Term Paper on "HIV and STD Behavior Interventional Strategies for Adolescents and Youths"

Term Paper 12 pages (4327 words) Sources: 12 Style: APA

[EXCERPT] . . . .

HIV and STD Behavior Interventional Strategies for Adolescents and Youths

Teenage sex has been viewed as a social problem for some time, but the spread of HIV / AIDS in society has increased fears of what can happen if young people have unprotected sex. The prevalence of HIV among young people has been increasing, with some populations seen as more vulnerable than others, such as homeless youth and black and Hispanic youth. Programs have been developed to educate these young people, and studies of how effective such programs can be have been undertaken to see if they do work and to improve them if they do not.

Many researchers focus on family influences on adolescent sexual behavior, and communication between parents and their children about sexual issues has been one important research area. Some studies show that parental discussions on sexual matters either delay the first sexual experience or encourage contraceptive use among adolescents, but others show no effect. In fact, some studies suggest that communication with parents may encourage sexual behavior. Studies show that these relationships depend on factors such as who reports the communication, whether the parents hold traditional or liberal attitudes, the sex of the adolescent, which parent conducts the discussion, and whether the outcome is sexual debut or contraceptive use. The researchers concluded,

We hypothesize that students who report having had discussions about HIV with their parents or other adults in their family will be less likely than those who had not to engage in HIV-related risk behaviors, discussed HIV with their peers will be more likely to report HIV? related risk behavior. We also expect that school-based instruction will increase communication with both parents and peers (Rubinson, 1995, p. 235).

Studies also show that many young people do not have such discussions and do not change their behaviors, and more concerted efforts have been developed to educate these young people and to change their behavior before they are infected.

Objectives

Below is a review of literature to suggest some of the approaches being taken today and how effective they have been found to be. The survey is also intended to show some of the ways in which the efficacy of these program has been tested and to suggest where more study is needed to improve these programs and make them as effective as possible, with the ultimate goal being to change risky behavior and so to reduce the incidence of HIV infection.

Selection Criteria

The studies examined include two types. One type offers surveys of a variety of studies to ascertain what sort of work is being done, what has been decided about the effectiveness of such programs, and so on. The other and more prevalent type consists of randomized controlled trials to test the effectiveness of specific programs and to demonstrate whether or not behavior is changed by exposure to these programs.

Participants considered in all cases are young people, most of high school age, examining both their sexual behavior and their exposure to some type of program intervention designed to change their behavior.

The types of intervention examined consisted of different forms of educational modules in different settings. Such programs were usually informative about HIV and its method of transmission and offered recommendations for how to reduce the likelihood of infection.

Outcomes were measured in terms of changes in behavior on the basis of such actions as increased use of condoms, reduced number of partners, lower drug use, and similar actions.

Search Strategy

Studies were found by making a systematic search of various electronic databases followed by a hand-search of journals to identify evaluations of behavioral interventions to reduce sexual risk behaviors among adolescents. Abstracts were read to determine the most relevant studies in each search.

Methods of the Review

Studies were selected if they illuminated some aspect of the issue and if they made a judgment about how effective either a given program or such programs in general were found to be. The sample, methodology, and results were extracted and used for purposes of comparison and explanation.

Description of Studies and Results

Numerous studies were found, with many in the 1990s as the scope of the AIDS problem was evident and as fears about the behavior of young people increased. Studies into this century have continued to address the increasing incidence of infection among certain populations, including young people, with more and more emphasis on the need for education to reduce the rate, though the question of how effective a given program might be was also given more and more attention.

Robin et al. (2004) offer a review of adolescent sexual risk-reduction programs that were evaluated using quasi-experimental or experimental methods and published in the 1990s. The authors describe evaluated programs and identify program and evaluation issues for health educators and researchers. They found the studies by making a systematic search of seven electronic databases and also hand-searched journals to identify evaluations of behavioral interventions to reduce sexual risk behaviors among adolescents. They included only articles that were published in the 1990s, that provided a theoretical basis for the program, offered information about the interventions, had clear aims, and used quasi-experimental or experimental evaluation methods, so identifying 101 articles and finding 24 that met the criteria for inclusion. The researchers then reviewed these evaluations to assess their research and program characteristics and found that the majority of studies included randomized controlled designs and employed delayed follow-up measures. They found that the most commonly measured outcomes were delay of initiation of sexual intercourse, condom use, contraceptive use, and frequency of sexual intercourse. The programs used ranged from 1 to 80 sessions, most with adult facilitators, and most commonly included skills-building activities about sexual communication, decision-making, and problem solving. The authors find that these programs suggest four overall factors that may impact program effectiveness, including the extent to which programs focus on specific skills for reducing sexual risk behaviors; program duration and intensity; what constitutes the content of a total evaluated program including researchers' assumptions of participants' exposure to prior and concurrent programs; and what kind of training is available for facilitators.

Emans et al. (1991) consider some of the newest medical advances in research on adolescent sexuality, such as contraceptive compliance, promotion of behavior change, relationships of ethnicity and pregnancy, and male reproductive health. Based on their analysis, the researchers find that the issues for the 1990's will be sexually transmitted diseases' morbidity and mortality, and they further identify such topics as sexual activity and adolescent pregnancy, care of the pregnant teen, sexually transmitted diseases, HIV infection, the male adolescent, sexual abuse in adolescents, gay and lesbian youth, interventions, reproductive health care of adolescents with disabilities and chronic illnesses, and training of primary care physicians. More attention has been directed at the reproductive behavior of males because of the HIV / AIDS. Research shows that sexual activity varies by racial/ethnic group, and this suggests that interventions to delay sexual initiation may be different for different racial/ethnic groups. The researchers say such issues need to be examined even though condom use has increased among 17- to 19-year-olds from 21% to 58% in metropolitan areas. At the same time, evidence shows that condom use is lowest among the group of men at highest risk of STDs, meaning those who had ever used drugs, those who had ever had sex with a prostitute, and those that had 5 or more partners per year. A survey of literature shows that male beliefs about contraception have been infrequently examined and that there are still misconceptions about heterosexual transmission of HIV. The authors call for better screening for STD detection. They also find that fathers are more involved in prenatal care and postnatal intervention programs and that 7% of children have been subjected to nonvoluntary sexual intercourse between the ages of 18-21, in the proportions of 12.7% of white women, 9% of black women, 1.9% of white males, and 6.1% of black males. Risk factors cited for white women include living apart form parents at 16 years of age, poverty, physical and emotional limitations, parental alcohol and smoking and drug use. Sexual assault is a problem associated with hitchhiking and alcohol and drug use. The authors state that physicians need to be sensitive to this issue and seek needed information from their patients. Among 12th graders. 1% of males and 1% of females saw themselves as mostly or completely homosexual or lesbian, and another 10% were unsure. Among the interventions the authors say are needed are reproductive and STD information, multiple approaches in a variety of settings, adolescent clinics, and outreach.

Crosby et al. (2003) note the value of condom promotion strategies for adolescents and find that such strategies typically include provision of STD/HIV-associated knowledge, fostering favorable attitudes toward condom use, promoting positive peer norms regarding condom use, improving condom-related communication skills and self-efficacy, and overcoming barriers to condom use. The authors conduct a study to identify which of these constructs were prospectively associated with condom use among a… READ MORE

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