HIV-related sexual behavior among youth and young adults: Toward a social ecology of risk and resilience

Sexual risk behaviors among youth continue to represent one of the most serious public health problems in the United States. The HIV/AIDS epidemic, in particular, is shifting to young people and disproportionately to ethnic minority and gay youth. This thesis pursues several lines of HIV behavioral research suggested by resiliency and social ecological theories. Both of these frameworks offer alternatives to the individual risk emphasis that permeates current HIV/AIDS research. Chapter II addressed HIV risk and related behavioral and perception variables among 504 sexually active urban African American youth. Youth were assigned to HIV risk groups based on patterns of sexual activity and condom use, using a cluster analytic approach. The results revealed gendered mechanisms of risk. Sexual activity, condom use, alcohol and other drug use during sex, partner age differences, and risk and condom perceptions may differentially affect HIV risk among African American male and female adolescents. The findings suggested interventions that might be differentially tailored to urban African American adolescents by gender. Chapter III used a grounded theory approach to explore protected and unprotected sex among 12 gay, lesbian and bisexual youth and young adults. In addition to risk and protective factors that may be population-specific, the findings suggested psychosocial benefits of unprotected sex. Rather than viewing unprotected sex as unilaterally dangerous, informants weighed competing risks and benefits. The findings may support a risk reduction, rather than a risk elimination, model of HIV prevention. Chapter IV addressed cumulative risks and assets regarding HIV-related sexual behavior among 770 urban adolescents. Individual-, familial- and community-level factors were assessed. The findings suggested that cumulative risk was associated with greater sexual risk-taking behavior. Cumulative assets demonstrated both compensatory and protective effects in attenuating the negative consequences of risk. The findings support strengths-based interventions that address the social context of HIV risk behavior. Chapter V discussed implications for a broad spectrum of preventive interventions. Overall, the results of this thesis suggest a risk and resiliency approach to the social ecology of HIV-related sexual behavior, which may facilitate interventions along the pathways of vulnerability that place youth at risk for HIV/AIDS.