Associate Professor of Nursing Loretta Sweet Jemmott delivered a Provost’s Lecture Series talk Dec. 4 about reducing HIV risk among African American adolescents in urban communities. The following excerpt taken from her lecture discusses her approach to research and HIV prevention and the strategies needed to help individuals change their sexual behaviors.

I’m from the school of the “so-what” theory. What do I mean by that? I’m a professor at Penn. So what? You know I do all this great research, and I publish in top journals. And the community people say, “So what.” The bottom line is, what does that mean for me? What does that mean for the community?

What I learned is [that] what I was doing in those [prevention] programs was talking to kids without understanding their total picture. They would come in and talk to me after school and say, “Ms. Sweet, I am hearing everything you say and I am really understanding it all.” And they would go back, and the next time they still practiced the behavior. “I still had sex and didn’t use anything.”

Facts were not enough

What’s going wrong here? I learned that I was looking at this person in a closed system and not looking in an open system. I didn’t understand all the issues that were impacting this one child’s life. All I was doing was teaching knowledge [and] factual information. But what I wasn’t doing was look at the other issues—family, community, peers, [personal] issues [and] poverty.

Based on all the work I was doing in West Philly, I decided to look at black male teenagers’ sexuality. My dissertation was on 200 black male teenagers in the city of Philadelphia, mean age, 14.

Now back in those days no HIV was in my community yet. We were looking at teen pregnancy and STDs. We were in the mid-’80s now. When I did that research I found out that they had average knowledge about teen pregnancy and STDs. They had negative attitudes about condoms though. Condoms don’t feel good. They reduce pleasure. They engage in a lot of different kinds of behavior too—anal sex, oral sex. But the mean for first sexual behavior among that population was 11. So my goal in life was to...again, the “so-what” theory. Am I going to publish these findings? Mean age, 11. Seventy-eight percent didn’t use anything the first time they had sex; 55% didn’t use anything the last time they had sex. And so my whole career progress in life was about doing something about what I found.

Design a new product

Why do I do this work today? Seventeen percent of the cases reported in 2001 were people 13 to 24. Kids still have a high rate of STDs and are still struggling to use condoms. So what I found in ’85 still counts today.

So what we had to do is design a product to change some of these young people’s risk behavior. But in doing this work we found that there were challenges in dealing with adolescents. They feel invulnerable. They resist these abstinence-based messages. And they have negative beliefs about safer sex practices and condom use.

Teach how to make a difference

In order to change behavior you have to build up somebody’s self-efficacy. Self-efficacy is defined as a person’s perception of their confidence to do the behavior that you want them to do. Outcome expectancy is defined as a person’s perception of the outcome of the behavior that you are trying to get them to do. If they perceive the outcome of the behavior to be negative, they are not going to do it.

People have sex because it is supposed to feel good. So when we tell them to use condoms, what do they say about condoms? “They don’t feel good.” So that’s a negative outcome expectancy. What we have to do is reverse that so they can understand that condoms don’t have to be that way. Condoms can feel okay. Condoms don’t have to interfere with pleasure. We could teach them how to make a difference.