Which Is More Important to High School Students: Preventing Pregnancy or Preventing AIDS?

A sample of about 2,900 high school students in greater Miami, Florida, was surveyed to determine their attitudes toward pregnancy prevention vs. AIDS prevention and how these attitudes affect condom use. Female, Hispanic and black respondents were the most likely to consider pregnancy and AIDS prevention to be equally important. White non-Hispanics and males were relatively more likely to believe that preventing pregnancy is less important than pre venting AIDS, whereas males and females involved in a steady relationship placed more emphasis on pregnancy prevention than AIDS prevention. The more knowledge about HIV and AIDS a respondent had, the less importance he or she placed on pregnancy prevention, and as the importance of preventing pregnancy declined, so did the frequency of condom use. Males who were in a steady dating relationship and perceived pregnancy prevention as more important than AIDS prevention were the most likely to report using condoms often.

(Family Planning Perspectives, 26:154-159,1994)

As of March 1993, 56,287 cases of AIDS have been re ported among teenagers and young adults aged 13-29 years in the United States. (1) Several factors contribute to the risk for HIV infection among adolescents, including the fact that young people are becoming sexually active at increasingly earlier ages and have more sexual partners than their predecessors. (2) Among 15-year-olds, nearly one-fourth of females and one-third of males have engaged in sexual inter-course. (3) Susan Milistein and colleagues found that 21% of some 560 adolescents aged 11-14 from a variety of social, racial and ethnic backgrounds were sexually active; almost half had had their first intercourse prior toll years of age. (4) Although 50-60% of adolescents have experienced intercourse by 17-18 years of age, condom use is not routine. (5) The high rates of sexually transmitted diseases (STDs) other than AIDS among adolescents are indicative of the potential for HIV transmission in this age-group. (6)

More than one million teenage girls become pregnant in the United States each year--approximately one out of every ten girls under the age of 20. (7) One-quarter of all babies born to U.S. teenagers are not first births. (8) Approximately 40% of pregnancies to both white and nonwhite 15-19-year-olds end in abortion, and 25% of abortions in the United States are obtained by adolescents. (9)

Condom use and other "safe sex" behaviors remain the only methods of protection against both pregnancy and STDs for sexually active adolescents. Recent studies have identified several barriers to condom use among adolescents. (10) One is that pregnancy may be the primary concern of sexually active adolescents due to the perceived low prevalence of HIV infection among their peers. They may use oral contraceptives, diaphragms, or other methods of birth control in lieu of condoms, thereby placing themselves at increased risk for STDs.

Barnard and McKeganey found that adolescents often find issues relating to sex embarassing, and therefore may find it easier to have unprotected sex than to discuss STD prevention. (11) In addition to needing effective interpersonal skills to negotiate condom use, there may be tremendou social difficulties for adolescents in purchasing and carrying condoms. Two such barriers to condom use were identified in a study of about 1,700 high school students. When students were asked why they personally did not use condoms, 42% reported they didn't have them at hand and 34% felt that condoms interfered with the pleasure of sex. (12) A French study of 1,500 students suggests that those who are sexually experienced use condoms less and have a more negative attitude toward condom use than those who are sexually inexperienced."

Unprotected sex among adolescents may be the result of unstable sexual relationships. (14) Thus, whether or not the adolescent is in a steady dating relationship may have important implications regarding interpersonal trust and the perceived importance of condom use. Regular sexual relations with one individual may result in an increase in concern for pregnancy prevention, but a diminished concern for prevention of HIV infection. In this sense, even the practice of serial monogamy among adolescents may increase their risk for HIV.