A mixed method study of HIV risk among Jamaican adolescent girls with older male sexual partners

Adolescent girls in Jamaica have an estimated risk of acquiring HIV infection that is two and a half times higher than that of their male counterparts. Age-discordant relationships, or sexual relationships between adolescent girls and men who are two or more years older, have been blamed for this disparate risk. The purpose of this study was to describe the context of age-discordant relationships between adolescent girls and older male partners in Jamaica, and examine the sexual risk behaviors for HIV that occur within these relationships. Guided by a Dyadic Expansion of the Theory of Planned Behavior, this study utilized a mixed method design consisting of both descriptive qualitative and quantitative research approaches. Purposively sampled focus groups and individual interviews were conducted with 43 late adolescent girls (18-21 years) living in Kingston, Jamaica and analyzed through qualitative content analysis. Surveys were administered to a convenience sample of 199 late adolescent girls (18-21 years) and analyzed using descriptive and association statistics. The findings from this study confirmed that age-discordant relationships in Kingston, Jamaica were widespread and the majority involved transactions of gifts, money or other resources. Age-discordant relationships were found to be culturally normative for Jamaican adolescents, and allowed adolescent girls to seek security from the multiple insecurities that are part of their day-to-day lives. Survey findings indicated no significant differences in rates of condom use between girls who were in age-discordant relationships and those who were not. However some girls in age-discordant relationships may have increased their risk of HIV/AIDS exposure through limited condom use and multiple partnerships. As the age differentials between partners widened, girls' relationship control decreased. Relationship characteristics, such as age differential and the relative importance of transactions were not significantly related to girls' intentions to use condoms with their older partners or actual condom use. Study findings highlighted culture-specific features of age-discordant relationships that can be incorporated into future HIV prevention programs for adolescent girls in Jamaica.