mental health AIDS

Fall 2007 Newsletter / Volume 9, Issue 1

HIV Prevention News

About Adolescents & Young Adults

Sales et al. (2007) explored the relationship between the shame and stigma associated with STDs and condom-protected intercourse among 192 African American female adolescents and young adults (ages 15 to 21 years) receiving services from teen-oriented sexual health clinics. According to the investigators, "[t]his prospective study found STD-related shame as predictive of condom-protected intercourse at 6-month follow-up assessment ... . Specifically, participants with higher STD-related shame, assessed at baseline, were more likely to use condoms during intercourse 6 months later" (p. 573.e6). In contemplating this finding, Sales and colleagues make the following observation:

Prior work with adolescents indicate[d] ... that STD-related stigma is a barrier to STD-related care ...[, since] adolescents with higher [perceptions of] stigma were more likely to delay seeking STD services. However, the present findings indicate that STD-related shame, rather than stigma, is an important factor in female adolescents' use of STD protective behaviors (i.e., condom-protected intercourse). The current findings suggest that some females may be engaging in a self-evaluative process in which they use the unpleasant feelings associated with "shame" as a lever to initiate health-promoting behavior changes designed to reduce the likelihood of subsequent STD infection (i.e., condom use). Thus, although shame is an unpleasant feeling, it can be a positive force motivating behavior change when used in a constructive manner; for example, by encouraging young women to use condoms as a way to avoid or decrease the unpleasant feeling of "shame" associated with contracting an STD. (p. 573.e5)

Sales and colleagues suggest that "incorporating a 'self-evaluative' component into interventions that explicitly link the unpleasant feelings associated with STD-related shame to STD-preventive practices (i.e., condom use) as a possible means to decrease the likelihood of contracting an STD and thereby experiencing the resultant feelings of shame, may be a beneficial intervention technique" (p. 573.e5).

DiIorio, McCarty, Resnicow, Lehr, and Denzmore (2007) conducted a randomized trial of an HIV prevention intervention for adolescent boys entitled REAL (Responsible, Empowered, Aware, Living) Men, designed "to promote delay of sexual intercourse, condom use among those who were sexually active, and communication on sexuality between fathers (or father figures) and sons" (p. 1084). A total of 277 fathers (or father figures) and their sons, ages 11 to 14 years, were randomized by site of intervention to the seven-session REAL Men program9 or to a control condition focusing on nutrition and exercise. Assessments were conducted with these predominantly African American dyads at baseline and again at 3, 6, and 9 months. DiIorio and colleagues found "[s]ignificantly higher rates of sexual abstinence and condom use and of intent to delay initiation of sexual intercourse ... among adolescent boys whose fathers participated in the intervention. Fathers in the intervention group reported significantly more discussions about sexuality and greater intentions to discuss sexuality than did control-group fathers" (p. 1084). On the basis of these findings, the investigators conclude that "fathers can serve as ... important educator[s] on HIV prevention and sexuality for their sons" (p. 1084).

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9 "In the REAL Men program, fathers were presented with information on communication with adolescents, general topics such as parental monitoring and relationships with peers, general sexual topics important in adolescence, and specific information about transmission and prevention of HIV and AIDS. ... The intervention, which consisted of seven 2-hour sessions for the fathers, was delivered once each week in a group format. Fathers attended the first 6 sessions alone, and fathers and sons attended the final session together. All sessions except the first began with a review of the previous session, a discussion of the take-home activities, and a review of personal goals set by study participants. Session content was delivered through a combination of lectures, discussion, role-plays, games and videotapes. Participants were given a participant manual to assist with weekly take-home activities and adherence to personal goals set each week. The last session included a celebration of the end of the intervention in which fathers and sons received certificates of completion" (p. 1085).

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