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News — Partner abuse leads to HIV infection, and black women are most at risk. A new study at the University of Pennsylvania School of Nursing has found that 46 percent of African-American adolescent girls report that their partner did not use a condom the last time they had sex -- often because of partner abuse. The girls described physical and sexual abuse and threats as preventing them from having their partner use condoms. The relationship between HIV and partner abuse is significant: In the U.S., at least 12 percent of HIV infections among women are a result of partner abuse.

Getting out of an abusive relationship should be considered an HIV prevention strategy, according to Anne M. Teitelman, assistant professor at the University of Pennsylvania School of Nursing, who published the study in the journal 鈥淎dvances in Nursing Science.鈥� Dr. Teitelman and her co-authors advocate the need for novel strategies to increase condom use among adolescents. The co-authors are Julie Tennille, MSW, LSW; Julia M. Bobinski, BSN, MS; Loretta S. Jemmott, PhD, RN, FAAN; and John B. Jemmott III, PhD.

鈥淧romoting healthy relationships among youth and preventing partner abuse in adolescent relationships should become a public health priority,鈥� writes Dr. Teitelman. 鈥淭his is necessary for primary prevention of the intersecting epidemics of partner abuse and HIV/STIs [sexually transmitted infections].鈥�

The study of 64 African-American adolescent girls, aged 14 to 17, illuminates the pressure a male partner may exercise to encourage girls to forgo condom use. Understanding the practice, which the authors term 鈥渃ondom coercion,鈥� can inform more tailored prevention methods and interventions for adolescent girls at high risk for HIV and STIs, the authors report. Forms of condom coercion include physical and sexual abuse and threats, emotional manipulation, and condom sabotage, as when a male partner surreptitiously removes a condom.

Of the sample, 59 percent of girls experienced partner abuse that was physical, verbal, or threatening. Nearly 30 percent reported having unwanted vaginal sex and about 9 percent reported having unwanted anal sex. More than half the girls indicated they had experienced vaginal sex without a condom when they wanted their partner to use one.

When faced with partners trying to dissuade them from using condoms, girls may also feel pressures that silence them from even raising the topic of condom use. In the study, 25 percent of participants responded affirmatively to the question: 鈥淗ave you ever wanted to talk with your sexual partner about using a condom during vaginal sex, but were not able to?鈥�

This comment addresses the issue of 鈥渟ilencing condom negotiation,鈥� which the authors define as girls鈥� reluctance to voice an interest in condom use at the risk of losing the relationship or facing other negative consequences.

As one study participant reported: 鈥淚f we talk about just STIs and HIV, we鈥檙e not addressing the whole picture. . . . I鈥檓 easily pressured into doing things that I don鈥檛 want to do and it鈥檚 hard to sit back at the time and ask myself, 鈥業s this something that I really want to do?鈥� . . . oftentimes it鈥檚 what he wants, but what I want . . . you don鈥檛 want a baby, you don鈥檛 want a STD, you don鈥檛 want HIV. . . . do you want him to beat you up? . . . Don鈥檛 let anybody tell you it鈥檚 not about what you want, and he鈥檚 going to be telling you that. There鈥檚 always a way out of things, always.鈥�

Dr. Teitelman and colleagues are developing a clinic-centered intervention for girls based on their findings.

***The University of Pennsylvania School of Nursing is one of the premier research institutions in nursing, producing new knowledge in geriatrics, pediatrics, oncology, quality-of-life choices, and other areas. Researchers here consistently receive more research funding from the National Institutes of Health than any other private nursing school, and many Master鈥檚 programs are ranked first in the country. This year, faculty, students, alumni, and staff celebrate 125 years of nursing at Penn.