The relationship of unsafe sexual behavior and the characteristics of sexual partners of HIV infected and HIV uninfected adolescent females

doi:10.1016/S1054-139X(01)00286-5

Journal of Adolescent Health

Volume 29, Issue 3, Supplement 1, September 2001, Pages 64-71

https://doi.org/10.1016/S1054-139X(01)00286-5 Get rights and content

Abstract

Purpose: To compare characteristics of sexual relationships in HIV infected and HIV uninfected female adolescents and their association with condom use.

Methods: HIV infected and uninfected subjects, aged 13–19 years, were enrolled in a prospective HIV study from 15 sites in 13 U.S. cities. Baseline data on demographic information, substance use, sexual behavior, partner information, and condom use were collected through direct and computer-assisted interviews from currently sexually active females. Univariate, multiple logistic regression, and repeated measures analyses were employed.

Results: Data from 153 HIV infected and 90 HIV uninfected female subjects showed, on average, that current partners were 4–6 years older. In multivariate analysis, HIV infected subjects were older (OR = 1.37; 95% CI: 1.04–1.81), had more lifetime partners (OR = 2.23; 95% CI: 1.03–4.82), initiated consensual vaginal sex earlier (OR = .74; 95% CI: .58–.95), perceived partner to also be HIV infected (OR = 7.46; 95% CI: 3.2–17.4), and had less unprotected sex (OR = .27; 95% CI: .16–.45). Length of relationship was associated with more unprotected sex for both HIV infected and uninfected subjects (OR = 2.59, 95% CI: 1.27–5.27, OR = 4.13; 95% CI: 1.31–13.05, respectively). Mean partner age difference was greater among HIV infected than for HIV uninfected (OR = 1.06; 95%CI: 1.01–1.12); this greater age difference for HIV infected females was associated with less protection (OR = 1.09; 95% CI: 1.03–1.15). HIV disclosure influenced condom use: without disclosure, less condom use was reported (OR = 6.8; 95% CI: 2.29–20.24) controlling for perception that partner was also HIV infected (OR = 1.1; 95% CI: 1.02–1.21).

Conclusions: Because age differential influenced reported condom use, more research, particularly qualitative, is needed into the dynamics of these relationships. Prevention efforts must address partners, particularly older ones.

Section snippets

Subject population

This examination was completed within the ongoing observational study of HIV infected and high-risk HIV uninfected adolescents called the Reaching for Excellence in Adolescent Care and Health (REACH), a project of the Adolescent Medicine HIV/AIDS Research Network (AMHARN). Characteristics of the cohort, recruitment, eligibility criteria, and study design are reported elsewhere 16, 17. The Institutional Review Boards of all participating institutions approved the study and all participants

Results

At the time of analysis, 242 HIV infected and 131 HIV uninfected female subjects were enrolled in REACH. Seventy-seven HIV infected and 34 HIV uninfected subjects were excluded because of no sexual activity in the previous 3 months. Additionally, owing to incomplete data at baseline, we excluded 12 subjects among the HIV infected and 7 among the HIV uninfected. One hundred and fifty-three HIV infected subjects and 90 HIV uninfected subjects were eligible for this analysis. These 243 female

Discussion

The adolescent females in this study, 16 years old on average, report sexual partners who are 4 to 6 years older than they. Other researchers have previously demonstrated that sizeable proportions of adolescent females report male sexual partners who are 3 or more years older than themselves 8, 9. For the HIV infected females in our study, the age differential was even greater. The age difference between an adolescent female and an adult male, and the power differential it implies, may

Acknowledgements

The views expressed in this paper belong to the authors alone and do not necessarily reflect the opinions of the agencies or institutions with which they are affiliated.

References (31)

B Leigh et al.
Sexual behavior of American adolescentsResults from a U.S. national survey
J Adolesc Health
(1994)
D Laraque et al.
Predictors of reported condom use in central Harlem youth as conceptualized by the health belief model
J Adolesc Health
(1997)
A.S Rogers et al.
The REACH Project of the adolescent medicine HIV/AIDS research network
J Adolesc Health
(1998)
C.M Wilson et al.
The REACH (Reaching for Excellence in Adolescent Care and Health) ProjectStudy design, methods, and population profile
J Adolesc Health
(2001)
L.J D’Angelo et al.
Disclosure of serostatus by HIV infected youthThe experience in the REACH study
J Adolesc Health
(2001)
S.N Seidman et al.
Predictors of high risk behavior in unmarried American womenAdolescent environment as risk factor
J Adolesc Health
(1994)
J.S St. Lawrence et al.
Factors influencing condom use among African American womenImplications for risk reduction interventions
Am J Community Psychol
(1998)
J.S Santelli et al.
Stage of behavior change for condom useThe influence of partner type relationship and pregnancy factors
Fam Plann Perspect
(1996)
B.H Thomas et al.
Adolescent sexual behaviourResults from an Ontario sample. Part II Adolescent use of protection
Can J Public Health
(1998)
J.J Murphy et al.
Increased condom use among teenage males, 1988–1995The role of attitudes
Fam Plann Perspect
(1998)

M.L Shew et al.

The validity of self-reported condom use among adolescents

Sex Transm Dis

(1997)

P Sweeney et al.

Teenagers at risk of Human Immunodeficiency Virus type I infection

Arch Pediatr Adolesc Med

(1995)

K.S Miller et al.

Sexual initiation with older male partners and subsequent HIV risk behavior among female adolescents

Fam Plan Perspect

(1997)

L Ku et al.

Young men’s risk behaviors for HIV infection and sexually transmitted diseases 1988–1991

Am J Pub Health

(1993)

L Ku et al.

The dynamics of young men’s condom use during and across relationships

Fam Plann Perspect

(1994)

Cited by (67)

Age at marriage and HIV vulnerability among young married women living with HIV in northern Karnataka, India
2021, Children and Youth Services Review
Citation Excerpt :
It can be argued that women who marry considerably older men may be more vulnerable than other young women. For instance, studies have shown that older husbands may be more likely to be HIV infected than younger men (Gregson et al., 2002; Sturdevant et al., 2001). Moreover, if spousal age difference is considerable, young women may be less capable of asserting themselves or denying sex (Jensen & Thornton, 2003; Maman et al., 2002; Martin et al., 1999; Nurse, 2003; Van der Straten et al., 1998).
The purpose of the study is to explore whether marriage age possibly a risk factor for HIV infection among young women living with HIV in a high HIV risk area of southern India. We used data from a cross-sectional survey of randomly selected currently married HIV-positive women aged 15 to 29. The analysis of the data revealed that more than 75% of them got married before they reach their 17th birthday. More than 71% are from rural areas, and about half of them are illiterate. Surprisingly, 28% of women began to live with their current husbands before the age of 15, and as many as 73% of respondents began to live with their current husbands below the legal age at marriage of 18 years. The average age of the interviewees was 25.6 years, while that of husbands was 32.5 years, indicating that the average age gap between husbands and spouses was 7 years. Regarding the timing of their HIV diagnosis, 37% of the respondents were diagnosed their HIV status during pregnancy and a higher percentage of younger ones were tested HIV positive when respondents were pregnant (61%) as compared to older respondents. In the past 2 years, 58% of the respondents have diagnosed with HIV. This could be mainly due to the increased awareness among women in the recent years as well as the government scaled up the HIV testing during the past few years, both in terms of increasing the testing facilities across the state and providing capacity of those staff involved in testing. Hence, there is a program need for the about-to-be-married and the newly-married couples to be educated about HIV transmission, the practice of safe sex as well as the use of HIV prevention services.
Transmission Risk Among Youth Living With HIV in the U.S.
2020, Journal of Adolescent Health
HIV treatment as prevention is effective for reducing the risk of HIV transmission and the messaging campaign, undetectable = untransmittable, is gaining recognition. As youth living with HIV (YLWH) who have condomless sex may acquire and potentially transmit other sexually transmitted infections (STIs), the purpose of this study was to assess potential differences in transmission risk of HIV and other STIs among YLWH to inform subsequent HIV and STI prevention efforts.
A cohort of 600 HIV behaviorally infected youth aged 13–24 years who were engaged in medical care completed an audio computer-assisted self-interview including questions about demographics, HIV disclosure, mental health, substance use, and sexual behaviors and beliefs. HIV viral loads and the presence of other STIs were abstracted from medical records. A viral load <200 copies/mL was considered undetectable. Univariate and bivariate analyses were conducted to examine differences by viral load and STIs.
Participants were categorized into four groups: (1) undetectable without STIs (55.2%); (2) undetectable with STIs (14.2%); (3) detectable without STIs (22.8%); and (4) detectable with STIs (7.8%). In comparison to the other three groups, youth in the undetectable group with STIs reported more favorable sexual risk reduction attitudes and beliefs, internet use for finding sex partners, anal sex with male partners, and condomless anal sex with male partners.
YLWH with undetectable viral loads and other STIs engaged in higher risk behaviors. To realize the promise of the messaging campaign, undetectable = untransmittable, efforts must focus on sustained viral suppression and prevention of STIs among YLWH.
Association between sex partner meeting venues and sexual risk taking among urban adolescents
2012, Journal of Adolescent Health
To increase understanding of the association between sexual partner meeting venue types (school, through friends or family, organized groups, public places, or on the street) and sexual risk taking among urban youths.
Data were from 17- to 18-year-old youths who reported having had sex (n = 1,656) by the time they participated in the 2008–2009 follow-up of a multicomponent alcohol preventive intervention, Project Northland Chicago. We used logistic regression to assess the association between partner meeting venue and sexual risk taking.
Approximately 20% of Chicago adolescents met their most recent sex partner on the street or in public places. Adolescents who met their partner in a public place, rather than in school, were more likely to report having ≥3 years age-discordant partner (women: odds ratio [OR] = 7.7, 95% confidence interval [CI] = 3.3–17.7; men: OR = 2.7, 95% CI = 1.1–6.6], alcohol use before sex (women: OR = 3.4, 95% CI = 1.8–6.5; men: OR = 2.4, 95% CI = 1.3–4.4), casual partner (women: OR = not significant; men: OR = 2.4, 95% CI = 1.3–4.5), anal sex (women: OR = not significant; men: OR = 2.4, 95% CI = 1.2–4.9), and unprotected sex (women: OR = 1.7, 95% CI = 1.0–2.7; men: OR = 1.9, 95% CI = 1.1–3.4). Meeting partners on the street was associated with increased probability of alcohol use before sex (women: OR = 2.2, 95% CI = 1.1–4.3; men: OR = 2.1, 95% CI = 1.0–4.6), age-discordant partnerships among women (OR = 14.2, 95% CI = 6.4–31.4), and casual sex partners among men (OR = 2.5, 95% CI = 1.4–4.8).
Targeting sexual risk taking with partners selected from public places or the street may improve adolescent HIV preventive interventions.
Patterns of disclosure among youth who are HIV-positive: A multisite study
2012, Journal of Adolescent Health
Citation Excerpt :
Therefore, health professionals need to promote disclosure and condom use by using strategies, such as motivational [7] and multisystemic therapy interventions [8], particularly with youth with multiple sexual partners. The lack of difference in engagement in unprotected sex between those with full and those with not full disclosure may be due to the high-risk sample, as other studies support this link [9]. Furthermore, this study focused on condom use in the past 3 months, and perhaps disclosure is associated with consistent condoms use over a longer period.
Disclosure of serostatus is critical in preventing the transmission of HIV among youth. The purpose of this exploratory study was to describe serostatus disclosure in a multisite study of youth living with HIV.
This study investigated serostatus disclosure and its relationship to unprotected sex among 146 youth participating in a multisite study of young people living with HIV who were sexually active within the past 3 months.
Forty percent of participants reported a sexual relationship with a partner to whom they had not disclosed their serostatus. Participants with multiple sexual partners were less likely to disclose their serostatus than those with one partner. Disclosure was more frequent when the serostatus of the sexual partner was known. Disclosure was not associated with unprotected sex.
Prevention initiatives should focus on both disclosure and condom use in this high-risk population, particularly for youth with multiple sexual partners.
A Systematic Review of the Impact of HIV-Related Stigma and Serostatus Disclosure on Retention in Care and Antiretroviral Therapy Adherence Among Women with HIV in the United States/Canada
2024, AIDS Patient Care and STDs
Trends and Correlates of Age-Disparate Sexual Partnerships in the United States: The National Health and Nutrition Examination Surveys
2022, Sexually Transmitted Diseases

View all citing articles on Scopus

View full text

The adolescent medicine HIV/AIDS research networkThe relationship of unsafe sexual behavior and the characteristics of sexual partners of HIV infected and HIV uninfected adolescent females

Abstract

Section snippets

Subject population

Results

Discussion

Acknowledgements

J Adolesc Health

J Adolesc Health

J Adolesc Health

J Adolesc Health

J Adolesc Health

J Adolesc Health

Factors influencing condom use among African American womenImplications for risk reduction interventions

Am J Community Psychol

Stage of behavior change for condom useThe influence of partner type relationship and pregnancy factors

Fam Plann Perspect

Adolescent sexual behaviourResults from an Ontario sample. Part II Adolescent use of protection

Can J Public Health

Increased condom use among teenage males, 1988–1995The role of attitudes

Fam Plann Perspect

The validity of self-reported condom use among adolescents

Sex Transm Dis

Teenagers at risk of Human Immunodeficiency Virus type I infection

Arch Pediatr Adolesc Med

Sexual initiation with older male partners and subsequent HIV risk behavior among female adolescents

Fam Plan Perspect

Young men’s risk behaviors for HIV infection and sexually transmitted diseases 1988–1991

Am J Pub Health

The dynamics of young men’s condom use during and across relationships

Fam Plann Perspect

The adolescent medicine HIV/AIDS research network
The relationship of unsafe sexual behavior and the characteristics of sexual partners of HIV infected and HIV uninfected adolescent females