Interview: Feelings matter in curbing HIV

WASHINGTON, March 23 (UPI) -- United Press International interviewed Celia Lescano, a researcher at Bradley Hasbro Children's Research Center and lead author of a recent study on HIV transmission in adolescents and young adults -- who now account for half of new HIV cases each year.

Without helping young people manage the feelings and stress around sexual encounters, simply telling them how to use a condom is not enough, the article says. If the stress goes unmanaged, adolescents may not be able to effectively negotiate for safe sex with their partners.


Q: How do mental health issues affect HIV prevention?

A: Mental health issues affect HIV in acquisition. When people get the disease, there can be psychiatric or mental health issues. What we have found in our research is that there are not necessarily diagnoses related to a higher risk for having HIV, but having psychiatric problems in general or higher distress issues can increase the likelihood. Some adolescents who may have psychiatric problems have more difficulty managing their experience, or affect, and that could determine whether or not they use condoms with their partner. It affects bringing up condom use with their partner or knowing how to use condoms.


Q: What are some specific mental barriers to HIV prevention?

A: It's not specific to any diagnosis -- it's that somebody with depression is more likely to have HIV risk or that somebody with anxiety is more likely to have HIV risk. Often it can be a constellation of problems that somebody might have encountered in their life. For example, research has shown that people with a history of sexual abuse are at more risk for acquiring HIV through risky sexual behaviors that stem from the trauma of what they have experienced.

And people with sexual abuse, for example, often have diagnoses of post-traumatic stress disorder. So it's not that post-traumatic stress disorder per se leads to the risky behavior. It may be the fact that somebody with a trauma history has difficulty in managing the difficult emotions around engaging in sexual behavior after their trauma, and then have difficulty negotiating for safer sex or using protection appropriately.

Q: You've mentioned the concept of self-efficacy. What is it, and how does it affect choices when it comes to safe sex?

A: Self-efficacy is a concept developed by a psychologist named Albert Bandura and it essentially means what a person believes they can or can't do around something. So you can have self-efficacy for any kind of behavior. However, the health literature has really been using self-efficacy a lot in terms of thinking about how self-efficacious someone feels about engaging in a certain behavior. Like how self-efficacious you feel about being able to stop smoking or lose weight.


Engaging in a behavior is one thing, but having the belief that you can do it is another. Some argue in order to change a behavior you really have to believe that you can change the behavior.

Q: What are things that health workers can do to make sure that mental health is being taken into account when trying to prevent the spread of HIV?

A: Mental health workers need to address how sexual situations bring up both positive feelings and distress or feeling unsure about how to behave in a certain situation. In the past, people have focused on making sure that adults and adolescents have accurate information about how to use condoms, for example, to prevent HIV and other sexually transmitted diseases.

Having that information and teaching them the skills about that is very helpful. But it's not sufficient. What we need to understand is that sexual experiences can be quite emotional experiences -- so it can be more difficult for somebody to use a condom correctly or to bring up condom use with their partner if they don't have the skills to approach a situation when something comes up.

For mental health professionals, the task is really what they do in general: help people manage their emotions, sometimes in difficult situations. If a patient brings an issue up, they should talk about how to manage emotions when you're in sexual situations so that you can do what's going to be most healthy for you.


Q: From a broader perspective, what do your findings tell us about our overall approach to HIV prevention?

A: The acquisition of HIV is quite complicated. Someone may see it as "Well, that person just didn't use a condom and that's how they got HIV, or that person didn't use a clean needle and that's how they got HIV." But the way we should envision it is that it's much more complicated. There are feelings that go into it. There are attitudes: how self-efficacious you might feel about your behavior and aspects of your relationship.

There's an emotions piece. It's not as simple as, "You need to use a condom, here's one, go use it." It really is, "Here's a condom and let's talk about how you might feel bringing up using this condom with your partner."

We teach about how to be assertive in a situation, how to not be aggressive with your partner in bringing up condoms. To not be passive about it. We can teach assertiveness skills -- but even with assertiveness skills, even with providing and having condoms at hand, one of the important things we've found is that we need to talk about the emotions that go along with it.


The question becomes, "How can we teach you to use this condom effectively?"

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