An Exploration of Family and Juvenile Justice Systems to Reduce Youth HIV/STI Risk

Abstract

Using in-depth interviews with 20 probation youth (60% female; 35% white; 30% Hispanic; mean age 15years, range=13–17), their caregivers (100% female; mean age 44years, range=34–71) and 12 female probation officers (100% white; mean age 46years, range=34–57), we explored how family and probation systems exacerbate or mitigate sexual risk. We conducted thematic analyses of interviews, comparing narratives of families of sexually risky (n=9) versus non-sexually risky (n=11) youth. Family functioning differed by youth sexual risk behavior around quality of relationships, communication, and limit-setting and monitoring. The involvement of families of sexually risky youth in probation positively influenced family functioning. Data suggest these families are amenable to intervention and may benefit from family-based HIV/STI interventions delivered in tandem with probation.

Funcionamiento familiar en relación con la conducta sexual de riesgo en adolescentes: Una revisión integradora de la literatura

“…Por otra parte, los estudios centrados en las ITS como conducta de riesgo en la adolescencia encontraron que niveles bajos de monitorización familiar y un estilo de crianza de tipo permisivo caracterizado por niveles de comunicación deficiente y el desapego actúan como factor de riesgo, mientras que una mayor supervisión parental mostraba una menor incidencia de conductas sexuales de riesgo en los adolescentes (Murry et al, 2011;Udell et al, 2011;Mmbaga et al, 2012;Rhucharoenpornpanich et al, 2012;Elkington et al, 2014).…”

Juvenile justice staff endorsement of HIV/STI prevention, testing, and treatment linkage

“…Furthermore, research documents a strong link between substance use and illegal activity (Ford & Rigg, 2015; Silva, Schrager, Kecojevic, & Lankenau, 2013) and between substance use and HIV/STI risk (Aalsma, Tong, Wiehe, & Tu, 2010; Teplin, Mericle, McClelland, & Abram, 2003). As youth under community supervision are frequently disconnected from services and may miss school-based or other community-located HIV/STI interventions, juvenile community supervision agencies are uniquely positioned to provide HIV/STI testing and prevention programming to a high-risk group of vulnerable youth (Elkington et al, 2015). Access to timely HIV prevention, including Pre-Exposure Prophylaxis (PrEP), can reduce risk of HIV infection among youth under community supervision, and early identification (i.e., HIV testing) with prompt referral to treatment for youth who are found to be living with HIV and STIs, may reduce the transmission of the infections in their communities (Allen, Gordon, Krakower, & Hsu, 2017; Donenberg, Emerson, & Kendall, 2018; Donenberg, Emerson, Mackesy-Amiti, & Udell, 2015; Godin et al, 2003; Tolou-Shams, Stewart, Fasciano, & Brown, 2010).…”

Outcomes of a family-based HIV prevention intervention for substance using juvenile offenders

“…In addition to risk attributes of adolescents, family-level factors influence adolescent criminality, substance abuse and HIV risk (Elkington et al, 2014; Lee, 2005; Patterson, DeBaryshe & Ramsey, 1989). A variety of family and parenting factors have been associated with poor adolescent outcomes, including family demographics (e.g., single-parent households, disadvantaged economic status, racial/ethnic minority status), infrequent parental monitoring, less parental warmth and support, increased family conflict and parental psychopathology (Brennan, 2002; Elkington, Bauermeister, & Zimmerman, 2011; McBride, Paikoff, & Holmbeck, 2003; Miller, Forehand & Kotchick, 1999; Samaan, 1998).…”

“…With the exception of one other intervention (Multidimensional Family Therapy) that demonstrated long-term reductions in the number of adolescent unprotected sex acts (Marvel, 2009; Rowe et al, 2016), to our knowledge, there have been no other published studies that incorporate family-based intervention for HIV/STI prevention for substance using juvenile offenders. The need to develop family-based HIV prevention interventions has received increasing attention because of studies highlighting important family structure and process correlates of adolescent HIV risk (Elkington et al, 2014; Perrino, Gonzalez-Soldevilla, Pantin, & Szapocznik, 2000). Interventions have been created to address these family factors for various subpopulations, such as within urban African American adolescents and their families [e.g., CHAMP; McKernan McKay et al, 2004 and The Mother-Son Health Promotion Project; Jemmott et al, 2000], younger African American children [e.g., Parents Matter program; Long et al, 2004], and families with adolescents in psychiatric care, [e.g., Project STYLE; (Brown et al, 2014; Jemmott et al, 2000; Long et al, 2004; McKernan McKay et al, 2004).…”