HIV This Week

Birungi H, Mugisha JF, Obare F, Nyombi JK. Sexual behaviour and desires among adolescents perinatally infected with human immunodeficiency virus in Uganda: implications for programming. J Adolesc Health. 2009;44:184-7.

Counselling programs for adolescents living with human immunodeficiency virus (HIV) encourage abstinence from sex and relationships. This Uganda study, however, found that many of these adolescents are sexually active or desire to be in relationships but engage in poor preventive practices. Programmes for HIV therefore need to strengthen preventive services to this group.

Editors’ note: In this study, 732 adolescents aged 15 to 19 years living with HIV in 4 districts in Uganda were interviewed, 48 participated in focus group discussions, and 12 underwent in-depth interviews for ethnographic case stories. One-third was sexually active and of these 38% had disclosed their HIV status to their current partners. Overall 51% feared disclosing their status to their friends. At first sex, 37% had used condoms and much of current condom use was for pregnancy prevention. Clearly, the sexual and reproductive needs of this unique and growing population of perinatally infected young people are not being adequately met by current service approaches.

Schmiege SJ, Broaddus MR, Levin M, Bryan AD. Randomized trial of group interventions to reduce HIV/STD risk and change theoretical mediators among detained adolescents. JConsult Clin Psychol. 2009;77:38-50.

Criminally involved adolescents engage in high levels of risky sexual behaviour and alcohol use, and alcohol use may contribute to lack of condom use. Detained adolescents (n = 484) were randomized to (1) a theory-based sexual risk reduction intervention (GPI), (2) the GPI condition with a group-based alcohol risk reduction motivational enhancement therapy component (GPI + GMET), or (3) an information-only control (INFO). All interventions were presented in same-sex groups in single sessions lasting from 2 to 4 hr. Changes to putative theoretical mediators ( attitudes, perceived norms, self-efficacy, and intentions) were measured immediately following intervention administration. The primary outcomes were risky sexual behaviour and sexual behaviour while drinking measured 3 months later (65.1% retention). The GPI + GMET intervention demonstrated superiority over both other conditions in influencing theoretical mediators and over the INFO control in reducing risky sexual behaviour. Self-efficacy and intentions were significant mediators between condition and later risky sexual behaviour. This study contributes to an understanding of harm reduction among high-risk adolescents and has implications for understanding circumstances in which the inclusion of group-based alcohol risk reduction motivational enhancement therapy components may be effective.

Editors’ note: Criminally involved adolescents in detention present challenges to effective HIV prevention on several levels but this is, after all, a ‘teachable moment’ when they may more easily contemplate the negative aspects of a behaviour as well as avenues of behaviour change. Most of the 14 to 17 year olds (82.7% male) in this study were sexually active (92.7%) with a median age at first intercourse of 13.02 years. Of these, 82% reported alcohol use during a sexual encounter. In the full group, 90.9% had used alcohol in the past year with the average number of drinks at one time being 4.7. This randomised controlled trial found that incorporating an alcohol-related sexual risk reduction component that was non-confrontational and supportive into a more traditional sexual risk reduction intervention resulted in increased condom use self-efficacy and intentions to use condoms. Retention at 3 months was low but nonetheless these promising findings deserve further study and practical application.