title: Risk Factors for HIV Transmission and Barriers to HIV Disclosure: Metropolitan Atlanta Youth Perspectives.
abstract: Youth carry the highest incidence of HIV infection in the United States. Understanding adolescent and young adult (AYA) perspectives on HIV transmission risk is important for targeted HIV prevention. We conducted a mixed methods study with HIV-infected and uninfected youth, ages 18-24 years, from Atlanta, GA. We provided self-administered surveys to HIV-infected and HIV-uninfected AYAs to identify risk factors for HIV acquisition. By means of computer-assisted thematic analyses, we examined transcribed focus group responses on HIV education, contributors to HIV transmission, and pre-sex HIV status disclosure. The 68 participants had the following characteristics: mean age 21.5 years (standard deviation: 1.8 years), 85% male, 90% black, 68% HIV-infected. HIV risk behaviors included the perception of condomless sex (Likert scale mean: 8.0) and transactional sex (88% of participants); no differences were noted by HIV status. Qualitative analyses revealed two main themes: (1) HIV risk factors among AYAs, and (2) barriers to discussing HIV status before sex. Participants felt the use of social media, need for immediate gratification, and lack of concern about HIV disease were risk factors for AYAs. Discussing HIV status with sex partners was uncommon. Key reasons included: fear of rejection, lack of confidentiality, discussion was unnecessary in temporary relationships, and disclosure negatively affecting the mood. HIV prevention strategies for AYAs should include improving condom use frequency and HIV disclosure skills, responsible utilization of social media, and education addressing HIV prevention including the risks of transactional sex.
authors.affiliation: 1 Division of Pediatric Infectious Diseases, Emory University School of Medicine , Atlanta, Georgia .|2 Ponce Family and Youth Clinic , Grady Infectious Diseases Program, Grady Health Systems, Atlanta, Georgia .
authors.forename: Andres F
authors.initials: AF
authors.lastname: Camacho-Gonzalez
authors.affiliation: 1 Division of Pediatric Infectious Diseases, Emory University School of Medicine , Atlanta, Georgia .|2 Ponce Family and Youth Clinic , Grady Infectious Diseases Program, Grady Health Systems, Atlanta, Georgia .
authors.forename: Amy
authors.initials: A
authors.lastname: Wallins
authors.affiliation: 3 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia .|4 ICF International , Atlanta, Georgia .
authors.forename: Lauren
authors.initials: L
authors.lastname: Toledo
authors.affiliation: 3 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Ashley
authors.initials: A
authors.lastname: Murray
authors.affiliation: 3 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia .|4 ICF International , Atlanta, Georgia .
authors.forename: Zaneta
authors.initials: Z
authors.lastname: Gaul
authors.affiliation: 3 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Madeline Y
authors.initials: MY
authors.lastname: Sutton
authors.affiliation: 5 Department of Pediatrics, Emory University School of Medicine , Atlanta, Georgia .
authors.forename: Scott
authors.initials: S
authors.lastname: Gillespie
authors.affiliation: 6 Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University School of Medicine , Atlanta, Georgia .
authors.forename: Traci
authors.initials: T
authors.lastname: Leong
authors.affiliation: 2 Ponce Family and Youth Clinic , Grady Infectious Diseases Program, Grady Health Systems, Atlanta, Georgia .|7 Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University School of Medicine , Atlanta, Georgia .
authors.forename: Chanda
authors.initials: C
authors.lastname: Graves
authors.affiliation: 1 Division of Pediatric Infectious Diseases, Emory University School of Medicine , Atlanta, Georgia .|2 Ponce Family and Youth Clinic , Grady Infectious Diseases Program, Grady Health Systems, Atlanta, Georgia .
authors.forename: Rana
authors.initials: R
authors.lastname: Chakraborty
mesh_terms: D000293:Adolescent; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D005845:Georgia / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D036301:Qualitative Research; D012307:Risk Factors; D012309:Risk-Taking; D021841:Safe Sex; D012725:Sexual Behavior; D012747:Sexual Partners; D014342:Truth Disclosure; D014505:Urban Population; D055815:Young Adult