HIV Prevention: Targeting Root Causes of Sexual Risk Behavior

Introduction: One goal of the National HIV/AIDS Strategy is to reduce incidence of HIV infection. Effective prevention messages are an essential component of these efforts and most focus on three proximal sexual risk behaviors:  condom use, number of partners, and sex under the influence of alcohol and drugs. However, these risk behaviors are not always predictive of diagnosed HIV or sexually transmitted infections (STI), and are themselves driven by more distal factors and developmental influences. The current study examines the role that early risk factors (family, peer, and school) play in the development of sexual risk behaviors and STI infection.

Method: The Raising Healthy Children (RHC) study, a longitudinal study of youth development, enrolled 1,040 children in grades 1 & 2 in 1993 and 1994 and followed them through age 24/25 (2011). Lifetime STI diagnosis at age 24 was measured as self-reported diagnosis or positive serology for chlamydia or herpes virus 2 (HSV2). Multivariate regression models assessed predictors of (a) STI diagnosis, (b) condom use, (c) number of partners, and (d) sex under the influence, including individual factors (pubertal age, behavioral disinhibition) and environmental factors (family management, school bonding, antisocial friends). Additionally, the three sexual risk behaviors (b, c, and d) were examined as predictors of STI diagnosis. Demographic controls included gender, race/ethnicity, socioeconomic status (SES), and being the child of a teen parent.

Results: Behavioral disinhibition was strongly associated with STI diagnosis and all three sexual risk behaviors (p<0.001). Predictors of more lifetime partners (low SES, child of teen parent, older pubertal age, antisocial friends) differed somewhat from those for sex under the influence and inconsistent condom use (female gender, non-white race, younger pubertal age, antisocial friends-sex under the influence only). STI diagnosis was associated with female gender, low SES, younger pubertal age, and poor family management, in addition to behavioral disinhibition. Lifetime number of partners and inconsistent condom use were associated with STI diagnosis, but sex under the influence was not.

Conclusion:  Lifetime number of sex partners was associated with different antecedents than other risk behaviors. Behavioral disinhibition, an individual difference trait, was a consistent predictor of both sexual risk behaviors and diagnosed STI, whereas situational influences, such as sex under the influence, were not associated with STI. The reduced risk associated with effective family management in childhood, suggests it may check behavioral disinhibition, leading to safer behaviors and less STI. Early risk factors may be viable intervention targets in reducing HIV/STI risk.