Academic journal article Health and Social Work

The Challenge of HIV Prevention among High-Risk Adolescents

Academic journal article Health and Social Work

The Challenge of HIV Prevention among High-Risk Adolescents

Article excerpt

Over the past two decades, rates of infection with sexually transmitted diseases have continued to increase among teenagers (Cates, 1991). Marginalized youths of color are at particular risk for HIV infection (Athey, 1991; Wheeler, 1992). Efforts to prevent infection among high-risk groups have been largely limited to health education initiatives (Massachusetts Medical Society, 1989; Stall, 1987). For those who are homeless and who use drugs and alcohol during sexual activity, the effectiveness of such efforts is reduced (Icard, Schilling, El-Bassel, & Young, 1992).

This article reports on research that examined knowledge and behavior related to HIV infection among a sample of 60 high-risk adolescents and young adults involved in the street life of Hollywood, California. The central research problem was to assess knowledge of HIV transmission and prevention among at-risk youths and to describe some of the factors that compound HIV risk and mitigate against risk reduction among this vulnerable population. Delineating the cofactors of HIV risk is essential to the development of interventions to diminish risk and enable youths to act on improved knowledge of HIV infection and prevention.


Adolescents and Social Contexts

From their study of 750 college juniors and seniors and a review of several other empirical studies of adolescents conducted between 1985 and 1990, Roscoe and Kruger (1990) concluded that although adolescents' knowledge of HIV transmission might have improved over the past few years, their risk-related behaviors had not. Similarly, Rotheram-Borus and Koopman (1991) concluded from their study of gay and bisexual male adolescents of color that positive AIDS prevention beliefs were significantly and inversely associated with a pattern of high-risk behaviors but not with abstinence from those behaviors. Inconsistencies between HIV-related knowledge and risk behaviors have been noted in a number of other studies as well (Atwood, 1992; Keller, 1993; McGill, Smith, & Johnson, 1989; Offir, Fisher, Williams, & Fisher, 1993). Walker and Small (1992) noted the significance of social context to the epidemiology of AIDS and crack use in African American communities and recommended ecosystemic approaches to intervention.

In a study of HIV infection in a national sample of adolescent intravenous drug users, Williams (1993) explored the relation between socioeconomic factors, level of drug involvement, and the exchange of sex for drugs. Recognizing that knowledge is not enough to counter the contextual and situational cofactors in HIV infection, numerous researchers have extolled the importance of behavioral interventions in combination with education in preventive programs directed toward adolescents (Botvin, 1983; Nutbeam, Aar, & Catford, 1989; Rotheram-Borus & Koopman, 1991; Schinke, Gilchrist, Schilling, Snow, & Bobo, 1986; Strunin & Hingson, 1987; Tobler, 1987).

Typically, the interventions that have derived from this research emphasize social skills training in social negotiation and the resistance of health-negative peer pressure as well as training in decision-making and problem-solving skills (Leland, 1990). These approaches recognize the predictive significance of the social context of health behaviors and the importance of the interactive effects of family, peer, and communications systems in shaping health-related behaviors.

Azjen and Fishbein's (1980) research noted that adolescents' attitudes and perceptions of social norms were significant predictors of their intention to adopt positive health behaviors and that these attitudes and perceptions had strong situational determinants. For the most part, however, the youths themselves, and not their situations, remained the focus of interventions in this research. Thus, approaches that attend to the perceptions, attitudes, and behavioral predispositions derived from the social context may still omit the context itself as a focus for intervention. …

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