Developing an AIDS prevention intervention for incarcerated male adolescents in Brazil.

The objective of this study was to investigate knowledge, attitudes, and practices regarding AIDS among incarcerated male adolescents in Brazil and to develop an AIDS prevention intervention for this population. A questionnaire administered to 275 boys in São Paulo covered demographic and social characteristics, drugs, and HIV risk perception and behavior. Subsequently, we collected qualitative data on the development and implementation of a prevention program. Ninety-eight percent of adolescents were sexually experienced, most initiating by age 13; 22% were fathers. Injection drug use was reported by 5.5%, 12% had exchanged sex for money, 35% had more than 15 partners and 8% had homosexual experience. Although 72% had used condoms, only 9% used them consistently, and only 35% used one in their last intercourse before incarceration. Predictors of condom use included carrying condoms and endorsing the statement "I would use condoms with my girlfriend." Many said their lives include other risks more important than AIDS, such as survival in the crime scene. Initial efforts at prevention based on commonly used approaches of providing information to guide future rational decisions generated limited participation. However, when we worked with them to develop interventions based on their interests and needs, using modalities such as music, hip-hop arts, graffiti, and helping them to create an AIDS prevention compact disk, they responded with enthusiasm. These incarcerated adolescents are at extremely high social risk and report high levels of risk behavior for HIV infection. Interventions for these youth were better received when developed in collaboration with them and based on their beliefs, aspirations, and culture. The intervention that resulted went beyond AIDS to include issues such as violence, drugs, sexuality and human rights.

[AIDS prevention among incarcerated teenagers, Brazil]. / Prevenção da Aids com adolescentes encarcerados em São Paulo, SP.

OBJECTIVES: To describe social and family support, drug use, and knowledge, practices and attitudes related to AIDS and its prevention among male teenagers. METHODS: Participants were 275 male teenagers interned in a youth detention center (FEBEM - State Foundation for Juvenile Well-Being) in São Paulo, Brazil. There were two segments. In segment 1, semi-structured interviews with 20 detainees took place. In segment 2, close-end self-administered questionnaires covering sociodemographic data, criminal records, sexual practices, drug use, attitudes, knowledge and AIDS-related practices were applied. RESULTS: Ninety percent of the detainees lived previously with their families. All of them had attended public schools, although 61% had already dropped out. Twelve percent had never used drugs, and 5.5% were intravenous drug users. Most (98%) were sexually active; 35% had had more than 15 sexual partners, 8% had homosexual experiences (inside or outside the center), 12% had exchanged sex for material return and 22% were fathers. Many said that getting HIV infected "that's life " and that they face greater risks in their lives, such as surviving on the streets. They think condoms are easily broken (83%) and interfere with sex (58%); 72% had used condoms but only 9% used them with all their partners. CONCLUSIONS: These teenagers have a very high risk of HIV infection. It is necessary to integrate AIDS prevention programs to their life ills and related problems such as racism, expectations for the future, criminality, drug use, basic rights including sexual and reproductive rights, and show them there are alternatives other than exposing themselves to HIV infection or dying as criminals.

Prevençäo da Aids com adolescentes encarcerados em Säo Paulo, SP / AIDS prevention among incarcerated teenagers, Brazil

OBJETIVOS: Descrever o perfil de adolescentes quanto ao apoio social e familiar, ao uso de drogas e os conhecimentos, as práticas e atitudes relacionadas à Aids e sua prevençäo. MÉTODOS: Foram estudados 275 jovens internos, do sexo masculino, de um centro de internaçäo da Fundaçäo Estadual do Bem Estar do Menor (Febem), em Säo Paulo, SP. A pesquisa foi feita em duas fases: a primeira por meio de entrevistas semi-estruturadas com 20 internos; a segunda, com questionários para auto-respostas aplicados aos 275 internos, com perguntas fechadas referentes a características sociodemográficas, criminalidade, práticas sexuais, uso de drogas, conhecimento, atitudes e práticas relativas à Aids. RESULTADOS: Do total estudado, 90 por cento dos jovens internos residiam com suas famílias antes da internaçäo; todos haviam estudado em escolas públicas, ainda que 61 por cento já houvessem abandonado os estudos; 12 por cento já haviam usado drogas; e 5,5 por cento eram usuários de drogas intravenosas. A maioria (98 por cento) era sexualmente ativa; 35 por cento haviam tido mais de 15 parceiras(os) sexuais ao longo da vida; 8 por cento haviam tido experiências homossexuais (dentro ou fora da Febem); 12 por cento já haviam trocado sexo por benefícios materiais; e 22 por cento já eram pais. Muitos dos adolescentes afirmaram que adquirir o HIV "é parte da vida" e que suas vidas apresentam riscos piores, como sobreviver na criminalidade. Acreditam que o preservativo é frágil (83 por cento) e atrapalha a relaçäo sexual (58 por cento); 72 por cento já haviam utilizado preservativo, mas apenas 9 por cento o utilizavam sempre. CONCLUSOES: Os adolescentes apresentaram um elevado risco de aquisiçäo do HIV. Assim, torna-se necessário integrar a prevençäo da Aids em sua problemática de vida e em temas como racismo, esperança pelo futuro, criminalidade, uso de drogas, direitos fundamentais, incluídos nestes os referentes ao sexo e à reproduçäo, mostrando existir alternativas a adquirir o HIV ou morrer na criminalidade