Risk Factors for HIV Transmission and Barriers to HIV Disclosure: Metropolitan Atlanta Youth Perspectives

Youth carry the highest incidence of HIV infection in the United States. Understanding adolescent and young adult (AYA) perspectives on HIV transmission risk is important for targeted HIV prevention. We conducted a mixed methods study with HIV-infected and uninfected youth, ages 18–24 years, from Atlanta, GA. 

We provided self-administered surveys to HIV-infected and HIV-uninfected AYAs to identify risk factors for HIV acquisition. By means of computer-assisted thematic analyses, we examined transcribed focus group responses on HIV education, contributors to HIV transmission, and pre-sex HIV status disclosure. T

he 68 participants had the following characteristics: mean age 21.5 years (standard deviation: 1.8 years), 85% male, 90% black, 68% HIV-infected. HIV risk behaviors included the perception of condomless sex (Likert scale mean: 8.0) and transactional sex (88% of participants); no differences were noted by HIV status. Qualitative analyses revealed two main themes: (1) HIV risk factors among AYAs, and (2) barriers to discussing HIV status before sex. Participants felt the use of social media, need for immediate gratification, and lack of concern about HIV disease were risk factors for AYAs. 

Discussing HIV status with sex partners was uncommon. Key reasons included: fear of rejection, lack of confidentiality, discussion was unnecessary in temporary relationships, and disclosure negatively affecting the mood. HIV prevention strategies for AYAs should include improving condom use frequency and HIV disclosure skills, responsible utilization of social media, and education addressing HIV prevention including the risks of transactional sex.

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By:  Andres F. Camacho-Gonzalez, MD, MSc,^1,2 Amy Wallins, LMSW,^1,2 Lauren Toledo, MPH,^3,4 Ashley Murray,MPH, CHES, CPH,³ Zaneta Gaul, MSPH,^3,4 Madeline Y. Sutton, MD, MPH,³ Scott Gillespie, MS,⁵ Traci Leong,PhD,⁶ Chanda Graves, PhD,^2,7 and Rana Chakraborty, MD, PhD^1,2

¹Division of Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia.

²Ponce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, Georgia.

³Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.

⁴ICF International, Atlanta, Georgia.

⁵Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.

⁶Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia.

⁷Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University School of Medicine, Atlanta, Georgia.

 

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