Issues of sexuality and prevention among adolescents living with HIV/AIDS since birth.(Report)

Abstract: There have been few studies on sexuality, relationships, and HIV prevention issues among HIV+ adolescents and fewer still that have dealt with youth living with HIV/AIDS since birth. In the present qualitative study, we conducted individual, semi-structured, taped interviews on these topics with 29 youth perinatally infected with HIV. The 15 girls and 14 boys, 10-18 years of age, have been followed at the Centre Maternel et Infantile sur le SIDA (CMIS), Centre Hospitalier Universitaire Sainte-Justine in Montreal. Content analysis of the interview transcripts revealed two dimensions related to HIV prevention. From a rational perspective, the youth were generally knowledgeable about modes of HIV transmission and modes of prevention, including consistent condom use. From an affective perspective, they were clear about their responsibility to protect their current or future partners but fearful that efforts to do so might disclose their HIV status with subsequent threat of rejection, stigmatization and compromised relationships. The concealment strategies they adopted to address the tensions inherent in this situation are discussed in terms of their own psychosexual development and of interventions by parents, caregivers and professionals to foster healthy and satisfying sexuality for HIV+ youth and their partners.

Introduction

For most youth, puberty and adolescence bring new experiences including increased interest in romantic relationships and sexual exploration (Millstein & Igra, 1995). The Canadian Youth Sexual Health and HIV/AIDS Study showed that the onset of sexual activities such as deep kissing, genital touching, oral sex, and sexual intercourse varied progressively by grade level and to some extent by gender (e.g., 40% of grade 11 males and 46%) of grade 11 females had ever had intercourse (Boyce et al., 2006). This finding fits with Maticka-Tyndale's (2001) observation that first intercourse in Canada generally takes place between 16 and 18 years of age. The timing of the onset of such sexual activities can be influenced by gender, ethno-cultural origins, degree of acculturation, and other socio-cultural factors (American Association of World Health, 2006; Entwisle, 2002). Adolescence is characterized by risk-taking (Sturdevant et al., 2001) and also decisionmaking as sexual relationships emerge. Youth face decisions about engaging in different sexual behaviours, safer sex practices, and the risk of sexually transmitted infections (STI) including HIV/ AIDS. These concerns take on added complexity when the adolescents involved are already living with HIV/AIDS. The present study therefore addresses these sexual adjustment issues through individual interviews with a specific and understudied population of HIV+ youth, those who have been living with HIV/AIDS since birth.

The literature on HIV with paediatric populations indicates that few studies have dealt with the sexual behaviour of adolescents living with HIV/AIDS (Brown, Lourie, & Pao, 2000) and fewer still have done so specifically with youth infected with HIV perinatally (Ezeanolue, Wodi, Patel, Dieudonne, & Oleske, 2006; Fielden et al., 2006). These youth collectively represent a unique group in that they have to manage the issues associated with adolescence (bodily changes, behavioural changes, the dawning of sexuality, etc.) while also coming to terms with the difficult reality of living with HIV, an illness that is chronic and sexually transmitted.

HIV+ adolescents infected mainly by sexual transmission

The available information on this topic has come mainly from studies of adolescents infected with HIV through sexual transmission. The samples studied were principally composed of gay youth (Anya, Swendeman, & Rotheram-Borus, 2005; Levin et al., 2001; Murphy et al., 2001; Naar-King et al., 2006; Rotheram-Borus et al., 2001; Vermund et al., 2001). Two of these studies of HIV+ adolescents specifically addressed age of first sexual activity, at-risk behaviour, and condom use (Rotheram-Borus et al., 2001; Vermund, Wilson, Smith Rogers, Partlow, & Moscicki, 2001). The results revealed that the first sexual activity occurred at age 14 on average and that almost 75% of the youth had engaged in anal practices (Rotheram-Borus et al., 2001). Between 42% and 66% of youth infected with HIV claimed to use condoms most of the time (Rotheram-Borus et al., 2001; Vermund et al., 2001), though only 8% reported using them consistently (Rotheram-Borus et al., 2001). Female HIV+ youth appeared to choose condoms principally as a method of contraception although their use was inconsistent; the size of their age difference from their partner was strongly correlated with lowered condom use (Vermund et al., 2001).

Naar-King et al. (2006) studied factors associated with sexual risk in 60 HIV+ youth of whom 91% were infected by sexual transmission, 58% defined themselves as prediminantly heterosexual, and 65% had been sexually active (had intercourse) within the last three months. Seventy-one percent of the latter group mentioned having unprotected intercourse during this time period. Analysis using the Transtheoritical Model (TTM) indicated that self-efficacy completely mediated the relationship between stage of change and acts of unprotected intercourse. Social support specific to reducing risk was associated with increased self-efficacy. On the other hand, emotional distress and low general social support were not associated with decreased condom use.