HIV, ABUSE AND PSYCHIATRIC DISORDERS AMONG YOUTH

Rhode Island Hospital (Providence, Ri), Providence RI

Investigators

Linked publications & trials

Abstract

DESCRIPTION: (Taken from abstract). Adolescents are at risk for HIV because of sexual and drug behavior initiated during this developmental period. One subgroup of adolescents at particular risk for HIV is those with psychiatric disorders. Risk behaviors that are prevalent include unprotected intercourse, IV drug use, sharing needles, being the sexual partner of a homosexual/bisexual male or IV drug user, self-mutilation or self-cutting behaviors, and sharing of cutting instruments. A recent project has developed and tested a social learning theory-based HIV prevention intervention that targets psychiatrically hospitalized adolescents. This intervention increases motivation for the change of risk behaviors and provides opportunities for skill building using behavioral rehearsal, and promotes peer norms for safer sex. Recent data suggest that the intervention is efficacious as compared to an information only control group. However, a large subgroup that is at particular risk and for whom the intervention has been less efficacious is those with a history of sexual abuse. These adolescents appear to be at increased risk for HIV because of affective dysregulation and dysfunctional cognitions that prevents them from having adequate communication and assertiveness skills that are necessary in sexual situations. When compared to their non-abused peers, those with a history of sexual abuse have been found to have riskier attitudes, poorer sexual communication skills, and less consistent condom use both before and after the intervention. It appears it is necessary to make affect management and cognitive monitoring strategies, particular to sexual situations, an integral part of HIV interventions with sexually abused adolescents with psychiatric disorders. In intensive psychiatric treatment settings, this project will implement and evaluate the comparative efficacy of an intervention with affect management and cognitive monitoring in changing HIV-related behaviors and attitudes of adolescents with histories of sexual abuse. The efficacy of the enhanced program will be established by assessment of the self-report of unprotected sexual intercourse and biological markers (STD rates by urine screening). Condom use attitudes will be measured, including intentions, decisional balance, peer and family norms, and self-efficacy. These variables will be examined at pretest, at posttest, and at three-and six-month follow-up.