In a recent study, teens in psychiatric care reported high rates of unprotected sexual intercourse (55%), sex while using drugs/alcohol (49%), sex with a high–risk partner (43%), and being currently sexually active (45%) ( Donenberg et al., 2001). Adolescents receiving mental health services are especially vulnerable to HIV because they engage in the same risk behaviors as their school–aged peers but at higher rates ( Brown, Danovsky, Lourie, DiClemente, & Ponton, 1997 Donenberg, Emerson, Bryant, Wilson, & Weber–Shifrin, 2001). Teens are most likely to acquire HIV through risky sexual behavior (e.g., sex without a condom), but risk is not uniform across youths. HIV infection doubles every 14 months in adolescents, and teenagers account for 25% of new sexually transmitted diseases (STDs) reported annually ( Centers for Disease Control and Prevention, 2000). HIV continues to spread among young people despite a decreased incidence of AIDS cases nationwide. The most powerful explanatory model will likely include a combination of cognitive, behavioral, developmental, social (e.g., family), and personal (e.g., psychopathology) risk mechanisms.
Results suggest that cognitive and behavioral factors alone may not explain sexual risk taking among teens whose cognitive and emotional deficits (e.g., impaired judgment, poor reality testing, affect dysregulation) interfere with HIV preventive behavior. Findings shed light on the contribution of AIDS information, motivation, and behavioral skills to risky sexual behavior among teens receiving outpatient psychiatric care. The amount of explained variance improved when age was included as a predictor in the model. Structural equation modeling revealed only moderate support for the model, explaining low to moderate levels of variance in global sexual risk taking. This study examined the utility of cognitive and behavioral constructs (AIDS information, motivation, and behavioral skills) in explaining sexual risk taking among 172 12–20–year-old ethnically diverse urban youths in outpatient psychiatric care.
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