"Running the Streets”: The influence of interpersonal and structural factors on sexual risk among out-of-school African American female adolescents in Raleigh-Durham, NC

Background: African-American female adolescents are disproportionately affected by HIV and other STIs compared to other female adolescents. Furthermore, African-American female adolescents face other issues, such as poverty, dropping out of school, pregnancy, violence and gangs. This CDC-funded study examines how these contextual issues affect adolescents' sexual risk.

Methods: As part of the formative phase for an RCT study, 20 individual in-depth interviews were conducted with sexually-active African-American female adolescents aged 16 to 18, who had ever used alcohol or other drugs, and who had dropped out of school. Participants were asked about education and employment, sexual risk, substance use, violence, social support and incarceration. This study activity was part of the adaptation of a “Best Evidence” behavioral HIV prevention intervention (Women's CoOp) for adolescents.

Results: The main themes that emerged were: adolescents' drug use and sexual behavior are influenced greatly by older boyfriends and friends; while adolescents are aware of HIV/STIs, condoms are rarely used; female adolescents turn to sex trading with older men because of the limited employment opportunities available without a high school education; adolescents' drug use leads to unprotected sex, sex with unknown people, and in some cases, rape; and females are attracted to gangs because of the males, and sometimes are “sexed in” as initiation.

Conclusion: Findings indicate that African-American female adolescents who are out of school encounter many issues that affect their HIV risk. In order to reach and prevent HIV among the most at-risk adolescents, interventions must find innovative methods to address these issues.