“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 US 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.

Keywords:

• adolescents
• HIV/AIDS
• HIV/AIDS prevention
• youth
• sexual health

Acknowledgements

During data collection, Dr Marhefka was supported by a training grant from the National Institute of Mental Health (NRSA T32 MH19139, Behavioral Sciences Research in HIV Infection; Anke A. Ehrhardt, Ph.D., Program Director) and Drs Marhefka and Mellins were supported by the HIV Center for Clinical and Behavioral Studies (P30 MH43520; Anke A. Ehrhardt, Ph.D., Principal Investigator), which provided funding for this study. Some data were collected in conjunction with a grant from the National Institute of Mental Health (R01MH069133, Mental Health and Risk in HIV+ Youth and Seroreverters; Claude Ann Mellins, Ph.D., Principal Investigator).

Notes

1. Of note, three of the participants knew the interviewer from prior participation in a behavioral intervention study with youth PIH and their families – in all other cases there was no prior relationship between interviewer and interviewee.

2. It was not a standard protocol to inform girls of misconceptions; however, the girl who had engaged in anal sex and did not know it was a transmission risk was informed of the risk following the interview.