Protecting adolescent girls from unwanted unprotected sex

Partner abuse leads to HIV infection, and black women are most at risk. A new study at the University of Pennsylvania School of Nursing has found that 46 percent of African-American adolescent girls report that their partner did not use a condom the last time they had sex - often because of partner abuse. The girls described physical and sexual abuse and threats as preventing them from having their partner use condoms. The relationship between HIV and partner abuse is significant: In the U.S., at least 12 percent of HIV infections among women are a result of partner abuse.

Getting out of an abusive relationship should be considered an HIV prevention strategy, according to Anne M. Teitelman, assistant professor at the University of Pennsylvania School of Nursing, who published the study in the journal "Advances in Nursing Science." Dr. Teitelman and her co-authors advocate the need for novel strategies to increase condom use among adolescents. The co-authors are Julie Tennille, MSW, LSW; Julia M. Bobinski, BSN, MS; Loretta S. Jemmott, PhD, RN, FAAN; and John B. Jemmott III, PhD.

"Promoting healthy relationships among youth and preventing partner abuse in adolescent relationships should become a public health priority," writes Dr. Teitelman. "This is necessary for primary prevention of the intersecting epidemics of partner abuse and HIV/STIs [sexually transmitted infections]."

The study of 64 African-American adolescent girls, aged 14 to 17, illuminates the pressure a male partner may exercise to encourage girls to forgo condom use. Understanding the practice, which the authors term "condom coercion," can inform more tailored prevention methods and interventions for adolescent girls at high risk for HIV and STIs, the authors report. Forms of condom coercion include physical and sexual abuse and threats, emotional manipulation, and condom sabotage, as when a male partner surreptitiously removes a condom.

Of the sample, 59 percent of girls experienced partner abuse that was physical, verbal, or threatening. Nearly 30 percent reported having unwanted vaginal sex and about 9 percent reported having unwanted anal sex. More than half the girls indicated they had experienced vaginal sex without a condom when they wanted their partner to use one.

When faced with partners trying to dissuade them from using condoms, girls may also feel pressures that silence them from even raising the topic of condom use. In the study, 25 percent of participants responded affirmatively to the question: "Have you ever wanted to talk with your sexual partner about using a condom during vaginal sex, but were not able to?"

This comment addresses the issue of "silencing condom negotiation," which the authors define as girls' reluctance to voice an interest in condom use at the risk of losing the relationship or facing other negative consequences.

As one study participant reported: "If we talk about just STIs and HIV, we're not addressing the whole picture. . . . I'm easily pressured into doing things that I don't want to do and it's hard to sit back at the time and ask myself, 'Is this something that I really want to do?' . . . oftentimes it's what he wants, but what I want . . . you don't want a baby, you don't want a STD, you don't want HIV. . . . do you want him to beat you up? . . . Don't let anybody tell you it's not about what you want, and he's going to be telling you that. There's always a way out of things, always."