Adolescent HIV Prevention and Education

Sexually active young people in the United States are at persistent risk for HIV infection. This risk is especially notable for youth of minority races and ethnicities.

Continual prevention outreach and education efforts are required in order for adolescents to receive clear and accurate information. Approximately 4,842cases of HIV are diagnosed yearly among people ages 15-24 years (Eaton et al., 2006). With this rate of HIV infections among adolescents it is clear that additional efforts are required as new generations replace the generations that benefited from earlier prevention strategies. Adolescents are receiving mixed messages regarding HIV due to the medications that are now available and longer life expectancy of those living with the disease. Nurses working with adolescents can be pivotal in reaching youth before high-risk behaviors are established by identifying high risk adolescent populations, promoting education, and eliminating barriers to testing.

The Centers for Disease Control and Prevention (CDC) has conducted biennial Youth Risk Behavior Surveillance (YRBS) studies since 1991 in order to identify priority risk behaviors among youth. The results for the YRBS are obtained from students in grades 9-12 who participate in national, state, or local surveys. Of the students surveyed, 46.8% had engaged in sexual intercourse at least once in their life (Eaton et al., 2006). Male students were consistently ranked higher in risk taking behaviors than female students. Minority students (African American and Hispanic) predominately had more risk behaviors than Caucasian males or Caucasian females. These behaviors included multiple sexual partners, unprotected intercourse, and injection drug use (Eaton et al., 2006). Although most students receive some form of preventative health care annually, few discuss STD, HIV, or pregnancy prevention at those visits (Burstein, Lowry, Klein, & Santelli, 2003).

Understanding and identifying adolescent populations that are statistically at higher risk for HIV is a key strategy for nurses. Beedy-Morrison, Nelson, and Volpe (2005) provide evidence that Caucasian adolescent girls engage in higher HIV risk behaviors and receive less HIV testing compared with African American adolescent girls. Although HIV prevalence is higher among African American adolescents, the authors emphasize the implications the result of this study has on health care professionals. According to the findings, if Caucasian girls are more likely to engage in risky sexual behaviors and yet are less likely to be tested, there may be many undiagnosed HIV cases. In addition to the undetected HIV cases, the information health care professionals utilize to identify high risk groups may be inaccurate. Authors Goodenow, Netherland, and Szalacha (2002) found significantly high rates of HIV risk behaviors among bisexual adolescents. A study conducted in Seattle and British Columbia supports the previous research but also found a higher likelihood of HIV risk behaviors among sexually abused students in all sexual orientation categories (Saewyc et al., 2006). Nurses must promote greater community awareness of at-risk adolescents and seek to educate those populations. Education can occur through street outreach, pamphlets with referrals, posters, and classes where youth are located such as the YMCA or Boys and Girls Clubs of America.

Another key strategy for nursing professionals is to provide reality based education. HIV education should include “skills in negotiation, conflict resolution, critical thinking, decision-making and communication, which improves their self-confidence and ability to make informed choices such as postponing sex until they are mature enough to protect themselves from HIV, other STIs and unwanted pregnancies” (Unicef, 2002, p.26). Rew, Whittaker, Taylor-Seehafer, and Smith (2005) suggest that nurses must make sure confidentiality boundaries are established in order to build trust. Adolescents are more receptive to nurses that are open and direct and move from less sensitive topics to more sensitive topics during an assessment. Nurses must assist youth in establishing clear goals for preventing HIV and focus on specific health behaviors related to those goals. Adolescents need to be encouraged to talk with their parents and delay sexual intercourse. If delaying sexual intercourse is not an option adolescents must be taught about the risks and effective contraception methods that will protect against pregnancy, STD’s, and HIV.

An additional strategy nurses need to utilize is to eliminate barriers to sexual health promotion in order to provide effective HIV education. Barriers such as embarrassment, worries about confidentiality, previously bad experiences, and access problems can prevent an adolescent from seeking care. Lindberg, Lewis-Spruill, and Crownover (2006) found that African American adolescents “viewed available healthcare systems as formidable and unwelcoming and healthcare providers as judgmental and disrespectful” (p.85). The adolescents pointed to lack of privacy, having to discuss the problem with multiple personnel including the receptionists, and long waiting times as major barriers. In order to target adolescents, they need a place where they can receive competent care in a relaxing, private, and adolescent focused environment. A teen health clinic with a non-medical environment and open staff is one solution to this problem. Other options include private entrances for teens or a prescribing nurse available at schools.

Currently, we do not yet have a cure or vaccine to prevent HIV. This disease is still winning the war but there is an arsenal of weapons at our command. Nurses must have the know-how and the ability to utilize the resources available. The key to making a difference for adolescents is the adoption of successful HIV prevention interventions, paired with ongoing evaluation of their effectiveness in reducing risky behaviors or increasing safer behaviors. The key strategies addressed provide a foundation to prevent adolescent HIV infection rates. However, many more strategies will be required in order to find success. Young people need the tools to protect themselves from HIV infection and it is going to require a community collaborative effort.

Intervention I- Provide Reality Based Education

Disadvantage I- Limited and Inconsistent HIV Education

HIV prevention work cannot take place without certain ‘tools’ – things that can be used by those at risk of HIV to prevent infection. Ongoing discrimination against HIV positive people and a high number of annual infections suggest that AIDS education in the US is not as effective or as widespread as it could be. A 2006 survey for example found that 10% of Americans thought that there were drugs that could cure HIV, and 29% thought HIV could be transmitted through kissing. Although comprehensive sex education in schools is generally considered the best context in which to teach about AIDS, only around 60% of teachers report using a comprehensive (or abstinence-plus) system. About 34% teach strict abstinence-only programs, while at least 6% teach absolutely nothing at all. The exact content of what is taught can also vary considerably, and many have reported that even in schools where comprehensive education is theoretically taught, a lot of important information can be missed out or glossed over.

UNICEF (2002). Young people and HIV/AIDS: Opportunity in crisis. New York, NY: Author. Retrieved October 2, 2007, from http://www.unicef.org/publications/files/pub_youngpeople_hivaids_en.pdf

Disadvantage II – Outside Variables Can Affect HIV Curriculum Success

Important factors other than curriculum characteristics may dramatically affect their success. In general, at least three groups of factors may affect whether a curriculum-based program produce behavior change: 1) the characteristics of the curriculum and its implementation; 2) the needs, deficits (and assets) of the youth being served by the program; and 3) the characteristics of the youths’ environment, especially the prominence of AIDS, other STDs or teen pregnancy. In some communities in the United States where few young people hear messages to delay sex until older and where HIV is a salient issue, programs that encourage young people to delay sex in order to avoid HIV may be effective, whereas they might not be effective in other communities where youth already hear those messages or where HIV is not a salient issue.

Kirby, D., Laris, B.A., & Rolleri, L. (2006). Sex and HIV education programs for youth: Their impact and important characteristics. Family Health International, 1-76. Retrieved from www.etr.org on January 28, 2008

Intervention II – Eliminating Barriers to HIV Prevention Education

Disadvantage I – Health Care Access and Poverty Prevent Youth From Seeking Care

Studies have found that young people face a host of barriers to health care, including limited access to transportation, lack of confidentiality and youth-friendly service delivery environments, fear about seeking care, and lack of information about services available. Nearly 1 in 4 African Americans and 1 in 5 Hispanics live in poverty. The socioeconomic problems associated with poverty, including lack of access to high-quality health care, can directly or indirectly increase the risk for HIV infection.

Burstein, G.R., Lowry, R., Klein, J.D., & Santelli, J.S. (2003). Missed opportunities for sexually transmitted diseases, human immunodeficiency virus, and pregnancy prevention services during adolescent health supervision visits. Pediatrics, 111(5), 996-1002. Retrieved January 3, 2007, from Expanded Academic ASAP database.

Disadvantage II- Less Effort to Reaching “Other” At-Risk Populations

There is a need to pay more attention to the needs of specific groups of young people like young parents, young lesbian, gay and bisexual people, as well as those who may be out of touch with services and schools and socially vulnerable, like young refugees and asylum-seekers, young people in care, young people in prisons, and also those living on the street. Young people who drop out of school are more likely to become sexually active at younger ages and to fail to use contraception.

Rew, L., Whittaker, T.A., Taylor-Seehafer, M.A., & Smith, L.R. (2005). Sexual health risks and protective resources in gay, lesbian, bisexual, and heterosexual homeless youth. Journal for Specialists in Pediatric Nursing, 10(1), 11-19. Retrieved October 2, 2007, from EBSCO Research database.

References

Beedy-Morrison, D., Nelson, L.E., & Volpe, E. (2005). HIV risk behaviors and testing rates in adolescent girls: Evidence to guide clinical practice. Pediatric Nursing, 31(6), 508-513. Retrieved January 14, 2007 from Expanded Academic ASAP database.

Burstein, G.R., Lowry, R., Klein, J.D., & Santelli, J.S. (2003). Missed opportunities for sexually transmitted diseases, human immunodeficiency virus, and pregnancy prevention services during adolescent health supervision visits. Pediatrics, 111(5), 996-1002. Retrieved January 3, 2007, from Expanded Academic ASAP database.

Eaton, D.K., Kann, L., Kinchen, S., Ross, J., Hawkins, J., Harris, W.A., & et al. (2006). Youth risk behavior surveillance-United States 2005. Morbidity and Mortality Weekly Report, 55(SS-5), 1-112. Retrieved January 31, 2007, from http://www.cdc.gov/mmwr

Goodenow, C., Netherland, J., & Szalacha, L. (2002). AIDS-related risk among adolescent males who have sex with males, females, or both: Evidence from a statewide survey. American Journal of Public Health, 92(2), 203-210. Retrieved January 9, 2007, from PubMed central database.

Kirby, D., Laris, B.A., & Rolleri, L. (2006). Sex and HIV education programs for youth:Their impact and important characteristics. Family Health International, 1-76Retrieved from www.etr.org on January 28, 2008.

Lindberg, C., Lewis-Spruill, C., Crownover, R. (2006). Barriers to sexual and reproductive health care: Urban male adolescents speak out. Issues in Comprehensive Pediatric Nursing, 29(2), 73-88. Retrieved October 2, 2007, from EBSCO Research database.

Rew, L., Whittaker, T.A., Taylor-Seehafer, M.A., & Smith, L.R. (2005). Sexual health risks and protective resources in gay, lesbian, bisexual, and heterosexual homeless youth. Journal for Specialists in Pediatric Nursing, 10(1), 11-19. Retrieved October 2, 2007, from EBSCO Research database.

Saewyc, E., Pooh, C., Murphy, A., Skay, C., Richens, K., Reis, E. (2006). Sexual orientation, sexual abuse, and HIV risk behaviors among adolescents in the pacific northwest. American Journal of Public Health, 96(6), 1104-1110. Retrieved October 2, 2007, from EBSCO Research database.

UNICEF (2002). Young people and HIV/AIDS: Opportunity in crisis. New York, NY: Author. Retrieved October 2, 2007, from http://www.unicef.org/publications/files/pub_youngpeople_hivaids_en.pdf