Sex and secrecy: How HIV-status disclosure affects safe sex among HIV-positive adolescents.
Sex and secrecy: How HIV-status disclosure affects safe sex among HIV-positive adolescents.
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DOI：
10.1080/09540121.2015.1071775
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发表时间：
2015
期刊：
影响因子：
1.7
通讯作者：
Kidia KK
中科院分区：
文献类型：
--
作者：
Toska E;Cluver LD;Hodes R;Kidia KK
从事不安全性行为的艾滋病毒阳性青少年传播或重新感染艾滋病毒的风险更高。向性伴侣披露艾滋病毒状况可能会影响避孕套的使用，但没有研究探讨（一）青少年对自己艾滋病毒状况的了解，（二）对伴侣状况的了解和（三）向伴侣披露对安全性行为的影响。本研究的目的是确定是否知识的艾滋病毒感染的青少年和合作伙伴的艾滋病毒状况与安全性行为。在南非东开普省的41个卫生设施中，对858名HIV阳性青少年（10-19岁，52%为女性，68.1%为垂直感染）进行了标准化问卷调查。定量分析采用多变量logistic回归，控制混杂因素。定性研究包括访谈，焦点小组讨论和观察43艾滋病毒阳性的青少年和他们的医护人员。总样本中有128例（14.9%）有过性行为，而性活跃的青少年中有109例（85.1%）有男/女朋友。总的来说，68.1%的样本知道他们的状态，41.5%的性活跃和恋爱中的人知道他们的伴侣的状态，35.5%的人向他们的伴侣透露。对于青少年，了解自己的状况与安全性行为相关（OR = 4.355，CI 1.085-17.474，p = .038）。既不知道伴侣的状况，也不向伴侣透露自己的艾滋病毒状况，与安全性行为有关。艾滋病毒阳性青少年害怕拒绝，耻辱和公开曝光，如果透露给性和浪漫的伙伴。医务工作者对艾滋病毒阳性青少年的咨询侧重于披露的好处，但没有解决与披露相关的恐惧和风险。这些研究结果挑战的假设，披露是自动保护性和浪漫的关系，艾滋病毒阳性的青少年，谁可能是装备不良，以协商更安全的性行为。迫切需要采取有效的干预措施，减少披露的风险，并向艾滋病毒抗体阳性的青少年提供进行安全性行为的技能。
HIV-positive adolescents who engage in unsafe sex are at heightened risk for transmitting or re-acquiring HIV. Disclosure of HIV-status to sexual partners may impact on condom use, but no study has explored the effects of (i) adolescent knowledge of one's HIV-status, (ii) knowledge of partner status and (iii) disclosure to partners, on safer sex behaviour. This study aimed to identify whether knowledge of HIV-status by HIV-positive adolescents and partners was associated with safer sex. Eight fifty eight HIV-positive adolescents (10–19 years old, 52% female, 68.1% vertically infected) who had ever initiated antiretroviral treatment in 41 health facilities in the Eastern Cape, South Africa, were interviewed using standardised questionnaires. Quantitative analyses used multivariate logistic regressions, controlling for confounders. Qualitative research included interviews, focus group discussions and observations with 43 HIV-positive teenagers and their healthcare workers. N = 128 (14.9%) of the total sample had ever had sex, while N = 109 (85.1%) of sexually active adolescents had boy/girlfriend. In total, 68.1% of the sample knew their status, 41.5% of those who were sexually active and in relationships knew their partner's status, and 35.5% had disclosed to their partners. For adolescents, knowing one's status was associated with safer sex (OR = 4.355, CI 1.085–17.474, p = .038). Neither knowing their partner's status, nor disclosing one's HIV-status to a partner, were associated with safer sex. HIV-positive adolescents feared rejection, stigma and public exposure if disclosing to sexual and romantic partners. Counselling by healthcare workers for HIV-positive adolescents focused on benefits of disclosure, but did not address the fears and risks associated with disclosure. These findings challenge assumptions that disclosure is automatically protective in sexual and romantic relationships for HIV-positive adolescents, who may be ill-equipped to negotiate safer sex. There is a pressing need for effective interventions that mitigate the risks of disclosure and provide HIV-positive adolescents with skills to engage in safe sex.