Lucky Kitty's Blog crew found this interview in the Spotlight on Women's Health section of womenshealth.gov website and we thought it important to share it with you.*Many people don't realize the impact of HIV on women and girls in the United States. But for Dr. Anne Teitelman, it's something she thinks about every day. Read about her thoughts on HIV/AIDS today and what she's doing to help stop this disease.
How did you first become interested in girls and HIV?
While I was a PhD student, I worked as a Family Nurse Practitioner at "The Corner", the largest and oldest adolescent health center in Michigan. We provided primary health care to young, low-income, people ages 11-22. I saw a lot of girls who came back with repeated sexually transmitted infections (STIs), a trend that was echoed nationally. Rates for many STIs, such as chlamydia and gonorrhea, are highest among adolescent girls. As I provided prevention education and counseling, some of the girls would talk about barriers in their relationships. I wanted to explore this further and so I focused my dissertation on exploring girls' perspectives about the different messages they received about sex, sexuality, and relationships. Also, during this time, our country was witnessing an increase in HIV rates for women and adolescent girls, primarily through sex with men. I became very interested in HIV as well as STI prevention for girls, since having an STI can also increase your risk of HIV.
What are the issues surrounding HIV and girls today in the U.S.?
In the US, almost half (46 percent) of high school aged adolescent girls have been sexually active. Among sexually active girls, their male partners used condoms approximately half of the time (55 percent). Although abstinence is the only 100 percent effective way to avoid infection, another effective method of HIV prevention for sexually active adolescent girls is condom use by their male partner. In order for girls to want to use condoms, they need to:
* Know how condoms can help lower their risk.
* Feel that others around them are supportive.
* Learn how to use condoms correctly.
* Become skilled at talking about condom use with their partners.
One common barrier that girls talk about is wanting to use a condom when their male partner does not. In these situations, girls may experience higher levels of abuse, which is associated with inconsistent condom use. This makes them more susceptible to acquiring HIV and other STIs. Also, girls who experience partner abuse are more likely to:
* Be scared of what may happen if they try to insist on condom use.
* Initiate sex at younger ages.
* Have riskier partners.
* Have symptoms of depression and anxiety.
* Struggle with substance abuse.
All of these issues can increase risk of HIV and other STIs. Therefore, promoting healthy relationships and preventing partner abuse needs to be a part of HIV prevention efforts.
Tell us more about the relationship between partner abuse and HIV among teens.
Unfortunately, many girls do not recognize partner abuse. Adolescent partner abuse, also called "dating violence", includes psychological, emotional, sexual or physical violence, as well as threats of violence. It also includes any attempt to dominate or control a partner that results in harm. Relationship violence is estimated to begin around age 15, though sometimes it occurs among younger teens as well. Partner abuse is common. Up to 1 in 4 adolescents report verbal, physical, emotional, or sexual violence each year.
In some communities, it is considered normal for men to have multiple partners, inappropriate for girls and young women to carry or know about condoms, and common for there to be partner abuse. So it is crucial to talk about these things as part of HIV prevention for adolescent girls.
What type of studies are you conducting now?
I am working on modifying an HIV prevention program for girls that is working, to see how changes can improve it, for the National Institute of Mental Health. In my modified version, I plan to adddress building healthy relationships, understanding gender norms and inequalities, recognizing abuse, accessing safety resources, and knowing the ways abuse interferes with safer sex. Right now I am conducting focus groups with girls attending family planning clinics, to see how much they understand about these issues. The next steps are to use the information from the focus groups to modify the program and then test how well the new combined HIV and partner abuse prevention program works.
What will the results of this research mean for girls with HIV or at risk of HIV?
If the modified program is shown to be more effective, then it will help girls:
* Better protect themselves from HIV in healthy and unhealthy relationships.
* Identify abuse.
* Be able to find help should they suffer from partner abuse.
The effective program can be used in family planning clinics across the country and can be adapted for other settings as well. In the future, I hope to develop programs for boys as well as kids who are HIV-positive.
Why do you think HIV/AIDS education is so important to girls?
Girls are a vulnerable group because of their unique risks. How their bodies are structured raises the HIV risk, but there are also many social factors involved in HIV risk. Girls' age and developmental level, their limited income, gender inequalities, and limited access to information and resources all play a role in HIV risk. Certain groups of adolescent girls have especially high risk, including those who are homeless, in detention, have limited English proficiency, or have a mental illness.
HIV/AIDS education is important for all girls — for avoiding getting HIV and avoiding passing HIV to others. Girls need to be informed about HIV/AIDS so they can make healthy choices and live to their fullest potential. Yet their HIV/AIDS education also must cover healthy and unhealthy relationships, safer sex beliefs and attitudes, social norms, and skills building. We also must empower girls to protect themselves and seek help when needed. It is also really important to have progams that work for African American and Hispanic adolescent females, who are disproportionally affected by HIV/STIs. In general, girls need environments that are safe from violence and abuse.
What do you think parents can do to teach girls about healthy relationships?
Girls care about what their parents think and parent-teen interactions can influence girls' safer sex practices. It's important for parents to explain their values. Parents can find teachable moments that do not involve passing judgment on their teens' behavior. For example, parents can present their views about sex and relationships by discussing events in the news or a situation in a movie.
It is also important for parents to establish comfortable open communication patterns before their girls date, so that conversations don't seem rushed or forced. Parents can ask questions and learn what girls' see as common behaviors amongst their teens' peers. For example, is sexual peer pressure common? What do your friends feel forced to do?
Finally, it's best if parents give honest answers. It can be dangerous to give teens wrong information, so it's OK for parents to say they don't know something and look for the answer together. When communicating, remember to talk about the red flags of abuse. For example, partners giving lots of gifts can be a sign of power and control, not generosity; jealousy can be dangerous, not flattering. It is important that teens recognize the warning signs of potential abuse early.
Are you surprised about how little or how much women and girls you talk with know about HIV?
In our focus groups, girls seem to know a lot of the basic facts about HIV and STIs, but they have many questions about how to apply this information in real life situations. This clearly shows that girls need a safe place to talk about these issues with others to figure out how to use the information in their own relationships.
How can women get involved in helping to raise awareness of HIV prevention?
Be honest with youth and provide them with the information that they are looking for. Encourage parents and other adults to do the same. Providing HIV prevention information does not increase youth's sexual activity, but fewer conversations make it less likely that they will use protection when they do become sexually active. Support comprehensive sexuality education in schools. Encourage sexually active youth to get tested for HIV and STIs and support increased access to these services.
There is now greater recognition in our country that adolescent relationships can be serious and can include abuse. These early experiences can strongly influence intimate partner relationships into adulthood. Adolescent girls who experience partner abuse are more likely to be in abusive relationships as young adults. But, dating violence can be prevented. Helping teens learn about healthy relationship skills, such as negotiation, voicing concerns, and listening will help them in the long run.
Youth want to talk about sex and relationships in a meaningful way. Adults can help by providing safe spaces for these conversations, promoting healthy relationships, and providing support if they are in unhealthy relationships.
Inside the Interview:
Dr. Teitelman is an Assistant Professor at the University of Pennsylvania School of Nursing, and affiliated with the school’s Center for Health Disparities Research.
Dr. Teitelman received her BA in Science, Technology and Society from Vassar College, her MSN in Community Health Nursing from Yale University, and her PhD in Nursing, along with a Graduate Certificate in Women's Studies, from the University of Michigan.
Dr. Teitelman's research focuses on HIV prevention among adolescents and understanding intimate partner violence as an HIV risk factor.
She has 20 years of experience as a family nurse practitioner providing primary care to underserved patients. She is credentialed at The Hospital of the University of Pennsylvania, where she currently practices in The Helen O. Dickens Center for Women's Health. She has been teaching advanced practice nurses in the university setting for over 15 years.
The above interview is from Spotlight on Women's Health on womenshealth.gov
About womenshealth.gov
The Office on Women's Health (OWH) was established in 1991 within the U.S. Department of Health and Human Services. Its Vision is to ensure that "All Women and Girls are Healthier and Have a Better Sense of Well Being." Its mission is to "provide leadership to promote health equity for women and girls through sex/gender-specific approaches." The strategy OWH uses to achieve its mission and vision is through the development of innovative programs, by educating health professionals, and motivating behavior change in consumers through the dissemination of health information.
*Womenshealth.org and Dr Teitelman do not endorse and are in no way affiliated with Lucky Kitty Co.
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