Marhefka Stephanie L, Valentin Cidna R, Pinto Rogério M, Demetriou Nicole, Wiznia Andrew, Mellins Claude Ann
College of Public Health, University of South Florida, Tampa, USA.
AIDS Care. 2011 Oct;23(10):1321-8. doi: 10.1080/09540121.2010.532536. Epub 2011 May 24.
Some adolescent girls perinatally infected with HIV (PIH) engage in sexual behavior that poses risks to their own well-being and that of sexual partners. Interventions to promote condom use among girls PIH may be most effective if provided prior to first sexual intercourse. With in-depth interviews, we explored gender- and HIV-specific informational and motivational factors that might be important for sexual risk reduction interventions designed to reach US girls PIH before they first engage in sexual intercourse. Open-ended interview questions and vignettes were employed. The information-motivation-behavioral skills (IMB) model guided descriptive qualitative analyses. Participants (20 girls PIH ages 12-16 years) had experienced kissing (n=12), genital touching (n=6), and oral (n=3), vaginal (n=2), and anal sex (n=1). Most knew sex poses transmission risks but not all knew anal sex is risky. Motivations for and against condom use included concerns about: sexual transmission, psychological barriers, and partners' awareness of the girl's HIV+ status. Girls were highly motivated to prevent transmission, but challenged by lack of condom negotiation skills as well as negative potential consequences of unsafe sex refusal and HIV status disclosure. Perhaps most critical for intervention development is the finding that some girls believe disclosing one's HIV status to a male partner shifts the responsibility of preventing transmission to that partner. These results suggest a modified IMB model that highlights the role of disclosure in affecting condom use among girls PIH and their partners. Implications for cognitive-behavioral interventions are discussed.
一些围产期感染艾滋病毒（PIH）的青春期女孩会进行性行为，这对她们自身以及性伴侣的健康都构成风险。如果在首次性交之前提供干预措施，以促进感染艾滋病毒的女孩使用避孕套可能最为有效。通过深入访谈，我们探讨了特定于性别和艾滋病毒的信息及动机因素，这些因素对于旨在在美国感染艾滋病毒的女孩首次性交之前降低性风险的干预措施可能很重要。我们采用了开放式访谈问题和情景描述。信息-动机-行为技能（IMB）模型指导了描述性定性分析。参与者（20名年龄在12至16岁之间的感染艾滋病毒的女孩）有过亲吻（n = 12）、生殖器接触（n = 6）以及口交（n = 3）、阴道性交（n = 2）和肛交（n = 1）的经历。大多数人知道性行为会带来传播风险，但并非所有人都知道肛交有风险。支持和反对使用避孕套的动机包括对以下方面的担忧：性传播、心理障碍以及伴侣对女孩艾滋病毒阳性状态的知晓情况。女孩们极有动力预防传播，但因缺乏避孕套谈判技巧以及拒绝不安全性行为和披露艾滋病毒感染状况可能带来的负面后果而受到挑战。或许对于干预措施制定最为关键的发现是，一些女孩认为向男性伴侣披露自己的艾滋病毒感染状况会将预防传播的责任转移给该伴侣。这些结果表明了一种经过修改的IMB模型，该模型突出了披露在影响感染艾滋病毒的女孩及其伴侣使用避孕套方面的作用。文中还讨论了对认知行为干预的启示。
