Academic journal article Child Welfare

HIV Prevention for Youths in Independant Living Programs: Expanding Life Options

Academic journal article Child Welfare

HIV Prevention for Youths in Independant Living Programs: Expanding Life Options

Article excerpt

The incidence of human immunodeficiency virus (HIV) infection among adolescents is increasing. Youths who were abused and neglected and in out-of-home care are among those at highest risk of acquiring HIV The concurrence of sexual activity and school failures contributes to their high-risk status. Research suggests that changing behaviors of troubled youths requires programs that not only include HIV-related knowledge, attitudes, and skills, but also incentives and skills for educational planning that will expand the future life options of these youths.

Youths who are abused and neglected and in out-of-home care are among those at highest risk of acquiring HIV [D'Angelo et al. 1994]. The concurrence of sexual activity, family instability and disruption, behavioral and emotional problems, and school failures contributes to their high-risk status. Although cognitive-behavioral strategies appear promising, they have had limited success in maintaining long-term behavioral changes. This article presents a conceptualization of HIV prevention for adolescents in independent living programs that links the reduction of HIV-risk behaviors with expansion of youths' life options through educational planning. Independent living programs, created by P.L. 99-272 and authorized by an amendment to Title IV-E of the Social Security Act, are funded under a federal entitlement and delivered by state child welfare agencies to prepare and support youths in their transition from out-of-home care to selfsufficiency and independence. HIV prevention should be an integral part of preparing youths for this transition and for survival.

This article presents (1) the characteristics of youths in the child welfare system that place them at risk of HIV infection; (2) previous attempts at HIV prevention used with this population, and their limitations; (3) data that provide a rationale for designing HIV prevention programs with a life options perspective; and (4) a strategy to prevent HIV infection that includes educational planning and the provision of assets for youths in out-of-home care.

Risk Characteristics of Youths in the Child Welfare System

Youths involved with the child welfare system usually present with psychosocial problems associated with risk behaviors that make them vulnerable to HIV infection. These problems include histories of physical or sexual abuse, neglect, family instability and disruption, poor health, educational deficits, substance abuse, and delinquent behaviors [Barth 1990]. One of the risk factors of adolescents leaving the out-of-home care system is limited educational options that diminish their life chances for economic and social stability [Cook 1994; DeWoody et al. 1993]. A national evaluation of independent living programs by Westat found that only 44% of 18-year-olds discharged from out-of-home care had completed high school [Cook 1994]. The study identified other educational deficits that included histories of grade retention, placements in special education, and disruptions in school attendance. Despite these problems, only 44% of the youths in the study received services in educational planning [DeWoody et al. 1993].

Youths in out-of-home care are also characterized by a high rate of pregnancy and sexually transmitted diseases. Forty-two percent of the youths surveyed in the Westat study reported giving birth to or fathering a child within one year of discharge [DeWoody et al. 1993]. Barth [1990] found that of youths discharged from out-of-home care for at least one year, 17% had a sexually transmitted disease and 40% reported a pregnancy. These data suggest that youths in out-of-home care are at risk for HIV infection because of their involvement in unprotected sexual activities. The combination of educational deficiencies and sexual risktaking among these youths multiplies their risk for HIV infection. In fact, Slonim-Nevo et al. [1995] found that among youths in outof-home care, educational deficits were positively associated with HIV-risk knowledge, attitudes, and behaviors. …

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