LaSala (2007) interviewed a diverse sample of 30 young gay men (between the ages of 16 and 25 years) in the northeastern United States and one or both of their parents to explore the role of family relationships and interactions in decisions to avoid unsafe sexual practices. According to LaSala, "[m]ost of the youths reported feeling obliged to their parents to stay healthy, and these feelings of obligation were important factors in their decisions to avoid unsafe sex. Youths who reported no parental influence came from families in which parents had historically been preoccupied with personal or marital problems or in which there was a history of parental rejection" (p. 49). LaSala encourages clinicians
to consider family influence as yet another resource to be used to persuade gay youths to consistently engage in safer sex. Practitioners ... need to ask ... [young gay men] about family relationships, and if the youths are out[, clinicians] ... are advised to consider engaging parents in their efforts. Alternatively ... [clinicians] could engage at-risk gay youths through their parents. ... [Clinicians] could then assess parent-child relationships and coach parents and children to discuss this awkward but important subject in a caring manner that decreases parental fear as well as youths' defensive "shut downs" or ineffective reassurances. Such parent-child dialogue could stimulate or enhance a gay youth's feelings of obligation to his parents to stay healthy and remind him that his sexual behavior has implications for the people who love him. Practitioners could also prompt parents to encourage their sons to avoid unsafe sexual behavior by periodically asking them about their sexual activity and ensuring that they have enough condoms.
Practitioners should not automatically assume that parents of gay youths are either unaware of or hostile toward their sons' sexuality and therefore unavailable as a resource in HIV prevention efforts for this population. Although more research is needed, parental involvement has the potential to ... diminish high-risk sexual behavior among gay male youths ... . (pp. 54-55)
Lightfoot, Tevendale, Comulada, and Rotheram-Borus (2007) conducted additional analysis of data generated in the study of an intervention that was efficacious in reducing HIV transmission risk among young people living with HIV (YPLH; Rotheram-Borus et al., 2004). This earlier paper examined the delivery format of the intervention (telephone or in-person) and reported that, overall, in-person delivery was associated with reductions in sexual risk behavior. The current investigators sought to determine if there were some youths who would derive greater benefit from the telephone delivery format of this intervention.
When examining the factors that moderate increasing the percentage of protected sex [acts], [the investigators found that] use of antiretroviral medications (ARV), time since HIV diagnosis, and mental health were important. YPLH who were not taking ARVs, reported lower emotional distress, and had know[n] their HIV diagnosis for a longer period of time were more likely to benefit from the in-person intervention [and did not appear to benefit from the telephone intervention]. ... These youth are likely to be difficult to engage because they are not highly motivated by their current context to seek ... help[,] as illustrated by [their] not taking medications, not needing mental health services and having lived with the virus for a long time. However, ... these youth can benefit from preventive interventions. ... Emphasizing the benefits of in-person sessions,... [such as] the opportunity to decrease isolation ... and ... to discuss life challenges with others, ... [may increase] the motivation of youth to attend in-person sessions.
In contrast, ... [t]hose YPLH who were taking ARVs and reporting more emotional distress were more likely to benefit from the telephone intervention ... [and increase their percentage of protected sex acts. Moreover,] while the telephone intervention was useful for youth recently diagnosed and those taking ARVs, these youth did not benefit from the in-person intervention. This is surprising because it would be expected that recently diagnosed youth would be most in need of in-person communication and interaction. However, recently diagnosed youth may be experiencing heightened affect such as depression or anxiety which would interfere with their ability to engage in an interpersonal setting. This is consistent with the finding that YPLH with heightened emotional distress benefited most from the telephone intervention. It is less clear why those youth taking ARVs did not benefit from the in-person intervention. ... It may be these youth are overwhelmed or overloaded by the ongoing in-person interaction [with providers] and conveying preventive information may require less interpersonally demanding modalities.
… [Data describing] reductions in the number of sexual partners … suggest that mental health status is an important consideration for the success of the intervention. For YPLH who were experiencing high levels of emotional distress or anxiety, the in-person intervention was most effective in reducing the number of sexual partners. ...
This finding contrasts with the results indicating YPLH experiencing high levels of emotional distress benefited from telephone delivery to increase the percentage of protected sex [acts]. It may be that ... YPLH who become connected to healthcare services or interventions delivered in-person ... reduce contact with potential sex partners. On the other hand, emotionally distressed youth who are not connected to services and who benefit from telephone[-]delivered intervention may seek social support and continue to have sex partners; however, with intervention, they may increase the percentage of protected sex [acts] with those partners. (pp. 68-69)
As these complex findings suggest, "[w]hen deciding which delivery strategy is ... [more] appropriate and beneficial for an individual young person, [clinicians should give] consideration … to the types of services the youth currently accesses and the youth's mental health" (p. 69).
Regarding the mental health of young people, Smith, Leve, and Chamberlain (2006) investigated the utility of a diagnostic trauma measure (i.e., the Diagnostic Interview Schedule for Children) and experiential trauma measures2 in predicting adolescent offending and adolescent health-risking sexual behavior. Among 88 girls between the ages of 13 and 17 who had been court mandated to out-of-home care and referred to treatment for chronic conduct problems, 16% met full diagnostic criteria for posttraumatic stress disorder (PTSD) and 46% met partial diagnostic criteria for PTSD. Interestingly, it was "the experiential measures of trauma (cumulative and composite trauma scores) [that] significantly predicted adolescent offending and adolescent health-risking sexual behavior, whereas the diagnostic measures of trauma (full and partial diagnostic criteria) did not" (p. 346).
These findings highlight the potential for identifying girls who are at the highest risk for delinquency and health-risking sexual behavior outcomes and who appear to need trauma … services even though they do not meet criteria for trauma diagnoses. Although many studies of trauma intervention identify participants based on PTSD diagnoses, ... [these] findings suggest that delinquent girls who have experienced high rates of trauma but who are not currently exhibiting PTSD symptoms might also benefit from trauma … services. (p. 351)
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Spring 2007 Newsletter / Volume 8, Issue 3
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