The "B" in the "ABC" HIV prevention strategy stands for being faithful. Little is known, however about what adolescents think about faithfulness and reducing one's number of partners, including their understanding of its implementation within relationships. Because youths face the dual threats of HIV and unintended pregnancy, "it is important to understand how adolescents may integrate their thinking on pregnancy prevention if they are using faithfulness or partner reduction as their HIV prevention strategy," wrote the authors of the current study.
The researchers conducted 20 focus group discussions with 158 adolescents ages 14 to 20. The groups were stratified by age, sex, current school attendance, rural or urban residence, and marital status. The results indicated that "the vast majority" of groups felt the "B" messages are important and relevant for both unmarried and married youths to hear, but that the messages need to be stated explicitly "(e.g., 'being faithful means having only one tested sexual partner at a time')."
The youths acknowledged the risks of multiple partners; a few recognized that concurrent partnerships are riskier than serial partnerships. "Faithful relationships are perceived as ideal in terms of romantic expectations and HIV prevention, but were considered unrealistic if the relationship had a power imbalance," the authors wrote.
"Condoms were given as the primary method for pregnancy prevention among youth, yet faithfulness was usually seen as precluding condoms use, and many youth considered condom use as evidence of a lack of faithfulness," the team concluded. "Overall, adolescents recognized that practicing fidelity is complex. Young people need life skills education for how to establish and maintain faithful relationships with one tested partner and how to integrate condom use for pregnancy prevention within that relationship. Programs also need to more explicitly address the issues of trust and repeat HIV testing within 'faithful' relationships, which is an uncomfortable but necessary reality for many adolescents."