The Relationship between Age, Age at Sexual Debut and HIV/STI Knowledge Amongst Indigenous Youth

Background and Purpose: Two-spirit American Indian/Alaskan Native communities (AIAN) are disproportionately represented in new HIV/AIDS cases relative to the overall population (CDC, 2015). Two-spirit is generally understood as a decolonizing term referring to an individual’s complex and fluid embodiment of both the masculine and feminine in opposition to gender as binary (Anguksuar, 1997; Balsam, 2004).   Research suggests a positive correlation between HIV knowledge and healthy sexual behavior (Swenson et al., 2010); however, HIV prevention programs for sexual minority youth in general and marginalized youth specifically are lacking (Harper & Riplinger, 2013).  This study assessed the relationship between 1) Age, age at sexual debut, and HIV/STI knowledge and 2) the effectiveness of a culturally-based HIV prevention program in increasing youth HIV/STI knowledge.  

Methods: The current study utilized the pre and post surveys from a mixed methods study.  A total of 23 self-identified Indigenous youth, ages 14 – 22, were recruited through community partnerships.  Indigenous identity eligibility criteria were defined inclusively.  Specifically, youth were included who identified as indigenous peoples of the Western hemisphere, including but not limited to: American Indian and Alaska Natives, First Nations, Latinos of indigenous descent such as Mexican American Indians, Central American Indians, South American Indians, as well as individuals of Mixed Race Indigenous heritage. 

Participants responded to pre and post surveys that assessed knowledge, attitudes, beliefs, and behaviors.  The analysis discussed here focused on knowledge acquisition of HIV (e.g., “You can get HIV by being bitten by a mosquito”) and STIs (e.g., “All sexually transmitted infections (STIs) are curable”).   Pre to post scores were assessed for knowledge change.  

Results:  Sexual debut prior to age 18 was associated with lower HIV/STI knowledge at pre-test overall, wider range of scores, and greater improvement between pre-test and post-test.  Stated differently, youth whose sexual debut was before 18 were less likely to have adequate knowledge about HIV/STIs to make safe sexual decisions.  Base knowledge and knowledge change were significantly predicted by age at sexual debut as described below. 

Participants’ age (F (1, 18) = 6.65, p = .019, r2 = .27) and age at sexual debut (F (1, 10) = 5.84, p = .036, r2 = .37) significantly predicted HIV/STI knowledge at pre-test.  In a hierarchical regression, only age at sexual debut remained significant (Age: F (1, 10) = 4.49, p = .06; Age at sexual debut: F (2, 9) = 6.56, p = .017, r2 = .59, r2 change = .28, F change = 6.27, F change p = .034).  Age at sexual debut also significantly predicted knowledge change following the culturally-based education (F (1, 8) = 6.51, p = .034, r2 = .45), but age did not (F (1, 18) = .028, p = .87).   

Conclusions and Implications:  The above findings suggest culturally-based HIV prevention programs can effect positive change in HIV and STI knowledge.  The findings further suggest that targeting adolescents before their sexual debut may be beneficial to reducing sexual risk taking.  The paper includes recommendations regarding components of culturally-tailored programs targeted at younger adolescents.