Adolescent Participation in HIV Vaccine Trials: Cognitive Developmental Considerations

Abstract

Adolescents form an important target group for HIV vaccine trials for a number of reasons. These include the high HIVprevalence and incidence rates amongst adolescents, early sexual debut, multiple sexual partners, and other high-risk sexual behaviours. It has therefore been argued that the focus of HIV vaccination attempts should be on early adolescents younger than 15 years of age. Indeed, vaccination of adolescents prior to their sexual debut has been argued to have the potential to be one of the most effective ways to curb the HIV pandemic. While the biological and epidemiological arguments for vaccination of adolescents have been elucidated, this article offers some insight into the cognitive aspects of decision making in adolescence that may inform strategies vaccine trial sites might employ when dealing with adolescent participants. After a brief overview of the educational, biological, and relationship changes that occur during adolescence, this article explores some of the more pertinent cognitive changes that occur during adolescence. More specifically, this article explores the cognitive changes during adolescence that affect decision making, such as differences between younger and older adolescents in (a) choice, (b) comprehension, (c) creativity, (d) compromise, (e) consequentiality, (f) correctness, (g) credibility, (h) consistency, and (i) commitment. Research findings relating to the above changes are discussed, creating an argument for the exclusion of early adolescents in vaccine trials and the concomitant active engagement with middle adolescents.