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Motivation for behavior change
Mar 3, 1997

Hi. I am a nursing student attempting to counsil teenagers on HIV/AIDS prevention. Any suggestions to help motivate them to change risky behaviors?

Response from Mr. Sowadsky

My experience has been that just telling teenagers to protect themselves against HIV/AIDS doesn't work well. This is because the average period of time from infection to AIDS related symptoms is 10 years. Teenagers cannot perceive life 10 years later. Their concepts of life are much more immediate. Therefore, if you want to get teens to postpone sex, or practice safer sex, taking the AIDS approach won't work well.

A much better approach is to teach them about other Sexually Transmitted Diseases (STD's) that cause symptoms much quicker, can also be incurable, and are much more unsightly. Some of these STD's are also potentially fatal. Teenagers will respond to this much better. For example, if you teach them about genital warts, show them pictures of these warts. When they learn about these warts and see them, they are much more likely to practice safer sex than if you just teach them about AIDS. Genital warts can cause symptoms weeks or months after infection (a time period they can relate to). It's also important to teach teens how we treat genital warts (burning them off, freezing them off, surgically removing them, putting chemicals on them etc.). In addition, tell them that this is caused by a virus (Human Papilloma Virus) that is also incurable, and the symptoms can come back again and again. And it's also important to tell them that this virus has been linked to certain forms of cancer.

When a teen sees the pictures of these warts, finds out that they can cause symptoms in weeks or months, finds out how they're treated (ouch!), and hearing that they can come back again and again, they are much more likely to practice safer sex. Also, teens are much more likely to protect themselves against herpes and syphilis than they are against HIV. This is because both herpes and syphilis also cause unsightly lesions within a few weeks after infection.

So rather than teaching teens about a disease that can lead to symptoms an average of 10 years after infection (an eternity in the minds of teenagers), teach them about other STD's, which can cause symptoms in weeks or months, and are very unsightly. They are much more likely to respond to this approach when it comes to protecting themselves against these diseases. When teens protect themselves against STD's, they're protecting themselves against HIV/AIDS at the same time.

This is only half of the prevention message. It is just as important to teach teens about the drug prevention message. I'm not just talking about IV drugs here. I'm talking about ANY drug that can affect a persons judgement. Drug use in teens is increasing at an alarming rate! It is well known that persons under the influence of alcohol and other recreational drugs (including cocaine, pot, etc.) are at increased risk for HIV and other Sexually Transmitted Diseases (STD's). This is because, while under the influence of these drugs, a persons judgement is significantly affected. When a person is drunk or high, they tend to put themselves at greater risk for HIV/STD's. These drugs reduce a persons inhibitions, and people tend to do things they wouldn't normally do. A person is more likely to have sex or share needles (IV drug needles or tattoo needles) with another person, when they are drunk or high. They are also less likely to use condoms, or use them correctly. Persons working with HIV/STD patients commonly see persons being under the influence of these drugs when they put themselves at risk. We therefore recommend that persons with a substance abuse history (including alcoholism) consider getting tested for HIV and other STD's. And remember, drug abuse and alcoholism are becoming more and more common among teens.

In persons who are addicted to various illegal drugs (like crack cocaine), their risk is also increased in another way. When a person is addicted to drugs like cocaine, they will often engage in prostitution as a way to get their illegal drugs (either by direct sex for drugs, or by prostitution for money that will pay for drugs). This is very common. So illegal drugs like cocaine can increase a persons risk for HIV/STD's, both by increased risk-taking while under the influence of these drugs, AND by engaging in prostitution in order to get access to the drugs.

It's hard to say whether the majority of persons infected with HIV/STD's became infected while under the influence of these drugs. But we can say that substance abuse (including alcohol abuse) significantly increases one's risk of becoming infected with these diseases. When most people think of AIDS and drugs, they commonly think only about intravenous (IV) drugs. It's important to remember that any drug that affects judgement (including cocaine, pot, alcohol, and other recreational drugs) also increases a persons risk of infection as well. If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide).



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