Abstract

PIP: The heterosexual transmission of HIV is increasing. A proclivity for engaging in risk-related sex, young age at first intercourse, nonuse of contraceptives or ineffective contraceptive practices, multiple sex partners, high rates of sexually transmitted diseases, and an apparent lack of AIDS knowledge place adolescents at a particularly high risk of contracting and transmitting HIV. A national study of the Centers for Disease Control found that almost 66% of male students and more than 50% of female students became sexually active before reaching age 17; of the sexually active, only 25% of males and 47% of females reported using condoms as a primary contraceptive method. 25-33% of sexually active adolescents never use any form of contraceptive. The authors explore factors associated with condom use and the number of sex partners in a statewide sample of 3893 public high school students in grades 9-12. Participants were sampled in April and May, 1990, with the self-report Youth Risk Behavior Survey in 57 schools across 37 districts in South Carolina. The survey included measures to assess respondent aggression, physical recklessness, alcohol use, illegal drug use, cigarette use, lack of exercise, and academic self-image. 74% of the participants were 15-17 years old, with 12% younger and 14% older. 63% were White and 37% were Black. 34% reported never having intercourse, 19% reported intercourse with 1 partner, 21% with 2-3 partners, and 26% with 4 or more partners. Among those reporting the highest level of sexual activity, 63% were male and 51% were Black. 52% of the sexually active students reported not using condoms at last intercourse. A strong correlation was observed between the failure to use condoms, higher numbers of lifetime sex partners, and reckless or aggressive behavior. A significant correlation was also found between alcohol use and risky sex behavior, consisting of multiple partners and no condom use, for all race-gender groups except Black males. A weaker correlation exists between the use of illicit drugs and risky sex behavior for White adolescents. Especially for White students, a clear pattern was revealed of declining condom use with increasing number of partners. Among the females, academic self-image strongly correlated with lifetime sexual activity and the failure to use condoms; the females also reported less frequent condom use than males. School-age youths desperately need more objective information about the routes of HIV infection and how to prevent infection. Education and prevention programs should not dwell upon the need for abstinence, but should be incorporated into the larger context of comprehensive school health education curricula. Specific interventions should focus upon improving the decision-making skills, communication skills, stress management skills, and goal-setting skills of adolescents.