HIV and Sexually Transmitted Diseases:
Implications for
Juvenile Sexual Offenders and their
Victims
Tiffany Chenneville, Ph.D.
Florida Psychological Association
November, 2005
Objectives
• Discuss estimated rates of HIV and STDs among
juvenile sexual offenders
• Discuss risk factors associated with HIV-risk taking
behavior among juvenile sex offenders
• Discuss legal and ethical issues associated with
juvenile sexual offenders known or suspected to be
HIV positive or the carrier of an STD
• Discuss intervention strategies for working with
juvenile sexual offenders to prevent the spread of
HIV and other STDs
Epidemiology of HIV Disease
in General Population
• AIDS cases globally
• CDC Surveillance Report (United States)
– Current cases
– Total deaths
– Trends based on age, gender, and ethnicity
• AIDS cases in Florida
– Adult
– Pediatric
Epidemiology of HIV Disease in
General Population
• Problems with epidemiological data
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Changing definitions
Adolescents grouped with adults (15-24 year olds)
Anonymous testing/HIV home test kits
Undiagnosed cases
HIV tracking vs. AIDS tracking
Conclusion: Estimates are gross underestimate!!
Estimating the Prevalence of HIV
and STDs among Juvenile Offenders
• Elevated rates of HIV and STDs among
correctional populations (including juvenile
correctional facilities) worldwide
– In some countries, 20-40% or correctional
populations are infected with HIV or STDs (Seal, 2005)
– Estimated that AIDS cases in prison
population is 5 times that in US general
population (Braithwaite, Hammett, & Jacob Arriola, 2002)
• African American incarcerated youth are
considered to be at even greater risk for HIV
infection (Gary, Yarandi, Verbosky, Lopez, Campbell, & Scruggs, 2000)
Risk Factors associated with HIV
and STDs among Juvenile Offenders
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Drug/alcohol use
Injection drug use
Mental illness
Infectious disease co-morbidity (e.g., hepatitis)
Relationship between adolescent psychopathology
and HIV-risk behaviors (Donenberg et al., 2001)
– Delinquency linked to drug/alcohol use
– Aggression related to risky sexual behavior
– Leads to hypotheses about juvenile sexual
offenders and estimated rates of HIV
(Donenberg, Emerson, Bryant, Wilson, & Weber-Shifrin, 2001; Seal, 2005)
HIV Knowledge and Safe Sex Practices
among Juvenile Sexual Offenders and
Juvenile Offenders
• Juvenile Sexual Offenders (limited data available)
– Comparison of juvenile sexual offenders to a group
of runaways (Rotheram-Borus, Becker, Koopman, & Kaplan, 1991)
• Juvenile sex offenders found to be less knowledgeable
about HIV and less likely to engage in safe sex practices
•
HIV Knowledge and Safe Sex Practices
among Juvenile Sexual Offenders and
Juvenile Offenders
• Juvenile Sexual Offenders
– Factors Associated with HIV Knowledge and Attitudes towards
Safer Sex in a Population of Juvenile Sexual Offenders
• Male adolescent juvenile sex offenders
• Variables
– Measures
(Trisdale, 1999)
» AIDS Knowledge Questionnaire
» Views about Sex Questionnaire
» Beck Depression Inventory
– Ethnicity
– Sexual orientation
– Total lifetime number of sexual partners
HIV Knowledge and Safe Sex Practices
among Juvenile Sexual Offenders and
Juvenile Offenders
– Results
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In general, this group had…
Very low scores on test of HIV knowledge
Low intent to engage in safer sex in the future
Negative correlation between HIV knowledge, intent to engage
in safer sex in the future, and scores on the BDI
– As depression increased, HIV knowledge and intent to engage in safe
sex decreased
HIV Knowledge and Safe Sex Practices
among Juvenile Sexual Offenders and
Juvenile Offenders
• Juvenile Offenders
– Most report… (Robertson & Levin, 1990)
• Being sexually active
• Early onset of sexual activity
• Unsafe sexual practices
• Low intent to engage in safer sex in the
future (Trisdale, 1999)
Legal/Ethical Issues
Mandatory Testing of Juvenile Sexual Offenders
• Do you think HIV testing should be legally
mandated for sexual offenders?
– What about for juvenile sexual offenders?
• Why or why not?
Legal/Ethical Issues
Mandatory Testing of Juvenile Sexual Offenders
• Arguments in Favor of Mandatory Testing
– Reduce the incidence of HIV
– Allows for treatment of HIV for victim and offender
– Reduce anxiety among victims of sexual crimes
• Arguments Against Mandatory Testing
– Fourth Amendment protection against unreasonable search and
seizure/privacy rights
– Victims can/should be tested themselves to ensure negative status
due to window period between HIV infection and development of
HIV antibodies, which can be diagnosed on the basis of an HIV
test
Legal/Ethical Issues
Mandatory Testing of Juvenile Sexual Offenders
• Washington Supreme Court (1993) ruled that a
state statute requiring HIV testing for all sexual
offenders applied to juvenile sexual offenders
– The court ruled that…
• Benefits to society outweighed possible intrusion into
juveniles’ privacy interests
• Intent of the law is to reduce the incidence of STDs, which is
consistent with public health policies
• Law beneficial to juveniles, victims, and society by making
HIV status known so that all concerned can receive treatment,
if necessary, and to prevent infection of others
Legal/Ethical Issues
Mandatory Testing of Juvenile Sexual Offenders
• People v. Benjamin G. (2004)
– In 2002, Benjamin (a minor child) admittedly committed a lewd
and lascivious act against his younger brother (a minor child under
the age of 14)
• Benjamin was placed on probation and was adjudged a ward of the court and
was placed in a group home, and imposed a $100 restitution fine
– In 2003, Benjamin came before the court on similar charges
• Court terminated probation, committed Benjamin to the California Youth
Authority, imposed a second $100 restitution fine, and ordered an HIV test
• Benjamin appealed the fine and the HIV test, claiming that penetration had
not taken place
• The court ruled that, according to CA law, every person convicted of a
sexual offense must submit to a blood test for HIV
Legal/Ethical Issues
Mandatory Testing of Juvenile Sexual Offenders
• State of New Jersey v. J.G.
– Initially, trial court refused to order HIV test of three
juveniles charged with raping a girl
• Medical testimony showed that best way for victim to
learn HIV status would be for her to under HIV test
herself
– New Jersey Superior Court Appellate Division
reversed the trial judge
• Mandatory testing may ease victim’s anxiety about HIV
status
Legal/Ethical Issues
Mandatory Testing of Juvenile Sexual Offenders
• State of Arizona v. Superior Court (1995)
– Law forcing juvenile sex offenders to submit to HIV
antibody test does not violate 4th Amendment protection
against unreasonable search and seizure
– However, neither judges nor prosecutors can order the
tests at their own initiative
• Rather, only the victim’s parents or guardians can request the
tests
– Applies to adjudicated delinquents who either
• Committed a sexual offense or
• “Significantly exposed” a victim to the offender’s blood or
body fluids (other than saliva, tears, or perspiration)
Legal/Ethical Issues
Mandatory Testing of Juvenile Sexual Offenders
Florida Law
• Florida Statute 960.003 (2005): “HIV testing for
persons charged with or alleged by petition for
delinquency to have committed certain offenses;
disclosure of results to victim”
• (1) Legislative Intent
– Victims have a right to know if the alleged offender is infected
with HIV
– Denying victims such information such information causes
“unnecessary mental anguish in persons who already have suffered
trauma”
– Early diagnosis and intervention beneficial to both victim and
offender
Legal/Ethical Issues
Mandatory Testing of Juvenile Sexual Offenders
Florida Law
• (2) Testing of Person Charged with or Alleged by Petition
for Delinquency to Have Committed Certain Offenses
– (a) Court shall order HIV testing for the alleged offender if
• Offense involves the transmission of bodily fluids from one person to
another AND
• The victim or the victims parent or legal guardian, if the victim is a
minor, requests the HIV testing
– (b) However, if, at the time of the offense, the victim is a minor, a
disabled adult, or an elderly person, then the condition that the
offense involve the transmission of bodily fluids need not be
present
• Testing must be performed under direction of Dept. of Health
• Testing performed on a defendant or juvenile offender will not be
admissible in any criminal or juvenile proceeding arising out of the
alleged offense
Legal/Ethical Issues
Mandatory Testing of Juvenile Sexual Offenders
Florida Law
• (3) Disclosure of Results
– (a)
Results must be disclosed within 2 weeks of
receipt, under direction of Dept of Health
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Victim
Alleged offender
Parent of alleged offender (if positive)
Public health agencies (if positive)
Results are otherwise confidential
– (b)
Opportunity for face-to-face counseling must be
made available at the time of disclosure of results,
pursuant to Florida Statute 381.004(3)
Legal/Ethical Issues
Mandatory Testing of Juvenile Sexual Offenders
Florida Law
• (4) Postconviction Testing
– HIV testing can be court order postconviction, if it has
not been ordered prior, consistent with the guidelines in
(1)-(3).
• (5) Exceptions
– (a) Alleged offender has undergone voluntary HIV
testing and
– (b) Results were provided to the victim and, if the victim
is a minor, his/her parents or legal guardians
Legal/Ethical Issues
Mandatory Testing of Juvenile Sexual Offenders
Florida Law
• (6) Testing During Incarceration, Detention, or
Placement; Disclosure
– If a juvenile offender has not been tested under the
conditions of subsection (2), but undergoes HIV testing
during incarceration, detention or placement
• Results shall be disclosed in accordance with subsection (3)
– Requests for disclosure shall be considered a “standing
request for any subsequent HIV test results obtained
within 1 year of the initial HIV test performed
• i.e., Request for disclosure need not be repeated after each test
administration performed within 1 year of the initial test
Intervention Strategies
• Sex education listed as an important content area to be
included in treatment (Righthand & Welch, 2001)
– Other Areas:
• Cognitive restructuring
• Empathy training
• Values clarification
– Abusive vs. nonabusive sexual behavior
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Impulsivity control training
Social skills training
Reduction of deviant arousal
Relapse prevention
• No sex education programs designed specifically for
juvenile sexual offenders
– Number of sex education programs designed for juvenile offenders
Intervention Strategies
• Sexual Risk Reduction Skills Training (ST) vs. Anger Management
(AM) Interventions for Incarcerated Male Adolescents
(St. Lawrence, Crosby, Belcher, Yazdani, & Brasfield, 1999)
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428 male juvenile offenders enrolled in a state reformatory
Randomly assigned to 6-week session (ST or AM)
Pre/Post test design
Cognitive mediating measures
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AIDS knowledge
Condom attitudes
Self-efficacy with regard to condom use
Perceived risk
Conflict tactics
Anger management
Impulsivity
– Behavioral skills in condom use assessed at baseline and 6 months post-release
– Results
• ST participants reported greater AIDS knowledge, self-efficacy, positive attitudes
about condoms, and significantly greater condom use than AM participants
• AM participants reported no changes in attitudes or knowledge following the
intervention
• Both groups showed significant decreases in sexual risk behaviors and drug use upon
follow-up
Intervention Strategies
• HIV and STD Prevention Program for Adolescents
in Juvenile Rehabilitation Centers (Godin, Michaud, Alary, Otis,
Masse, Fortin, Gagnon, & Gagnon, 2003)
– HIV/STD prevention program designed for adolescents
with social adaptation difficulties
– Pre-test/Post-test quasi-experimental design
– Experimental group
• 296 adolescents (12-18 year old males and females)
• Participated in the prevention program
– Control group
• 240 adolescents (12-18 year old males and females)
• Did not participate in the prevention program
Intervention Strategies
• Intervention Program
– Theoretical Basis (Theory of Reasoned Action, Theory of
Planned Behavior, Theory of Interpersonal Behavior, &
Social Cognitive Theory )
– 10 sessions (each 75-90 minutes in length)
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Meaning of sexual intercourse
Unsafe and safer sexual activities
Pros and cons of condom use
Values and sexuality
Negotiation of safer sex
Communication skills
Self-affirmation
Arguing to overcome obstacles to safer sex behavior
Intervention Strategies
– Learning Activities
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Group discussions
Brainstorming
Role playing
Problem solving
Demonstrations
Condom manipulation
Improvisation
Audiovisual documents
Intervention Strategies
– Variables measured
• Intention to use condom
– Ex. “I have the intention to use a condom each time if I have sex with a new
partner during the next 3 months”
• Attitude toward condom use (using rating on paired adjectives)
– Ex. “useless/useful, unpleasant/pleasant, shameful/honorable, etc”
• Perceived behavioral control about condom use (using rating on paired
adjectives)
– Ex. “For me, using a condom each time that I might have sexual intercourse
with a new partner during the next 3 months would be….very difficult/very
easy.”
• Personal/normative belief (Likert scale…strongly agree/disagree)
– Ex. “If I had sexual intercourse with a new partner during the next 3 months, I
would feel guilty about not using a condom each time.”
• Knowledge about transmission modes and prevention of HIV and other
STDS
• Habit of using condoms
– Assessed by asking respondents to evaluate how often they used condoms in the
last 3 months when having intercourse with a new partner
Intervention Strategies
• Results
– No significant differences between groups at baselines in terms of
variables measured
– Significant findings for adolescents in experimental group
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Intention to use condoms
Increased self-efficacy
Personal normative beliefs toward using a condom was higher
Attitude toward using condoms was higher
Behavioral beliefs were higher
Perceived behavioral control was higher
Knowledge about HIV/STDs was higher
Intervention Strategies
• What problems might you foresee in attempting to
apply an HIV prevention program designed for a
“juvenile offender” to a “juvenile sexual offender”?
Intervention Strategies
• Implications of Research Findings for Practice
– Need to individual interventions
– Determine function of sexual behavior
– Assess HIV knowledge, intentions, behavior skill level
with regard prevention efforts
– Assess for emotional factors which may impede HIV
prevention
Conclusion
• More research is needed in this area
– Epidemiological information about rates of HIV among population
of juvenile sexual offenders
– HIV prevention programs specifically designed for this population
• Contact Information
– Tiffany Chenneville, Ph.D.
University of South Florida
Department of Psychological and Social Foundations
4202 East Fowler Avenue, EDU 162
Tampa, Florida 33620
813-974-9499
727-644-5911
chennevi@coedu.usf.edu or chenneville@juno.com