"Take the condom off”: A qualitative exploration of HIV behaviors of male adolescents in rural North Carolina

BACKGROUND: African American and rural adolescents are more likely to report HIV risk behaviors such as having multiple sexual partners and early initiation of sexual intercourse compared to other adolescents. Recent studies have shown that rural adolescents are particularly vulnerable to HIV and that prevention efforts need to target his population. Project GRACE uses a participatory approach to understand contextual factors affecting HIV risk among African Americans in two rural North Carolina counties. OBJECTIVE/PURPOSE: To explore rural African American male adolescents' perceptions of individual and interpersonal factors contributing to HIV risk among African Americans. METHODS: Participants were recruited using flyers, radio announcements, local youth organizations, and word-of-mouth. We conducted 4 focus groups with 20 rural African American males aged 14-22 in 2006. These groups were audio-taped, transcribed and entered into Altas.ti for analysis. Thematic coding was performed using grounded theory and 2 independent coders. RESULTS: Male adolescents in this study did not seem to personalize HIV risk in terms of preventative behaviors. Few reported regularly engaging in preventive behaviors. Participants noted the importance of peer and partner influences on sexual decision-making stating that female sex partners often request that condoms be removed during intercourse. Lack of disclosure among sexual partners about risk status or risk behaviors was cited as problematic. Many felt that HIV prevention messages should be targeted to groups other than themselves. CONCLUSION: We need more research to target peer influence and norms and the relationship to HIV behavior among rural male adolescents when creating HIV prevention programs.