Relación diádica adolescente y riesgo para ITS/VIHprograma de prevención

Resumen

Summary In recent years, epidemiological data and different studies demonstrate that, despite the prevention measures implemented, Spanish adolescents continue to engage in sexual risk behaviors, thus increasing their probability of contracting a Sexually Transmitted Infection (STI), HIV or unwanted pregnancies. Considering the different strategic plans for the prevention and control of infection by HIV and other STIs, both on a global and national level, there is a particular need for actions focused on the prevention of sexual risk behaviors in adolescents, both in men and women. Such actions should be based on comprehensive approaches and consider a gender perspective to correct the consequences of inequality and discrimination for reasons of sex, in order to foster the improved performance and effectiveness of prevention programs. Thus, besides addressing individual psychosocial and behavioral variables such as knowledge about STIs/HIV, training in skills and self-efficacy when using condoms, there is also a marked need to take action with regards to variables that are indicative of gender inequality related to the intimate relationship, enabling adolescents to acquire attitudes of equality, respect and responsibility in their sexual and romantic relationships. Therefore, this doctoral thesis has two general objectives. The first general objective is to learn about and analyze the sexual risk behaviors and their relationship with attitudinal, cognitive and emotional variables, such as sexism, attitudes towards love, irrational beliefs about the relationship and interpersonal dependency on the partner, from a gender perspective, in a representative sample of Spanish adolescents. The results obtained will make it possible to design prevention strategies against STIs/HIV and against unwanted pregnancies, not only encompassing psychosocial and behavioral aspects, but also attitudinal, cognitive and emotional aspects involved in adolescent romantic relationships, which are indicative of gender inequality and that put them at risk for STIs/HIV from a gender perspective. The second general objective is the improvement of an STI/HIV prevention program of proven effectiveness in behavioral and psychosocial variables associated to the risk of STIs/HIV in female Spanish adolescents. This will be achieved by extending intervention on attitudinal, cognitive and emotional variables indicative of gender inequality in relationships and involved in romantic relationships, reducing session times and adapting them to the male adolescent population along with applying and evaluating the effectiveness of said prevention program against the transmission of STIs/HIV and unwanted pregnancies, both in male and female Spanish adolescents. In order to achieve the two general objectives of this doctoral thesis, five studies were conducted. To achieve the first general objective, the first four studies were conducted, and the fifth study was concluded to accomplish the second general objective. The summaries of each of the five studies are presented below. Study 1. Sexism in adolescent relationships: A systematic review Background/Objective. Numerous studies show the support for sexist attitudes in adolescent population in different countries and cultures. Sexism affects interpersonal relationships and, therefore, the behaviour of adolescents within dating relationships that begin to emerge at this stage of development. The aim of this theoretical study is to learn which cognitive, emotional, attitudinal and behavioural variables involved in relationships are related to the maintenance of sexist attitudes by adolescents and how they relate to one another. Method. After searching scientific articles published between 2005 and 2015 on PsycINFO, Psicodoc, PubMed, Scopus and Web of Science databases, 1,170 studies were obtained. However, after conducting the selection process, 20 were included in the review. Results. In short, the results of these studies show that adolescents who display attitudes that are more sexist have a more positive attitude towards intimate partner violence, greater sexual risk behaviours, greater attraction to sexist partners, greater support for the myth of idealized love and myth of love-abuse link, greater emotional dependence on the partner, and poorer quality in relationships, revealing gender-based differences in some of the mentioned variables. Conclusions. It is concluded that maintaining sexist attitudes is related to harmful forms of intimate interaction among teenagers. The need to prevent sexism or intervene in reducing sexism in the adolescent population is also highlighted. Study 2. Analysis of coital and non-coital sexual behavior in adolescents. Spain, 2016 Background/Objective. The adolescent population is considered a group that is at risk for Sexually Transmitted Infections (STIs) or HIV. The objective of this study is to analyze the characteristics of the sexual behavior (both coital and non-coital) of Spanish adolescents and the differences on the basis of gender. Method. It was a representative sample of 2,703 Spanish adolescents of between 14 and 20 years old. In total, 49.9% of participants were males (M = 15.95; SD = 1.30) and 51.1% females (M = 15.83; SD = 1.28). Results. The results show that 27% of adolescents maintain penetrative sexual relations, 45.7% engage in non-penetrative sex and 27.3% have never had sexual experience. On the basis of gender, males initiate non-penetrative sexual behavior, vaginal sex and anal sex earlier than females, have a greater number of non-penetrative sexual encounters under the influence of alcohol and have a greater number of anal and vaginal sex partners. Females, on the other hand, tend to have partners who are older than them. No gender differences were found in the case of condom use in the first and last sexual contact with anal and vaginal penetration, or in the consistent use of condoms in anal and vaginal sexual encounters, of which it is particularly worth noting that 47.2% of adolescents use condoms inconsistently in vaginal sexual relations, and 81.9% in anal relations. Conclusions. It can be concluded that it is necessary to intervene and educate adolescents on the prevention of STIs/HIV at an early age, taking into account a gender perspective. Study 3. Sexism and sexual risk behavior in adolescents: Gender differences Background/Objective. This study examines whether there are differences in the maintenance support of ambivalent sexist beliefs on the basis of gender and sexual experience in adolescents. The study also investigates whether the sexist beliefs themselves are linked to sexual risk behaviors. Method. A representative sample of 2,703 Spanish adolescents was carried out in public and private secondary schools, with an age range of 14 to 20 years old (M = 15.89; SD = 1.29). Results. Males maintain more report greater support towards hostile, benevolent and ambivalent sexist beliefs compared to females. Sexual experience (both coital and non-coital) is linked to a greater degree of hostile and benevolent sexist beliefs, but only within the male group. In males, greater support of benevolent sexism is linked to vaginal sex initiation at an earlier age, while greater support of hostile sexism is linked to a lower proportion of condom use. In females, greater support of hostile sexism is linked to a greater number of sex partners. Conclusions. It is necessary to include specific actions on sexist beliefs in programs for the prevention of sexually transmitted infections and HIV. Study 4. Attitudinal, cognitive and emotional variables involved in sexual risk behavior in adolescents Background/Objective. The initial concept of the ideal romantic relationship is established during adolescence, based on beliefs, emotions, feelings and behaviors that, in part, are determined by the values of society. The objectives of this study are to discover which attitudes towards love, which irrational beliefs about the relationship and how interpersonal dependency differ according to gender, as well as their connection to sexual risk behavior in adolescents. Method. It was a representative sample of 2,703 Spanish adolescents. In total, 49.9% of participants were males (M = 15.95; SD = 1.30) and 51.1% females (M = 15.83; SD = 1.28). Results. The results reveal gender differences in love styles, irrational beliefs about the relationship and interpersonal dependency. In the male group, a playful love style and the irrational beliefs "disagreement is destructive" and "men and women are different" are associated to greater inconsistency in condom use. In the female group, a playful love style, the irrational beliefs "disagreement is destructive", "mind reading" and "sexual perfectionism", along with greater interpersonal dependency towards the partner are associated with greater inconsistency in condom use. Conclusions. These results will make it possible to design prevention strategies against STIs/HIV and against unwanted pregnancies that encompass attitudinal, cognitive and emotional aspects related to the concept of love and romantic relationships from a gender perspective. Study 5. Evaluation of the effectiveness of the program “Face To Face, Heart To Heart” for the prevention of STIs/HIV in Spanish adolescents Background/Objective. The objective of this study is to evaluate the effectiveness of an emotional and sex education program called “Face To Face, Heart To Heart” (FTF-HTH) for the prevention of the transmission of STIs/HIV in male and female Spanish adolescents. Method. It followed an experimental design with an independent variable and two randomized groups. The sample was formed by 159 Spanish adolescents (78 women and 81 men) aged between 15 and 18 (M = 16.36; SD = 0.96), which were randomly assigned to the intervention group (application of the FTF-HTH program) and to the control group (no intervention). Results. The results reveal that, at the 3-month follow-up, both the men and women demonstrated a significant increase in consistent condom use and a decrease in the vaginal sex risk index for STIs/HIV, compared to the control group. Participants in the intervention group showed more positive attitudes towards condom use, greater self-efficacy to refuse sexual relations, fewer sexist beliefs and a lesser degree of sexual double standards, fewer irrational beliefs about the romantic relationship and less interpersonal dependency towards their partner. The male group also demonstrated more sexual assertiveness and less fear of negotiating condom use. Conclusions. It can be concluded that the FTF-HTH program is effective in reducing sexual risk behaviors and in attitudinal, cognitive and emotional variables indicative of gender inequality in relationships between male and female Spanish adolescents.