Abstract
The HIV/AIDS epidemic is disproportionately impacting young African Americans. Efforts to understand and address risk factors for unprotected sex in this population are critical in improving prevention efforts. Situational risk factors, such as relationship type and substance use before sex, are in need of further study. This study explored how established cognitive predictors of risky sexual behavior moderated the association between situational factors and unprotected sex among low-income, African American adolescents. The largest main effect on the number of unprotected sex acts was classifying the relationship as serious (event rate ratio=10.18); other significant main effects were alcohol use before sex, participant age, behavioral skills, and level of motivation. HIV information moderated the effect of partner age difference, motivation moderated the effects of partner age difference and drug use before sex, and behavioral skills moderated the effects of alcohol and drug use before sex. This novel, partnership-level approach provides insight into the complex interactions of situational and cognitive factors in sexual risk taking.
Highlights
In the United States the HIV/AIDS epidemic disproportionately impacts youth and African Americans
The adolescents and caregivers were from predominantly African American, very low-income neighborhoods in the southern U.S Participants were recruited from a community-based, multiple cohort longitudinal study with annual data collection, the Mobile Youth Study (MYS); the MYS has been described in detail elsewhere.[60,61]
There was an average of 3.70 episodes of unprotected sex in each partnership; the intraclass correlation (ICC) indicated 43% of the variance in unprotected sex was across participants and 57% across partnerships
Summary
In the United States the HIV/AIDS epidemic disproportionately impacts youth and African Americans. The primary goal of this approach is to identify individuals who are at risk, and situations that potentiate risk in order to develop interventions that target these factors without necessarily specifying the causal chain linking the risk factors with the outcomes Within this collection of literature, three of the most widely studied predictors of sexual risk are relationship type (i.e., serious versus casual),[3,4,5,6,7] substance use prior to sex,[8,9,10,11,12] and partner age difference.[13,14] The second major collection of literature focuses on cognitive factors directly related to sexual risk behavior, such as HIV knowledge, attitudes towards risk and prevention behaviors, expectations, motivations, and abilities related to risky or safer sex.[15,16] Here, the goal is to identify cognitive factors related to HIV that can be changed through intervention so as to facilitate the individual’s engagement in protective behaviors
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