Factors associated with lack of protection against HIV and pregnancy among African-American female adolescents

Background: Although practitioners recommend using both condoms and hormonal birth control to safeguard against pregnancy and HIV, it is estimated that only 15.5% of young women (17-19 years) use any form of protection. This study examined factors associated with lack of protection against HIV and pregnancy among African American adolescents.

Methods: Data were collected from 701 African American adolescent females seeking services at reproductive health clinics, aged 14 to 20 years, who enrolled in an HIV prevention intervention. Sociodemographic, psychosocial, and self-reported behavioral data related to hormonal birth control and condom use were collected using ACASI at the baseline assessment, prior to randomization. Pearson's chi-square and logistic regression analyses were conducted to identify factors associated with adolescents identified as non-protectors, defined as adolescents who did not use a condom or hormonal birth control at last sex.

Results: Approximately 37% (n=259) of adolescents were identified as non-protectors. In bivariate analysis, depression, smoking, history of emotional and physical abuse, forced vaginal sex, fear of condom negotiation, sexual refusal self-efficacy, partner and parent communication about sex skills, and sex while partner was high or drunk were significantly associated (p<.05) with adolescents' lack of protection. Logistic regression revealed that adolescents with low partner and parent communication, physical abuse, and history of forced vaginal sex were significantly more likely to be non-protectors (p<.05).

Conclusions: Non-protection was highly prevalent in this sample of African American adolescents. Findings indicate that non-protectors could benefit from interventions that enhance communication skills with both partners and parents about sexual health.