Advancing Sexual and Reproductive Health and Rights
Perspectives on Sexual and Reproductive Health
Volume 42, Number 2, June 2010

Lowering the Risk of Secondary HIV Transmission: Insights From HIV-Positive Youth and Health Care Providers

By Amy D. Leonard, Christine M. Markham, Thanh Bui, Ross Shegog and Mary E. Paul

CONTEXT: Both perinatally and behaviorally infected HIV-positive youth engage in sexually risky behaviors, and a better understanding of the perceptions of these youth and of health care providers regarding disclosure of HIV status and risk reduction would aid in the development of behavioral interventions for such youth.

METHODS: In spring 2007, some 20 HIV-positive inner-city youth (aged 13–24) and 15 health care providers who work with HIV-infected youth participated in in-depth, semistructured interviews. Youth were recruited at an HIV clinic, AIDS clinics and an AIDS service organization, and had received care from participating providers. Detailed contextual and thematic discourse analysis was performed on interview transcriptions.

RESULTS: Eighteen of the 20 youth had disclosed their HIV status to another individual at least once. Eleven reported being sexually active, and three of these had been perinatally infected. Qualitative analysis revealed four subthemes related to disclosure: stigma and emotions, trust issues, reasons for disclosing and strategies for addressing disclosure. Five subthemes were identified related to sexual risk reduction: dating challenges, attitudes toward condom use, self-efficacy for condom use negotiation, pregnancy attitudes and sexual risk reduction strategies. Providers reported that access to more engaging and interactive educational tools within the clinic setting could enhance their risk reduction counseling with HIV-positive youth.

CONCLUSIONS: HIV-positive youth experience multiple challenges regarding disclosure and sexual risk reduction, and health care providers need innovative tools that can be used in clinic settings to improve adolescents' skills in reducing risky sexual behavior.




Amy D. Leonard is a research coordinator, and Mary E. Paul is associate professor, both in the Department of Allergy and Immunology, Texas Children's Hospital, Baylor College of Medicine, Houston. Christine M. Markham and Ross Shegog are assistant professors, and Thanh Bui is a doctoral student, all at the Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston.