INFLUENCE OF SEXUAL ABUSE ON HIV-RELATED ATTITUDES AND BEHAVIORS IN ADOLESCENT PSYCHIATRIC-INPATIENTS

Objective: To investigate the associations between sexual abuse and hu man immunodeficiency virus (HIV)-related attitudes and behaviors of ad olescents with a psychiatric disorder. Method: HIV-related knowledge, attitudes, and behaviors were examined by self-report assessment of ad olescents admitted to a psychiatric hospital (N = 100). A subsample (n =30) completed a role-playing exercise regarding HIV-preventive behavi or that was scored for the degree of effective communication by raters blind to the subjects' abuse history. Results: HIV-related risk behav iors were prevalent, including unprotected sexual intercourse (67%) an d multiple partners (27%) among the sexually active (71% of the total) . Also frequent were alcohol and drug use (25%) and sharing cutting in struments (22%) among those engaged in self-cutting behavior (62%). Th e 38% of the sample identified as having a history of sexual abuse ind icated significantly poorer self-efficacy concerning condom use than t heir peers. Abused females scored significantly lower on the self-effi cacy of condom use scale and reported significantly more frequent alco hol use than nonabused females (p=.003). A hierarchical multiple regre ssion that controlled for consistency of condom use and tolerance of p eople with acquired immunodeficiency syndrome found that abuse history uniquely accounted for 16% of the variance in condom use self-efficac y. Analysis of the videotaped role-play found that abused adolescents were significantly less competent and had more difficulty in effective communication than their peers (p=.003). Conclusion: A history of sex ual abuse is associated with impaired safe sexual decision-making and HIV-preventive communication skills, even in this already at-risk grou p. This study also underscores the importance of actively addressing t hese issues in the context of clinical care.