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“Adolescents are often very in tune to subtle cues, so if the person speaking to them is nervous or uncomfortable, they will likely know,” said Dr. Stephanie Marhefka, professor in the USF College of Public Health’s Department of Community and Family Health.

She explored sexual health communication for adolescent girls with perinatally-acquired HIV infection (PHIV+) in comparison to girls who did not acquire infection despite the fact that their mothers were living with HIV and could have passed HIV to them (PHIV-).

“They said “be careful'”: sexual health communication sources and messages for adolescent girls living with perintally-acquired HIV infection,” published in AIDS Care, examines how HIV infection influences sexual health communication among PHIV+.

Using a sample of 30 girls living in New York city, 20 PHIV+ and 10 PHIV-, she conducted semi-structured interviews and surveys to discover with whom the girls experienced sexual health communication, their comfort levels with the communication and how that communication differed based on HIV status.

She found that girls PHIV+ were more comfortable receiving their sexual health information from their health providers, whereas PHIV- girls were more comfortable receiving that information from their caregivers.

“I suspect it could be that girls who are living with perinatally-acquired HIV have a longstanding relationship with their healthcare provider, who may, given the nature or his or her work, be inquisitive about the girls’ sexual development and activity, and be skilled in talking about it in a non-judgmental, caring manner,” Marhefka said. “Their mothers may be less comfortable talking about sex with their daughters, especially because they may be concerned about their daughters passing HIV to a sexual partner and yet may not know how to communicate that without seeming judgmental—particularly if they have guilt about passing HIV onto their daughter.”

Marhefka said girls PHIV- may visit their health care providers less frequently, thus resulting in lower trust and comfort in speaking with them on the topic.

“Caregivers may have been more proactive in talking with their girls PHIV- about sex, as they were particularly keen to prevent their daughters from acquiring HIV,” she said. “These girls had already learned that their mothers were living with HIV and their mothers may have even told the girls in the context of providing sexual health education. Because their mothers shared their own vulnerability, these girls may have been more comfortable talking with their mothers about sex than other sources.”

She also found that both groups of girls reported the sexual health messages they received were vague.

She said that using clear language is vital, such as instead of saying ‘use protection,’ provide specific types of protection, such as ‘use a male or female condom.’

“Any person talking with an adolescent about sex can improve their message delivery by reducing their own anxiety about the conversation; it may help to practice saying what they would like to say or asking what they would like to ask—on their own or with another adult,” she said.

As a licensed psychologist in New York, Marhefka worked clinically with the PHIV+ adolescent population and said she wanted to examine how they experienced their sexual development, emerging as sexual young adults in the context of a life-threatening and sexually transmitted infection.

“I wondered what they were learning from their medical providers and who they felt comfortable talking with about their sexuality and related questions and concerns,” she said. “Providers and parents may need assistance in knowing how to communicate with these girls about sex, to foster their healthy psychosexual development and to help them make choices that will reduce the likelihood of subsequent mother-to-child HIV transmission as well as transmission to sexual partners.”

Marhefka’s research highlights the unique position both providers and caregivers have in communication of responsible sexual behavior decision-making.

“Providers and caregivers should be sure that they communicate care and support along with any questions or information, while avoiding judgmental language and tone,” she said. “Judgment and fear of punishment may not prevent sexual behavior, but will likely prevent the adolescent from communicating their questions, concerns, and needs now and in the future.”

Although the number of adolescent girls with prenatally acquired HIV in the U.S. is relatively low, Marhefka said that there are many such girls around the globe, particularly in Africa and other settings where prevention continues to pose challenges.

“Providers and parents may need assistance in knowing how to communicate with these girls about sex, to foster their healthy psychosexual development and to help them make choices that will reduce the likelihood of subsequent mother-to-child HIV transmission as well as transmission to sexual partners,” she said. “Moreover, if these girls receive appropriate and healthy sexual health communication, they are then more likely to communicate positively with their own children one day.”

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Marhefka, S., et al. “They said “be careful”: sexual health communication sources and messages for adolescent girls living with perintally-acquired HIV infection. AIDS Care, 2017. Oct;29(10):1265-1269. doi: 10.1080/09540121.2017.1300626. Epub 2017 Mar 12.

 Story by Anna Mayor, USF College of Public Health