Preventing HIV Among Young, Black Teens With Mental Illness

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Each year, the Journal of the Association of Nurses in AIDS Care (JANAC) honors nurses at the forefront of HIV research. This year, University of Pennsylvania associate professor Bridgette Brawner, Ph.D., APRN, won the Richard L. Sowell Article of the Year Award for her research on heterosexually active black teens with mental illness -- a group that's under-represented in HIV prevention campaigns.

In her paper, Brawner concludes that heterosexual black teens with mental illness have a greater risk of HIV and other sexually transmitted infections (STI), yet there are not many prevention strategies designed to address this specific population.

Brawner accepted her award and summarized her findings at the 2018 Association of Nurses in AIDS Care (ANAC) conference in Denver. Her research comes at a time when the rate of STIs among teenagers is on the rise. Meanwhile, black adolescents and young adults ages 13 to 24 have HIV diagnosis rates that are more than three times higher than those of white people who are the same age.

So what's the best way to protect young, black teens struggling with mental illness? For Brawner, the easiest way to figure out what teens want is to ask them.

For the first part of her research, she invited 33 teens to attend seven focus groups. Participants were given $30 in cash as compensation, and the focus groups were two hours long. Prior to their first discussion, each participant completed a survey aimed at identifying their baseline beliefs, behaviors, and demographics.

On average, the teens who attended were about 16 years old, and over half were male. The most common type of mental illness they reported was depression (36.4%) followed by attention deficit hyperactivity disorder (30.3%).

On average, they had started having sex at age 13, and just under half reported using a condom for each encounter. The teenagers in the study reported an average of seven partners with whom they had engaged in vaginal sex since becoming sexually active, followed by an average of 3.8 and 3.0 partners for oral and anal sex, respectively.

During the focus group conversations, Brawner identified several key themes. The participants talked about the idea of 'Blackness' -- in popular media and as a source of pride and resilience. The study participants understood the consequences of sex -- particularly pregnancy -- and the potential benefits of sex. They also discussed the reasons they did (or did not) use condoms, and broadly articulated their attitudes and beliefs toward certain sexual behaviors. Finally, they talked about coping mechanisms, both positive and negative.

Collectively, all these factors contributed to the HIV risk of the cohort. Armed with that knowledge, Brawner then tried to identify programs and interventions that might help young black people with mental illness slash their HIV risk.

"I'm a fixer," she said, speaking at ANAC, "so long-term, the intent was to inform the development of interventions."

She wanted her proposed interventions to be informed by the young people themselves, so, once again, she asked them for their opinions. Overall, her survey results showed that the majority of young people liked the idea of weaving HIV prevention education into mental health treatment programs.

That could be because many of them were using sex as a coping mechanism; chiefly, as a way of dealing with their emotions.

"For young women with depression ... sex became a means of connection."

Only six of the participants said they wouldn't likely participate in a mental health program that included HIV/STI education as well. For people in treatment for their mental illness, incorporating sex into the conversation could help them build more valuable coping strategies, like calling a friend or going for a walk, rather than seeking sex.

"These are young people dealing with mental illness," said Brawner. "If sex is a stress reliever, and you say, 'Don't have sex,' what else are you going to offer them?"

Brawner also recommended that further interventions include group discussions that are engaging and fun. The young black teens she surveyed said they wouldn't necessarily care if the group leader was white (or non-black), but Brawner suspects that they might identify better with a black person who is close to their own age and can speak from experience.

As one of the male participants put it, "If you got a room full of black kids, you bring a white person in and he start talking, 'Yeah, I lived the hard life.' ... No, I'm not listening, because I know he didn't face the same challenges I face."

She also reported that most participants made it clear that they just needed something to do. Teens have time on their hands and providing them with extracurricular programs and appropriate role models can make a big difference -- not only in HIV risk but in life overall, she said.

Brawner is continuing her research, hoping to build better interventions for young black teens with mental illness -- interventions that are inspired by the very people she's trying to help.