIV Agents/therapeutic use , HIV Infections/drug therapy , HIV Infections/psychology , Patient Compliance , Physicians/psychology , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Patients/psychology , Practice Patterns, Physicians'/statistics & numerical data , United States , Young AdultABSTRACT
The southeastern US sustains the highest high school dropout rates, and gangs persist in underserved communities. African American female adolescents who drop out of school and are gang members are at substantial risk of exposure to severe violence, physical abuse, and sexual exploitation. In this study of 237 female African American adolescents 16-19 years of age from North Carolina who dropped out or considered dropping out, 11% were current or past gang members. Adolescents who reported gang membership began smoking marijuana at a mean age of 13, whereas those who reported no gang membership began at a mean age of 15 years (P<0.001). The mean ages of first alcohol use were 14 years and 15 years for gang members and non-gang members, respectively (P=0.04). Problem alcohol use was high in both groups: 40% and 65% for non-gang and gang members, respectively (P=0.02). Controlling for frequent marijuana use and problem alcohol use, adolescents who reported gang membership were more likely than non-gang members to experience sexual abuse (odds ratio [OR] =2.60, 95% confidence interval [CI] [1.06, 6.40]), experience physical abuse (OR =7.33, 95% CI [2.90, 18.5]), report emotional abuse from their main partner (OR =3.55, 95% CI [1.44, 8.72]), run away from home (OR =4.65, 95% CI [1.90, 11.4]), get arrested (OR =2.61, 95% CI [1.05, 6.47]), and report violence in their neighborhood including murder (OR =3.27, 95% CI [1.35, 7.96]) and fights with weapons (OR =3.06, 95% CI [1.15, 8.11]). Gang members were less likely to receive emotional support (OR =0.89, 95% CI [0.81, 0.97]). These findings reinforce the urgent need to reach young African American women in disadvantaged communities affiliated with gangs to address the complexity of context and interconnected risk behaviors.
ABSTRACT
Formative research was conducted to understand the social determinants of HIV risk among African American female adolescents as part of a systematic adaptation of an evidence-based behavioral HIV prevention intervention, the Women's CoOp. Semi-structured in-depth interviews were conducted between November 2008 and April 2009 with 20 African American female adolescents aged 16-18 who reported engaging in sex, using alcohol or other drugs, and dropping out of school. All interviews were audio recorded, transcribed, and coded for key themes and emergent content patterns. The findings indicate that while female adolescents are knowledgeable about HIV and other sexually transmitted infections (STIs), myriad social factors relate to their level of risk. Interpersonal relationships, primarily with older boyfriends and friends, played a pivotal role in their decision-making regarding sex risk behavior, substance use, and educational attainment. A lack of viable employment opportunities, exacerbated by the lack of a high school education, resulted in some young women trading sex to make money. In addition, violence, victimization, and gang involvement are pervasive in their communities. Out-of-school African American female adolescents face a plethora of issues that are directly and indirectly related to their sex risk behaviors and consequently their HIV/STI risk. To reach a vulnerable population disproportionately affected by HIV and other STIs, these factors must be addressed in prevention interventions, when feasible. The findings were incorporated into the intervention adaptation that is currently being tested in a randomized controlled trial.