Risk Factors for HIV Transmission: Perspectives from Metropolitan Atlanta Youth

Background: African-American youth carry the highest burden of HIV-infection in the US. Understanding adolescent and young adult (AYA) perspectives on HIV transmission risk may serve as an important framework for targeted interventions and improved access.  

Methods: We conducted exploratory qualitative focus groups and quantitative surveys with HIV-infected and uninfected youth, ages 18-24 years, from Metropolitan Atlanta. Audio Computer-Assisted Self-Interviewing surveys gauged potential risk factors for HIV acquisition using categorical, and Likert scale (LS) responses (1-10). We examined perceptions regarding HIV-education and contributors to HIV-transmission.

Results: Of 68 participants, 85% were male, 90% were African-American, 68% were HIV-infected, and 50% had high school education or less. Participants had a mean age of 21.5 years (SD: 1.8 years). Risk factors for HIV acquisition included high rates of unprotected sex (LS mean: 8.0) with personal preference (63%) and fear of rejection (55%) as main reasons. Transactional sex for food (77%), living expenses (87%) or drugs (82%) were reported by 87% of participants. No significant differences (p<0.05%) in risk behaviors were observed when stratified by HIV-status. Thematic analyses revealed that many participants had HIV-education from school or caregivers; however, they felt this education was inadequate, lacked specificity and relatability. Participants perceived that widespread use of social media, frequent sexual encounters, need for immediate gratification, and lack of concern about HIV disease were contributors to HIV-transmission among AYA.

Conclusions: HIV-prevention strategies for AYA require gender-specific HIV educational tools, including strategies for increased condom use, responsible utilization of social media, and understanding reasons for transactional sex.