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The incidence of human immunodeficiency virus (HIV) infection among adolescents is increasing. Youths who were abused and neglected and in out-of-home care are among those at highest risk of acquiring HIV The concurrence of sexual activity and school failures contributes to their high-risk status. Research suggests that changing behaviors of troubled youths requires programs that not only include HIV-related knowledge, attitudes, and skills, but also incentives and skills for educational planning that will expand the future life options of these youths.
Youths who are abused and neglected and in out-of-home care are among those at highest risk of acquiring HIV [D'Angelo et al. 1994]. The concurrence of sexual activity, family instability and disruption, behavioral and emotional problems, and school failures contributes to their high-risk status. Although cognitive-behavioral strategies appear promising, they have had limited success in maintaining long-term behavioral changes. This article presents a conceptualization of HIV prevention for adolescents in independent living programs that links the reduction of HIV-risk behaviors with expansion of youths' life options through educational planning. Independent living programs, created by P.L. 99-272 and authorized by an amendment to Title IV-E of the Social Security Act, are funded under a federal entitlement and delivered by state child welfare agencies to prepare and support youths in their transition from out-of-home care to selfsufficiency and independence. HIV prevention should be an integral part of preparing youths for this transition and for survival.
This article presents (1) the characteristics of youths in the child welfare system that place them at risk of HIV infection; (2) previous attempts at HIV prevention used with this population, and their limitations; (3) data that provide a rationale for designing HIV prevention programs with a life options perspective; and (4) a strategy to prevent HIV infection that includes educational planning and the provision of assets for youths in out-of-home care.
Risk Characteristics of Youths in the Child Welfare System
Youths involved with the child welfare system usually present with psychosocial problems associated with risk behaviors that make them vulnerable to HIV infection. These problems include histories of physical or sexual abuse, neglect, family instability and disruption, poor health, educational deficits, substance abuse, and delinquent behaviors [Barth 1990]. One of the risk factors of adolescents leaving the out-of-home care system...