Scenarios for HIV Training; Practicing Counseling Skills with Adolescents Contemplating

Scenarios for HIV training; practicing counseling skills with adolescents contemplating sexual relationships, at risk for HIV, thinking of submitting to an antibody test)

Scenario 1

S., a 13-year-old sexually inactive female, lives with her mother and two siblings in a low-income housing project. Her mother recently sought treatment for herself in a local emergency room after enduring several days of heavy vaginal bleeding. The hospital staff informed S.’s mother that the bleeding had resulted from a miscarried pregnancy and additionally revealed that S’s mother carries the virus that causes AIDS. Because S. has a history of sexual abuse at the hands of some of her mother’s boyfriends it seems like a good idea to encourage S. to submit to an HIV test.

Scenario 2

U., a 15 year sexually active old male living in foster care, began having sex at the age of 11 almost always with older men with whom he has little ability to negotiate the use of a condom. In fact, it has become pretty much a non-issue at this point. U. would have avoided any type of intervention, as he has received many expensive “presents” (not payments, he insists) from his friends but he found himself in the custody of authorities as the result of an investigation into the drug use of one of his partners. A bright, likable student, he earned respectable grades in an alternative high school that allowed him a good half-a- day to pursue these relationships before his mother got home from work. He and his mother ran away from his abusive father four years ago, even changing their last names and minimizing community contact to avoid being traced by him. He presents as good-natured but his emotional development bears the scars of life

1 Scenarios for HIV training; practicing counseling skills with adolescents contemplating sexual relationships, at risk for HIV, thinking of submitting to an antibody test) experiences that taught him he has little control over his own future. He clearly understands the nature of HIV but states, “If God wants me to get AIDS, I’ll get it.”

Scenario 3

V., a 17 year old sexually active female lives with her financially secure biological parents, attend school regularly, participates in after school activities and expects to graduate this year from high school. Her referral to you came as the result of confidential notifications made after the death of an old boyfriend in a car accident. At the time of admission to the hospital, her routine test came back positive for HIV antibodies. Although V. had multiple unprotected partners she has never known the sero-status of any of them. V. has long-standing goals for the future and has already registered for the fall semester at an out of town state college, close to some extended family. She feels as if she has everything to lose and has not told her parents about the notification. Both her parents have fairly prominent roles in the local community and she fears for their rejection as well as her own if she should test positive for HIV.

Scenario 4

W., a 13 year old sexually active male, lives with his biological mother and two older siblings, 15 and 17, in a local homeless shelter subsequent to the family’s dislocation due to his father’s gambling addiction and linked conviction for embezzlement. His close relationships with his brothers have allowed him

2 Scenarios for HIV training; practicing counseling skills with adolescents contemplating sexual relationships, at risk for HIV, thinking of submitting to an antibody test) access to a much older peer group in which he initiated alcohol and occasional

IV drug use, and sexual relationships with girls much older than he, beginning at age 11. He had previously excelled in athletics and his physical maturity literally puts him head and shoulders above the crowd. Lately, he’s experienced a dry cough, fatigue, some skin rashes, and a decreasing level of commitment to his swim team. While most concerned adults attribute the symptoms to the upheaval he’s currently experiencing, you think that reasons exists for greater concern. As the case manager for this shelter, you have to take a thorough psychosocial history on all clients and you think this might serve as a bridge to a discussion of

X’s sexual history and related concerns.

Scenario 5

X., a 14-year-old sexually active female, lives in foster care subsequent to removal from the custody of her 19 year old brother’s custody. Their parents died in a car accident one year ago and X’s brother adamantly assumed responsibility for her care and upbringing. He obtained a fulltime job, ensured her school attendance and performance, and maintained her general health and nutrition.

Their remarkable determination to stay together in their home seemed to sustain them through a life with few extras, and they had kind neighbors who often left them gifts of essential items. However, it recently came to the brother’s attention that X has granted some of his friend “sexual favors” in exchange for money she uses for shopping, in an effort to dress and feel more like one of the girls at school. He, himself, called CPS and now he insists that she undergo testing for

3 Scenarios for HIV training; practicing counseling skills with adolescents contemplating sexual relationships, at risk for HIV, thinking of submitting to an antibody test)

HIV. Criminal charges related to her status as a minor remain unfiled, as X will not divulge the identities of her partners.

Scenario 6

K., a 13 year old perinatally infected female, lives in and out of foster care because her HIV+ mother spends frequent periods of time in jail. K. admits to actively seeking pregnancy through unprotected intercourse with her boyfriend who knows her status but says her doesn’t care nor does her use condoms. His sero-status remains undetermined though he admits to infidelity and promiscuity, all un-protected. Due to chronic non-compliance, K.’s doctors now hesitate to give her more meds as she’s running out of options for treatment. Currently living with her mother (or her boyfriend when she and mom fight) and chronically truant from school, K. has few support systems and a seriously compromised health status.

Scenario 7

P., a 16-year-old perinatally infected female who looks more like 12, lives with her mother who actively enables P.’s non-compliance with medications by sanctioning P.’s decision to take just one dose per day. P. uses alcohol and drugs weekly x 2 at unspecified doses and usually in the company of older

“friends” who help her sneak into dance clubs and bars. She regularly engages in body piercing and sexual intercourse without any precautions or disclosure to her partners. She longs to feel “normal” and this translates into a very tough impenetrable exterior that makes approaching her with assistance very difficult.

She lacks role models, a health self image, environmental and therapeutic support systems, and just plain old real friends.

Scenario 8

Z., a 14 year old sero-negative female, has lived in foster care since age

11 when her mother died of AIDS and extended family members refused to give her and her siblings a home, despite their negative status. Z. rarely talks about her mother and seems to harbor tremendous posthumous anger. She expresses little interest in seeing her siblings though her foster mother has made many efforts to bring them all together. Z.’s foster mother believes that Z has initiated sexual relationships subsequent to reading several entries in Z.’s diary, and needless to say, this revelation has caused a tremendous rift in their previously good relationship. The foster mother grew concerned when reports from school indicated unexplained tardiness and absenteeism, curfews went unobserved, and Z began wearing “unauthorized” articles of “hip hop” clothing and suddenly displayed several, equally unauthorized, body piercings. Z. insists that she remains a virgin though happily reports that many boys her age and older have expressed explicit interest in her. You know that many young girls often engage in anal sex as a means of “protecting” their virginity and preventing pregnancy, and if Z. has done so, only a remote likelihood of her insisting on condom use exists.

Revised 9-12-01