Strengthening Families to Disrupt Intergenerational Health InequitiesWith Adolescents at Risk for Commercial Sexual Exploitation, Substance Use, and HIV

• Published in: American journal of public health (1971) 2023-01, Vol.113, p.S124-S128
• Main Authors: Bounds, Dawn T, Rodrigues, Sarah M, Milburn, Norweeta G
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adaptation; Adolescents; Aggression; AIDS; Basic needs; Bisexuality; Caregivers; Childhood; Childhood factors; Children; Clustering; Communication; Crime; Discrimination; Disease transmission; Drug abuse; Drug use; Ethnic identity; Exploitation; Families & family life; Family power; Gender; Gender aspects; Gender identity; Health care; Health risks; HIV; Homeless people; Homophobia; Households; Housing; Human immunodeficiency virus; Inequality; Intervention; Lesbianism; LGBTQ people; Marginality; Mental health services; Minority groups; Oppression; Parents & parenting; Public health; Racism; Recruitment; Risk factors; Sex; Sexism; Sexual behavior; Sexuality; Sexually transmitted diseases; Social exclusion; STD; Stress; Substance abuse; Substance use; Teenagers; Transgender persons; Trauma; Violence; Vulnerability
• ISSN: 0090-0036

Individuals aged 13 to 24 years account for one out of every five new HIV diagnoses in the United States.1 The commercial sexual exploitation (CSE) of children is a major risk factor for transmission of HIV and other sexually transmitted infections.2 CSE is a complex crime encompassing recruitment of minors for the performance of commercial sex acts, buying sexual services, and "survival sex" or the exchange of any sexual activity for basic needs regardless of the monetary value.2 While children from every demographic in the United States have experienced CSE, minoritized adolescents-particularly those identifying as racially/ethnically minoritized or minoritized because of sexual preference or gender identity (lesbian, gay, bisexual, transgender, queer or questioning, or other [LGBTQ+]) are disproportionately vulnerable.2The substance abuse, violence, and HIV/AIDS syndemic refers to the documented clustering of substance abuse, violence (including CSE), and HIV among marginalized groups.3 A syndemic lens views these phenomena as interrelated health disparities occurring within a broader milieu of power relations, trauma, and structural inequities.3 A syndemic approach to CSE prevention recognizes the contribution of social environments to vulnerability and centers families and communities as key protective resources.4Family-based public health interventions must shift away from the historical focus on individual risk factors (e.g., gender, race, sexual orientation) to adequately consider how identity, historical trauma, and systemic and internalized oppression (sexism, racism, homophobia, and transphobia) affect minoritized individuals' vulnerabilities and disproportionate exposure to adversity.2 Key to preventive public health approaches is recognizing that adversity-impacted adolescents who simultaneously experience adverse childhood experiences, financial strain, and housing instability are most vulnerable to CSE, substance use, and HIV infection. While racially/ethnically minoritized adolescents navigate added burdens of racial stress, trauma, and discrimination, their parents are shouldering the added responsibility (and stress) of enabling their children to cope with racism and discrimination.5 Public health practitioners working with high-risk populations must therefore be careful not to perpetuate narratives about minoritized families that fail to examine how oppressive power structures impede healthy family functioning.