School-Based Protective Factors for HIV Prevention in the United States: Secondary Analysis of the Youth Risk Behavior Survey 2015-2019.
David R Garcia, Jason Fletcher, Lloyd Goldsamt and 3 others
PMID 39259519WHAT IT FOUND
Adolescent boys who identified as gay, bisexual, or unsure and had sexual experience were less likely to engage in HIV risk behaviors if they felt safe at school and achieved academically.
Having both protective factors lowered odds further. School nurses are key contacts for testing and condom advice.
Key findings
01Feeling safe at school was associated with reduced likelihood of early sexual debut, having multiple partners, and sex under the influence of drugs or alcohol.
02Academic achievement was associated with increased condom use but, paradoxically, decreased HIV testing.
03Students who experienced both protective factors (safe school and academic achievement) had significantly lower odds of multiple sexual partners and sex under the influence compared to those with none.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used self-reported data, which can be subject to bias. The sample excluded students who had dropped out or were in alternative education programs, who may have the highest risk. The cross-sectional design means the study shows association, not causation; safe schools do not necessarily cause lower risk behaviors. The dataset lacked geographic and socioeconomic information, preventing analysis of structural determinants of health.
Declared interests
The study was supported by the National Institutes of Health. The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the associations as proof that making schools safer or improving grades will directly reduce HIV risk behaviors. The data is cross-sectional and self-reported, so it is possible that students who are already less risky feel safer and perform better academically.