Promoting safer sex among HIV-positive youth with haemophilia: theory, intervention, and outcome.

The goal of the project was to develop and evaluate theory-based interventions designed to change sexual behaviour and promote safer sex practices of HIV seropositive young men and adolescents with haemophilia to prevent transmission to sexual partners and offspring. Safer sex was defined as abstinence, consistent condom use, or 'outercourse' (intimate, non-intercourse sexual behaviour). This project utilized the Transtheoretical Model developed by Prochaska and DiClemente, which describes behaviour change as an incremental, stage-based process. The 1-year intervention protocol consisted of two individual sessions and two peer-centred activities. One hundred and four adolescents, residing in 22 states, participated. Pre- and post-intervention evaluations were conducted to measure stage progression for participants. The number who were in the action or maintenance stage of change for safer sex was significantly greater at post-test than at pre-test (79 vs. 62%, P < 0.0001). Participants also reported an increased use of outercourse. In addition, significant increases in self-efficacy and knowledge regarding safer sex were demonstrated. Following these stage-based interventions, participants were significantly more likely to be engaging in safer sex behaviours than they were previously. These intervention activities can be adapted for use with other adolescent populations and for other behaviour change goals in adolescents with haemophilia.

Sexual behavior change among human immunodeficiency virus-infected adolescents with hemophilia. Adolescent Hemophilia Behavioral Intervention Evaluation Project Study Group.

PURPOSE: To determine the factors associated with the adoption or maintenance of consistent safer sexual behaviors among human immunodeficiency virus-positive adolescents and young adults with hemophilia. METHODS: One hundred eleven adolescents at 10 hemophilia care sites participated in an intervention program designed to increase safer sexual behaviors (abstinence, condom use, or nonpenetrative behavior). The theory-based intervention spanned 1 year. Adolescents attended individual sessions, small group activities, and an intensive group retreat. RESULTS: Patients who maintained or improved safer sexual behaviors were compared with those who relapsed or did not improve. Logistic regression analyses found that improvement and maintenance of safer sexual behavior were significantly associated with perceived peer support for outercourse (odds ratio [OR]: 5.47; confidence interval [CI]: 1.4-20.8), perceived peer support for abstinence (OR: 5.08; CI: 1.2-20.1), and decreased general emotional distress (OR: 4.65; CI: 1.04-20.6). Perceived health status and previous sexual behavior were unrelated to change in safer sexual behavior. CONCLUSIONS: These longitudinal data indicate that improvement and maintenance of safer sexual behavior among adolescents during an intervention is strongly associated with perceptions of peer support for safer sex and lesser degrees of emotional distress. Programs for human immunodeficiency virus-infected adolescents may require developmentally appropriate social and psychological approaches to impact peer norms and emotional well-being.

Perinatal social work with childbearing adolescents.

Issues relating to adolescent childbearing have rapidly moved to the forefront of this nation's agenda. The implications of an adolescent's decision to have a baby have health, social and economic consequences for the adolescent, her offspring, partner and family and for all of society. This article will discuss the health, social and developmental consequences of adolescent childbearing and provide an overview of social work practice with childbearing adolescents.

PIP: Hospital social workers who work with pregnant adolescents are in a key position to facilitate positive parenting outcomes even before delivery. The adolescent's decision to complete a pregnancy has vast health, social, and economic implications for the teen mother, her child, her partner, her family, and US society. In many cases, the tasks of pregnancy and parenting are diametrically opposed to the developmental tasks of adolescence: emergence of an autonomous identity, independence from family, and peer acceptance. Social workers must make a comprehensive assessment of the pregnant adolescent's strengths, needs, and developmental stage. Social work functions include clinical case management, family system interventions, outreach to the father, facilitation of peer group support, and individual psychotherapy. Although early childbearing may place a teenager and her child at a social disadvantage, there are an increasing number of studies attesting that adolescents can overcome these disadvantages. Positive reinforcement of demonstrated competencies can enhance the adolescent's self-esteem and promote confidence in handling new situations.