The impact of AIDS on an urban population of high-risk female minority adolescents: Implications for intervention

Abstract

Purpose: This study's purpose was to describe acquired immunodeficiency syndrome (AIDS)-related concerns, risk behaviors, and psychosocial/situational determinants of condom use among an urban minority population of sexually active, adolescent girls. In addition we sought to define the accuracy of personal AIDS risk-assessment, the relative importance of AIDS in relation to other concerns, and the broader context of sexual experience and attitudes in this population. Methods: A cross-sectional interview study was conducted involving sexually active female adolescents attending a pediatric clinic in an inner-city university-affiliated community hospital. Sixty-nine subjects (ages 13–19 yr, 90% African-American) were enrolled. While the goals of this study were primarily descriptive, subject characteristics felt to impact on condom use were identified prior to data collection and were examined against several measures of usage including: use at the time of last sexual intercourse, overall frequency of condom use, and reported behavior change to include initiation of or increased condom usage. Results: Forty-one percent of participants reported knowing someone with AIDS. Global concern regarding this disease was high, although worry about povertyrelated issues was often greater. Despite concern and high measures of AIDS risk (median number of sex partners, 3; past sexually transmitted disease, 55%; past pregnancy 77%), most participants perceived themselves to be at low personal risk owing to current monogamy, lack of intravenous drug use, and implicit trust in their partner's safety. Discussion with their partner about actual risk and awareness of the importance of past behaviors was generally lacking. Although 98% were aware that condoms may prevent AIDS, 64% used condoms half of the time or less when they had sex and use appeared to be primarily for contraception. Several intrinsic cognitive/psychological and extrinsic social/situational factors were found to correlate with measures of condom use. Conclusions: Participants' sexual histories and behavior emphasize the need for concern regarding AIDS risk in this population. Patterns of sexual behavior and beliefs regarding committed relationships raise challenging questions regarding how to motivate sexually active members of this population to use condoms more frequently. Programs aimed at AIDS prevention among urban minority adolescents need to be cognizant of the larger personal and sociocultural context in which these teenagers are making health-behavior choices.