title: Influence of sexual abuse on HIV-related attitudes and behaviors in adolescent psychiatric inpatients.
abstract: OBJECTIVE
  To investigate the associations between sexual abuse and human immunodeficiency virus (HIV)-related attitudes and behaviors of adolescents with a psychiatric disorder.
  
  
  METHODS
  HIV-related knowledge, attitudes, and behaviors were examined by self-report assessment of adolescents admitted to a psychiatric hospital (N = 100). A subsample (n = 30) completed a role-playing exercise regarding HIV-preventive behavior that was scored for the degree of effective communication by raters blind to the subjects' abuse history.
  
  
  RESULTS
  HIV-related risk behaviors were prevalent, including unprotected sexual intercourse (67%) and multiple partners (27%) among the sexually active (71% of the total). Also frequent were alcohol and drug use (25%) and sharing cutting instruments (22%) among those engaged in self-cutting behavior (62%). The 38% of the sample identified as having a history of sexual abuse indicated significantly poorer self-efficacy concerning condom use than their peers. Abused females scored significantly lower on the self-efficacy of condom use scale and reported significantly more frequent alcohol use than nonabused females (p = .003). A hierarchical multiple regression that controlled for consistency of condom use and tolerance of people with acquired immunodeficiency syndrome found that abuse history uniquely accounted for 16% of the variance in condom use self-efficacy. Analysis of the videotaped role-play found that abused adolescents were significantly less competent and had more difficulty in effective communication than their peers (p = .003).
  
  
  CONCLUSIONS
  A history of sexual abuse is associated with impaired safe sexual decision-making and HIV-preventive communication skills, even in this already at-risk group. This study also underscores the importance of actively addressing these issues in the context of clinical care.
authors.affiliation: Rhode Island Hospital, Brown University School of Medicine, Providence, USA.
authors.forename: L K
authors.initials: LK
authors.lastname: Brown
authors.forename: S M
authors.initials: SM
authors.lastname: Kessel
authors.forename: K J
authors.initials: KJ
authors.lastname: Lourie
authors.forename: H H
authors.initials: HH
authors.lastname: Ford
authors.forename: L P
authors.initials: LP
authors.lastname: Lipsitt
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology*; D003657:Decision Making; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D017008:Negotiating; D011581:Psychological Tests; D012044:Regression Analysis; D012309:Risk-Taking; D012737:Sex Factors; D012725:Sexual Behavior