mental health AIDS

Spring 2005 Newsletter

HIV Prevention News

About Adolescents

Kowal and Blinn-Pike (2004) surveyed 297 Midwestern high school students with an older biological sibling under the age of 30. They found that "when sibling discussions about safe[r] sex practices take place in concert with parent-adolescent conversations about sex, adolescents reported less risky attitudes about appropriate sexual behavior for people their age and higher levels of self-efficacy for communicating with partners about condom use and for buying and using condoms. [They] did not find similar results with regard to adolescents' perceived ability to refuse sex" (p. 382). Kowal and Blinn-Pike also note that "sibling discussions about sex were more likely to occur when adolescents report positive relationships with their older siblings. ... Further, [they] found that when sibling relationship quality was relatively high, discussions about sex were equally likely to take place regardless of whether adolescents perceived their older siblings to have risky or conservative sexual attitudes [italics added]" (p. 382).

Turning to intervention, the authors observe that

younger siblings may learn from their older siblings that it is appropriate and important to talk to parents about sex. Older siblings also may help parents begin and sustain conversations with adolescents about safe[r] sex practices and educate parents about appropriate terminology. Older siblings are in the unique position of being able to explain to parents the sexual situations that their younger siblings are likely to encounter and the potential barriers to safe[r] sex practices that they may experience. Parents who are more aware of the realistic problems and issues their children face are better able to provide them with pertinent and timely information. (p. 383)

Kowal and Blinn-Pike further observe that "older siblings who care about their younger siblings may provide them with information about safe[r] sex practices regardless of their own views about the importance of safe[r] sex for adolescents in general" (p. 383). With sibling relationship quality appearing to serve a protective function, the authors encourage clinicians to provide caring older siblings "with tools and information about how to protect their brothers and sisters from potential risk" (p. 383) and to integrate older siblings into existing programs focused on adolescents' responsible sexual behavior, "so they too learn about their important role in the development of their younger siblings' attitudes about and self-efficacy for safe[r] sex practices" (p. 383).

Psychiatric care can also serve a protective function. Brown, Houck, Hadley, and Lescano (2005) studied 293 adolescents receiving intensive psychiatric treatment. They found that "being female, being Caucasian, having been sexually abused, and reporting less impulse control were predictive of self-cutting . Further analysis found that those who self-cut were three and a half times more likely to report infrequent condom use than those who did not self-cut, even after the analysis controlled for sexual abuse history and HIV prevention self-efficacy" (p. 216). These investigators go on to observe that "[s]elf-cutting frequently raises clinicians' concerns about a patient's potential for suicidal behavior and drug use. However, the strong relationship between self-cutting and sexual risk behavior observed in this study suggests that treatment providers must consider a range of risk behaviors in treatment planning, recognizing that impulsivity and affect dysregulation may take many forms. Self-cutters appear particularly vulnerable to harm given the association with impulsivity, hopelessness, and sexual risk behavior" (p. 218). For this reason, Brown and colleagues encourage clinicians to assess sexual risk behaviors carefully among teens who engage in self-cutting.

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