Unwitting trust of sexual partners results in infection
Study shows how youth perceive trust
Young people who fail to use condoms during intercourse often say they trust their partners and don’t want to jeopardize that trust by asking their partners about their sexual histories or asking them to engage in safer sex practices. However, as the HIV/AIDS epidemic disproportionately affects youth across the world, it’s apparent that some strategies need to be put in place to help youth look at condoms and safe sex as a normal practice, according to a study presented at the 14th International AIDS Conference held in Barcelona, Spain.1
"We found out that across the countries we looked at, the number one reason people don’t use condoms with regular partners is because they trust them," says Kim Longfield, PhD, MPH, research officer for the AIDSMark Project of Population Services International in Washington, DC. "What we wanted with the study was to find out what this trust means and how we can help people use protective behaviors," she says.
Investigators held 33 focus groups in Eritrea, Tanzania, Zambia, and Zimbabwe, and discussions were divided by the age groups of 15-19 years and 20-24 years and by sex.1 They explored what trust meant to these young people, what kind of criteria they used to determine trustworthiness, and how young people identified the types of individuals whom they could trust. "We looked at how trust then influences sexual decisionmaking and perceptions and how sexual partners can violate your trust and how that can affect your sexual decision making," Longfield explains.
Youths were asked to give examples of these decisions, and from their list researchers drew up a mental checklist of trustworthy criteria, which includes the following:
- meeting through family or close friends;
- passing an informal assessment;
- perceiving fidelity;
- exchanging financial support and gifts;
- dressing appropriately/projecting the right appearance;
- saying the right things/sweet talk;
- being from the right neighborhood;
- knowing the family;
- keeping appointments/dates.1
"What we found is that youth have these superficial criteria which are not good criteria for making decisions about sex and risks for HIV," Longfield says. "It’s better to know their HIV serostatus and concrete measures for risk, but they’re reluctant to talk about things like this because they don’t want to jeopardize the relationship."
Even when youth begin a relationship with condom use, they are likely to abandon it over time once they felt they trusted their partner enough, she adds. These attitudes were prevalent even in Zimbabwe and Zambia, which have very high rates of HIV infection, Longfield says.
In Zambia, which has a 20% HIV prevalence rate among the general population, only one-third of youth reported using condoms in their last sexual contact with a regular partner, and Zimbabwe, which has a 25% HIV prevalence rate, condom use remains very low, she says.
There were some differences in responses among youth from Eritrea and Tanzania, which each have a single-digit HIV prevalence rate. In Eritrea, youths said they wanted promises of marriage and commitment in relationships before they were likely to enter into a sexual relationship, Longfield says.
Investigators concluded that while it’s a human need to trust a partner, prevention programs are needed that teach youth to disassociate trust from risk. "You can have a partner whom you care about and trust, but that’s not enough to protect you from the risks of sexually transmitted diseases (STDs) and HIV, so you should evaluate your risk by getting tested," Longfield says. "This research was used to develop a regional campaign that these countries can adopt," she continues. "The first is a mass-media spot that we’re working on right now, and that will be followed up by interpersonal communication activities."
Prevention programs need to talk about accurate risk perception, consistent condom use, and getting to know one’s own HIV status, as well as that of partners, and why they should delay sexual activity as long as possible, Longfield says. One of the challenges of convincing youths to engage in safer sex activities is that even in nations where HIV prevalence is high, youths are more concerned about other life issues, such as their education, relationships, and economic status, she explains. "Youth are youth and have a hard time living in the moment and at the same time seeing how something might protect them from risk years from now," Longfield says. "AIDS rides on the back of poverty, and when you’re struggling to survive, there are other competing issues that fight for your attention, such as making money, getting to school, so risk perception takes a backseat," she adds.
Reference
1. Longfield K, Klein M. Multi-country study on trusted partners among youth. Presented at the 14th International AIDS Conference. Barcelona, Spain; July 7-12, 2002. Abstract ThPeE7786.
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