Special Considerations: Pediatric to Adolescent Care Transitions
Clinicians may not be comfortable discussing sexual issues with adolescents. However, providers who are caring for adolescents must be comfortable addressing these issues so that the care team can adequately respond to the patients' concerns, feelings, and problems in a constructive, nonjudgmental fashion (see Psychosocial Issues module for tips on addressing sexuality with youth). 12 If adolescents sense that a provider is not comfortable discussing sexual issues, they may withhold information that can compromise their care and put them at risk of transmitting HIV to others. It is important for providers to strive to establish an environment in which adolescents feel safe and eventually comfortable discussing sexuality so that it will be easier to assist them in making healthy choices. In the best-case scenario, the health care team also works with family members to give anticipatory guidance regarding the young person's sexual development.
Cultural beliefs, values, and practices may influence family communication about sexuality. For example, in some cultures, premarital sex is strictly forbidden. Thus, young people may have difficulty talking honestly about their sex lives with family members. In the clinical setting, patients will rely on providers to ensure that they have the opportunity to discuss sensitive issues such as sex privately. In many cultures, sex and related issues are not considered proper subjects for discussion. For some youth, especially young women, attempting to negotiate safer sex many be considered promiscuous.3
Disclosing HIV Status to Sex Partners
Several states have laws governing the self-disclosure of one's HIV status to a sexual partner. All youth must be informed by the health care provider of the moral, ethical, and legal implications of participating in unprotected sexual activities with a partner who is unaware of one's HIV-positive status. Among youth, self-disclosure to a sexual partner is a more complex process than disclosure among the general population because adolescent sexual relationships may be of short duration and the partner may not keep confidentiality. Adolescents should receive guidance and support from the health care team to assist with this process.
Formation of Sexual Identity with Periods of Experimentation with Both Genders
Cognitive and social development during adolescence is a complex process characterized by acquiring a sense of self apart from the family, a sexual identity, the capacity for intimacy, and the ability to be self-sufficient. For those adolescents who develop a gay orientation in a social culture based on heterosexuality, the transition during adolescence is expanded and expressed somewhat differently during the stage of forming a sexual identity.13 Cultural beliefs and practices can strongly influence what adolescents perceive is "appropriate" sexual behavior. If young persons receive the message that their feelings of attraction are wrong or inappropriate, they may face some emotional difficulties in developing their sexuality. This may be particularly pronounced in communities where religious beliefs affirm heterosexuality while disaffirming homosexuality. Members of racial/ethnic minority groups who are gay may internalize the stigma of homosexuality, developing low self-esteem and even self-hatred. The stigma is greater for these individuals who are living with HIV. Internalizing such negative feelings causes a substantial number of gay individuals to feel unworthy of receiving help.144
- Yep GA. Overcoming barriers in HIV/ AIDS education for Asian Americans: Toward more effective cultural communication. In: Confronting the AIDS epidemic: Cross-cultural perspectives on HIV/AIDS education. Umeh DC, editor. (pp. 219-230). Trenton, NJ: Africa World Press. 1997.
- Chodon T. The Role of Culture in HIV/AIDS Health Care--A Practical Guide for Providers Serving Asian and Pacific Islander Americans. New York: Asian and Pacific Islander Coalition on HIV/AIDS; 2001.
- Neinstein LS. Adolescent Health Curriculum. Los Angeles: University of Southern California; 2004.
- Smith S, McClaugherty LO. Adolescent homosexuality: a primary care perspective. Am Fam Physician. 1993 Jul;48(1):33-6.
- Choi K-H, Lew S, Vittinghoff E et al. The efficacy of brief group counseling in HIV risk reduction among homosexual Asian and Pacific Islander men. AIDS. 1996;10:81-87.