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Repeated Acquisition of Sexually Transmitted Infections: Feelings, Perceptions, and Explanations of Adolescent Girls

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Title:
Repeated Acquisition of Sexually Transmitted Infections: Feelings, Perceptions, and Explanations of Adolescent Girls
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MCGHAN, CHERYL
Copyright Date:
2008

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Adolescents ( jstor )
Chlamydia ( jstor )
Condoms ( jstor )
Daughters ( jstor )
Gonorrhea ( jstor )
Infants ( jstor )
Mothers ( jstor )
Narratives ( jstor )
Pregnancy ( jstor )
Sexually transmitted diseases ( jstor )
City of Jacksonville ( local )

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University of Florida
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University of Florida
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Copyright Cheryl Mcghan. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
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5/31/2006
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74811693 ( OCLC )

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REPEATED ACQUISITION OF SEXUALLY TRANSMITTED INFECTIONS: FEELINGS, PERCEPTIONS, AND EXPLAN ATIONS OF ADOLESCENT GIRLS By CHERYL McGHAN A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLOR IDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2005

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Copyright 2005 by Cheryl McGhan

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To the girls who shared their intimate storie s with me; and also to adolescent girls everywhere who are trying to find meaning in their lives and in their relationships.

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ACKNOWLEDGMENTS This research was supported by funding from the Florida Department of Health, Bureau of Sexually Transmitted Disease Prevention and Control; and the Centers for Disease Control, Sexually Transmitted Disease Control through Contract Number COA7V from the Florida Department of Health, Bureau of STD Prevention and Control. I thank Karla Schmitt for her support and assistance and especially for providing the opportunity for me to participate in the state study and to present my findings at the National STD Conference in 2004. I thank Jami Leichliter for her support and assistance during this project. I thank Sharleen Simpson who has mentored me during my doctoral research, and who assisted in my professional and personal growth and helped me view myself and the world through different eyes. I thank the staff at the Duval County Health Department, who made time in their busy clinic schedule to assist in this endeavor (especially Chip, who personally made it his business to make our project successful; “Big Mike” for his countless hours of computer searching: and Otto for the formidable task of helping me to decipher my tapes). I thank my son, Christopher, for his unending comradery, humor, support and technical guidance through many projects and papers during my doctoral studies; and especially for his help with the dissertation. Without him I could not have accomplished this project. I thank my son, Joshua, for bearing with me during this process and for his many hours of running errands and taking care of things at home. iv

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I thank my committee members (Sandra Seymour, for providing insight and guidance to my study of adolescent girls; Dr. Yarandi, for his time in tutoring me through statistics; and Dr. Chen, for his advisement and guidance in my minor study in health education). v

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TABLE OF CONTENTS page ACKNOWLEDGMENTS .................................................................................................iv LIST OF TABLES ...............................................................................................................x LIST OF FIGURES ...........................................................................................................xi ABSTRACT ......................................................................................................................xii CHAPTER 1 THE PROBLEM...........................................................................................................1 Comparison of Chlamydia Rates..................................................................................2 Comparison of Gonorrhea Rates..................................................................................2 Reinfection with Gonorrhea and Chlamydia................................................................3 Increased Significance of Gonorrhea and Chlamydia for Adolescent Girls.................5 Rationale for State Study on STI Reinfection in Adolescents......................................6 Purpose of Study...........................................................................................................7 Theoretical Perspective.................................................................................................7 2 REVIEW OF LITERATURE.....................................................................................12 Theories of Adolescence and Gender Differences.....................................................12 Erikson’s Adolescent Developmental Tasks.......................................................13 Piaget’s Theory of Cognitive Development in Adolescence..............................13 Effects of Cognition on Sexual Decision-Making...............................................14 Delayed or absent cognitive maturity...........................................................14 The personal fable or perceived invulnerability to risk................................15 “Hot” cognition............................................................................................15 Developmental Theory Applied to Adolescent Sex, Intimacy, and Relationships.....16 Adolescent Girls: Identity Formation and Meaning of Relationships.................18 Adolescent Girls: Gender, Power, and Relationships.................................................20 Relationship Factors............................................................................................20 The Theory of Gender and Power.......................................................................21 State of the Research..................................................................................................23 Three Generations of Adolescent Risk Behavior Research................................25 The first generation......................................................................................25 The second generation..................................................................................26 vi

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The third generation.....................................................................................26 3 METHODOLGY........................................................................................................29 Narrative Inquiry as a Fit for the Study......................................................................29 Narrative Theory.........................................................................................................31 Truth and Reality.................................................................................................31 Personal Meaning.........................................................................................32 Reflexivity....................................................................................................33 The Narrative Self........................................................................................33 Narrative as Methodology..........................................................................................34 From Story to Narrative.......................................................................................34 Data Collection....................................................................................................35 Data Analysis: Analysis of Narratives and Narrative Analysis...........................35 Study Design...............................................................................................................37 Ethical Considerations.........................................................................................37 Procedures for the protection of human subjects.........................................37 Post interview counseling and follow up.....................................................39 Study Population.................................................................................................41 Eligibility......................................................................................................41 Recruitment..................................................................................................41 Enrollment....................................................................................................43 Data Collection....................................................................................................43 Conducting the interviews............................................................................43 Transcribing the interviews..........................................................................46 Data Analysis.......................................................................................................48 Analysis of narratives...................................................................................48 Narrative analysis.........................................................................................49 Evaluation............................................................................................................50 Ethical validation..........................................................................................51 Substantive validation..................................................................................52 4 NARRATIVE ANALYSIS OF STORIES TOLD BY TWELVE GIRLS.................54 Profiles of Twelve Girls..............................................................................................54 Girls Who Are Mothers.......................................................................................54 Girls Who Are Not Mothers................................................................................57 Narratives of Life Stories Told by Twelve Girls........................................................59 Ashley’s Story: Told on October 10, 2002..........................................................59 Priscilla’s Story: Told on March 6, 2003............................................................63 Rose’s Story: Told on March 10, 2003...............................................................69 Jenny’s Story: Told on September 17, 2002.......................................................74 Nicole’s Story: Told on March 10, 2003.............................................................80 Princess’s Story: Told on October 28, 2002........................................................84 Tarianna’s Story: Told on June 2, 2003..............................................................89 Poo’s story: Told on September 16, 2002...........................................................94 Poo’s Story Continued: Told on February 27, 2004............................................97 vii

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Maurteeona’s Story: Told on November 11, 2002............................................100 Maurteeona’s Story Continued: Told on February 17, 2004.............................105 Shan’s Story: Told on July 22, 2003.................................................................109 Tosha’s Story: Told on October 17, 2002.........................................................113 Keisha’s Story: Told on March 3, 2003............................................................116 5 ANALYSIS OF NARRATIVES..............................................................................124 Inadequate Parenting................................................................................................124 Absent Fathers...................................................................................................124 Mothers..............................................................................................................126 Supportive mothers....................................................................................126 “OK, but not the best” mothers..................................................................127 Abusive and absent mothers.......................................................................128 Grandmothers.............................................................................................129 Aunts and uncles........................................................................................129 Trust and Betrayal of Trust in Intimate Relationships..............................................130 Men Cheat and Lie about It...............................................................................130 Men Cheat and Lie and Blame the Girl for It....................................................131 He Admitted He Cheated...................................................................................131 He Cheated but He Doesn’t Know Why...........................................................132 That’s Any Man.................................................................................................133 I Know I Can Trust Him....................................................................................133 Staying with Him...............................................................................................135 Women Cheat Too Sometimes..........................................................................137 Trusting and Using Condoms............................................................................139 Betrayal of Trust as Abandonment....................................................................144 Betrayal of Trust Seen as Having a Child with Another...................................145 Power Imbalances and Violence in Dating and Relationships..........................146 Becoming Pregnant and Being a Mother..................................................................148 Girls who are Mothers.......................................................................................149 Girls who are not Mothers.................................................................................151 Hope for the Future...................................................................................................153 6 DISCUSSION AND CONCLUSIONS....................................................................158 Factors Contributing to the Acquisition of Repeat STIs..........................................158 Absent or Inadequate Parenting.........................................................................158 Need for Intimate Relationships........................................................................160 Desire for Pregnancy.........................................................................................162 Hope for the Future...........................................................................................163 STI Risk Reduction Intervention Needed Now........................................................164 Practical Interventions and Theories.................................................................165 Sexual Risk Reduction Interventions for Adolescents in a Public Clinic Setting............................................................................................................167 Proposed Clinic Interventions to Reduce Repeat STIs in Duval County Adolescents....................................................................................................168 viii

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Inservice for STD clinic staff.....................................................................169 STD clinic protocol for adolescent STI repeaters......................................171 Standardized utilization of professional services.......................................173 Dual Method Approach for STI and Pregnancy Prevention.............................175 Implications for Nursing...........................................................................................176 Future Research........................................................................................................176 APPENDIX A INFORMED CONSENT..........................................................................................178 B HIPPA INFORMED CONSENT.............................................................................184 C TEEN REFERENCE LIST.......................................................................................189 D INTERVIEW GUIDE...............................................................................................191 E ORIGINAL TRANSCRIPTS OF TWO INTERVIEWs..........................................194 Interview with Priscilla.............................................................................................194 Interview with Tarianna............................................................................................215 LIST OF REFERENCES.................................................................................................238 BIOGRAPHICAL SKETCH...........................................................................................252 ix

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LIST OF TABLES Table page 1-1 Chlamydia case rates (per 100,000 people)...................................................................9 1-2 Gonorrhea case rates (per 100,000 people)...................................................................9 3-1 Demographics and STI history of adolescent girls in study........................................53 x

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LIST OF FIGURES Figure page 1-1 Incidence of Chlamydia in adolescent girls in Duval County compared to State incidence...................................................................................................................10 1-2 Incidence of Gonorrhea of adolescent girls in Duval County compared to State incidence...................................................................................................................11 2-1 Conceptual model of adolescent risk taking behavior.................................................28 xi

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Abstract of Dissertation Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy REPEATED ACQUISITION OF SEXUALLY TRANSMITTED INFECTIONS: FEELINGS, PERCEPTIONS, AND EXPLANATIONS OF ADOLESCENT GIRLS By Cheryl McGhan May 2005 Chair: Sharleen Simpson Major Department: College of Nursing This study explored factors that contributed to re-infection with gonorrhea (GC) or chlamydia (CT) among low income, inner-city adolescent girls in Jacksonville, Florida. In-depth qualitative interviews or narratives of 12 girls were taped, transcribed, and analyzed. Narratives are stories related from the perspective of an individual’s lived experiences. These stories allowed the girls to express their feelings about themselves, their relationships, and specific events in their lives that contributed to having repeated sexually transmitted infections (STIs). An analysis of the narratives identified recurring themes across interviews; and then narrative analysis identified recurrent themes in individual interviews. Stories were compared to find commonalities and differences, and to identify patterns in story plots. No one profile described a typical girl who was an STI repeater. Girls interviewed ranged from high-school dropouts who were teen parents, to those who were high-school honor students on birth control. The analysis of these narratives revealed four general themes. xii

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First, many girls experienced either inadequate or abusive parenting. Second, in spite of many extenuating life circumstances, the desire and need to form meaningful relationships with a male partner was central and took precedence over other issues. The girls knew about STIs and “safe sex” and had access to condoms, but the need for a need to trust someone, even after repeated STIs indicated betrayals, often won out over the need for safety. Third, many girls wanted to be pregnant or were already mothers. Desire for pregnancy competed with condom use, and contributed to risky behaviors. Fourth, in spite of past or current circumstances, these girls were survivors. They showed enormous resiliency and were very optimistic about their futures. These findings suggest that interventions designed to prevent further STIs must address life issues more far-reaching than having an STI before girls can hear preventive messages. xiii

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CHAPTER 1 THE PROBLEM Although the impact of the human immunodeficiency virus (HIV) has shifted attention away from other sexually transmitted infections (STIs), the disease burden from bacterial STIs (such as chlamydia and gonorrhea) is great. Some population groups are disproportionately affected by STIs and their complications. Women suffer more frequent and more serious complications than men. Adolescents between 15 and 19 years old and young adults between 20 and 24 years old have higher rates of STIs than any other age group (Centers for Disease Control and Prevention, 2004b) Chlamydia (CT) and gonorrhea (GC) infection rates are extremely high among Jacksonville, Florida, adolescents. The scope of the problem for adolescents in Jacksonville may be placed in context by examination of national and state statistics for these two STIs. Statistics quoted from different sources sometimes differed slightly because different formats for computing were used. Nationwide statistics were obtained from data from The Centers for Disease Control and Prevention (CDC). All Florida statistics were obtained from data from the Florida Department of Health, Division of Disease Control, Bureau of STD. Statistics for the year 2000 were the most recent available at the time the study began, and are quoted in this chapter. At this time 2003 national and state statistics are available. The case rates for chlamydia nationwide, Florida, and Jacksonville have all increased since 2000. However since 2000, case rates for gonorrhea have continued to 1

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2 decline (Centers for Disease Control and Prevention, 2004a; Florida Department of Health, 2004). Comparison of Chlamydia Rates Recent statistics from the CDC indicate that chlamydia is the most frequently reported infectious disease in the United States. It is estimated that more than 2.8 million cases occur annually (Centers for Disease Control and Prevention, 2004a). Nationwide, the total rate of chlamydia in 2000 was 248.5 cases per 100,000 (Centers for Disease Control and Prevention, 2004b). The rate of chlamydia for women (392.4 cases per 100,000) was four times higher than the case rate for men (99.1 cases per 100,000). Nationwide, the case rate for all adolescents was 1,318.6 per 100,000. For adolescent girls, however, the rate was 2,352.5 per 100,000; while for adolescent boys, the rate was only 340.8 per 100,000 (Centers for Disease Control and Prevention, 2004b). In 2000, the Florida total case rate for chlamydia (207.7 cases per 100,000) was slightly below the nationwide case rate as was the adolescent case rate of 1,253.2 per 100,000 (Florida Department of Health, 2004). However, the Jacksonville case rate of chlamydia (447.2 per 100,000) was twice as high as the Florida case rate. Jacksonville adolescents had a case rate of 2,354.6 per 100,000. Adolescent girls in Jacksonville had an astonishing rate of 4,113.4 cases per 100,000. This rate is nearly twice the statewide rate of 2,292.1 (Florida Department of Health, 2004) and the nationwide rate of 2,352.5 (Centers for Disease Control and Prevention, 2004b) for adolescent girls. Table 1-1 shows a comparison of these rates. Comparison of Gonorrhea Rates The rate of gonorrhea has declined during the last decade. The Centers for Disease Control and Prevention (2004b) reported that in 2000, the nationwide case rate of

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3 gonorrhea remained stable at 127.1 cases per 100,000. The nationwide rate of gonorrhea for adolescents was 519.9 per 100,000. In 2000, the Florida overall gonorrhea rate was 141.7 per 100,000, which was slightly higher than the national rate. For adolescents in Florida, the rate was 610.7 per 100,000. In Jacksonville, however, the case rate of gonorrhea rose by 22% in 2000, despite the declining trend noted nationwide (Centers for Disease Control, 2002). The overall rate of gonorrhea in Jacksonville was 465 per 100,000, three times higher than the Florida rate (Florida Department of Health, 2004). The rate of gonorrhea for adolescents in Jacksonville was 1,788.3 per 100,000. This disparity was reflected even more dramatically in adolescent girls. The 2000 nationwide case rate for gonorrhea in adolescent girls was 700 per 100,000, and in Florida the case rate was 826 per 100,000 (Centers for Disease Control and Prevention, 2004b; Florida Department of Health, 2004). However, Jacksonville reported a gonorrhea case rate of 2,139.4 per 100,000 among adolescent girls, which was two and one-half times the statewide rate and three times the nationwide rate. Table 1-2 shows a comparison of these rates. It is interesting to note that the gap between the state and Duval County lessened between the 2000 and 2003 statistics for gonorrhea rates; however the gap between the state and Duval County for chlamydia rates increased (Figure 1-1; Figure 1-2). It was beyond the scope of this study to determine the significance of this finding, although understanding why this occurred could be helpful in future prevention efforts. Reinfection with Gonorrhea and Chlamydia A substantial proportion of individuals infected with gonorrhea or chlamydia will become reinfected with one of these STIs (Baker et al., 2001; Hughes et al., 2001; Gunn,

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4 Fitzgerald, and Aral, 2000; Richey, Macaluso, and Hook, 1999). In fact, several recent studies indicate that the strongest predictor of a subsequent infection of gonorrhea or chlamydia is a recent history of gonorrhea or chlamydia infection (Crosby, Leichliter, and Brackbill, 2000; Gunn et al., 2000; Mosure, Berman, Kleinbaum, and Halloran, 1996). Further, adolescents and young adults are more likely than adults to become reinfected with an STI (Thomas, Weiner, Schoenbach, and Earp, 2000). Recent studies of women reported that “age under twenty-five” was the strongest predictor of chlamydia infection and reinfection (Burstein et al., 2001), and that young age (especially among adolescents) was the strongest predictor of one or more repeat infections (Xu et al., 2000). In addition, adolescent girls are more likely than boys to become reinfected. Among adolescent girls who had an initial chlamydia infection, 54% of girls under 15 years old and 30% of girls between 15 and 19 years old experienced a recurrence of chlamydia (Hillis, Nakashima, Marchbanks, Addiss, & Davis, 1994). Adolescent girls were reported to be at particular high risk for reinfection with acute STI (Hughes et al., 2001). Among 12 to 15 year olds, 20% had a repeat STI within 12 months; and among 16 to 19 year olds, 24% had a repeat infection. A recent study by Whittington et al. (2001) found that 13.4% of young women became reinfected with chlamydia within 4.3 months of the initial infection. A longitudinal study noted that more than 50% of inner-city adolescent girls with a chlamydia infection had a repeat infection within a 6to 7-month period. Whittington et al. also determined that adolescence was the single strongest independent predictor of recurrent chlamydia infection (Burstein et al., 1998). Fortenberry et al. (1999) found that more than 40% of infected adolescent women had at least one subsequent STI within a year, but this study also included trichomoniasis. A

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5 later study of adolescents and young adults (14 to 21 years old) reported that 60% of male subjects (mean age 18 years old) and 73% of female subjects (mean age 17 years old), who were infected with gonorrhea, chlamydia, or trichomoniasis at the time of the study enrollment, became reinfected within 7 months of the initial infection (Orr, Johnson, Brizendine, Katz, and Fortenberry, 2001). Increased Significance of Gonorrhea and Chlamydia for Adolescent Girls Sexually active adolescent girls are at higher risk than adult women to become infected with chlamydia or gonorrhea because of a biologic condition called cervical ectopy.” Cervical ectopy is an immature anatomic condition in which the columnar epithelium of the uterine endocervical canal temporarily extends to the outer surface of the cervix. The columnar epithelium is the primary site of invasion by both chlamydia and gonorrhea. Because of increased access and surface area, these pathogens are more likely to thrive (Biro and Rosenthal, 1995; Cates, 1991; Taylor-Seehafer and Rew, 2000). The much higher rate of both gonorrhea and chlamydia in adolescent girls is alarming because women experience a disproportionate burden of complications from these STIs. Infections due to gonorrhea and chlamydia are a major cause of PID in the United States. It is common for PID to be subclinical and chronic and therefore to remain undiagnosed and untreated. Up to 40% of women with untreated chlamydia will develop PID. Of those women with PID, 20% will become infertile, 18% will experience chronic pelvic pain, and 9% will experience a tubal pregnancy, which is the leading cause of first trimester pregnancy-related deaths in American women (Bolan, Ehrhardt, and Wasserheit, 1999). Repeat or recurrent infections with gonorrhea or chlamydia are responsible for tubal scarring that causes infertility and ectopic pregnancy (Cates and Brunham, 1999; Hillis et al., 1994).

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6 Sexually transmitted infections may also result in emotional consequences for adolescent girls. Adolescent girls frequently blame themselves for contracting an STI, which researchers feel could interfere with healthy sexual development (Baker et al., 2001). Although adolescent girls reported a decrease in sexual intercourse after acquiring an STI, their rates of STI did not decrease. Based on these statistics, researchers concluded that girls may have reported their intent (to not have intercourse) rather than what they actually did. These researchers also advised that if adolescent girls continued to have intercourse even though they did not want to, it could interfere with healthy sexual development (Biro and Rosenthal, 1995). Rationale for State Study on STI Reinfection in Adolescents Hughes et al. (2001) stated that reinfection with an STI represents a failure of primary and secondary prevention activities at STD clinics. Yet, research on determinants of STI reinfection among adolescents is limited. Because of the high rates of STIs (including repeat infections of chlamydia and gonorrhea among adolescents in Florida) the State of Florida Bureau of STD Prevention and Control, in collaboration with the CDC, funded and supported a study titled “Determinants of Re-Infection with Gonorrhea or Chlamydia among Adolescent Females and Males Attending an STD Clinic.” A qualitative study design used in-depth interviews to explore underlying contextual, psychosocial, and relational factors that may contribute to reinfection with STIs among adolescents who attended the Duval County STD Clinic in Jacksonville. This site was selected because the reinfection rates with chlamydia and gonorrhea are higher in Jacksonville adolescents than in the rest of Florida. During 2000, Duval County (Jacksonville) reported 20% of the total adolescent STI male reinfections and 12.5% of female reinfections for the year in Florida (personal communication, Florida Bureau of

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7 STD Prevention). The intent of the study was to uncover information from the interviews that would be useful as a guide in the development of an intervention to help reduce rates of STI reinfection in this and similar populations. Purpose of Study The larger state study focused on STI reinfection in both boys and girls. However, because of the disproportionate incidence of gonorrhea and chlamydia in adolescent girls (and the severe impact that these STIs can have on their future health and childbearing potential) this dissertation concentrated on the interactions among contextual, psychosocial, and relational factors to help explain why some adolescent girls repeatedly acquired STIs. We conducted in-depth interviews using a narrative approach to obtain information from the perspective of the adolescent girls. By listening to significant stories that the girls told us about their lives, we gained insight into how they understood their sexual behaviors and justified decisions about risky sexual behaviors that resulted in STIs. Theoretical Perspective No single conceptual framework can explain complex social behaviors, such as sexual risk-taking behaviors and acquisition of STIs. Jessor (1991) described complex social behavior as embedded in a “web of causation” that must be understood when human behaviors are risk factors for various health risks. Some familiarity with several bodies of literature is needed to understand why adolescent girls may repeatedly acquire sexually transmitted infections. Theories of adolescent development have been reviewed as background for understanding sexual decision-making of adolescent girls from an individual and relational perspective. Research literature has been reviewed relating to gender issues concerning sex and romance and the use of power and control in male

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8 female relationships. Several articles that described Decision Theory as it related to adolescent risk-taking decision-making (Fischhoff, Downs, and Bruine de Bruin, 1998; Furby and Beyth-Marom, 1992) were also reviewed for background before the study.

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9 Table 1-1. Chlamydia case rates (per 100,000 people) Nationwide Florida Jacksonville 2000 2003 2000 2003 2000 2003 All cases 248.5 304.3 207.7 246.9 447.2 550.2 All men 99.1 134.6 74.3 93.2 182.3 259.3 All women 392.4 468.1 334.9 393.4 696.9 824.6 All adolescents 1,318.6 1,523.9 1,253.2 1,384.6 2,354.6 2,853.6 (15 yo) Adolescent boys 340.8 423.4 270.4 277.5 627.9 751.8 Adolescent girls 2,352.5 2,687.3 2,292.1 2,552.1 4,113.4 5,019.3 Table 1-2. Gonorrhea case rates (per 100,000 people) Nationwide Florida Jacksonville 2000 2003 2000 2003 2000 2003 All cases 127.1 116.2 141.7 110.5 465.0 285.7 All men 129.7 113.3 151.9 114.1 537.0 320.2 All women 124.6 119.0 132.0 107.2 396.7 253.2 All adolescents 519.9 443.4 610.7 436.5 1,788.3 899.9 (15 yo) Adolescent boys 321.0 262.4 407.2 269.2 1,443.5 596.7 Adolescent girls 700.0 634.7 826.4 612.9 2,139.4 1,212.3

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10 Figure 1-1. Incidence of Chlamydia in adolescent girls in Duval County compared to State incidence. Data Source: Florida Dept. of Health, Division of Disease Control, Bureau of STD data files. Population Source: Florida Department of Health, Office of Planning, Evaluation and Data Analysis based on the Demographic Estimating Conference Projections by the Executive Office of the Governor, Chlamydia was first reported in September 1993

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11 Figure 1-2. Incidence of Gonorrhea of adolescent girls in Duval County compared to State incidence. Data Source: Florida Dept. of Health, Division of Disease Control, Bureau of STD data files. Population Source: Florida Department of Health, Office of Planning, Evaluation and Data Analysis based on the Demographic Estimating Conference Projections by the Executive Office of the Governor, Chlamydia was first reported in September 1993

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CHAPTER 2 REVIEW OF LITERATURE Theories of Adolescence and Gender Differences Research has shown that testing limits and taking risks are functional, purposeful, and necessary for normal adolescent development. In fact, they are necessary for identity formation and achievement of autonomy (Baumrind, 1987; Jessor, 1991; Muuss, 1996). Adolescents frequently are able to engage in these behaviors without significant risk to health. However, sexual risk-taking behaviors that result in contracting STIs can have serious long-term consequences (Jadack & Keller, 1998; Baumrind, 1987; Burke, 1987). During adolescence, a process of psychosocial and cognitive maturation occurs, usually in an orderly, predictable sequence. The contributions of two important developmental theorists, Erik Erikson (1902) and Jean Piaget (1896), have been explored in order to best explain these developmental factors and the important implications they have for understanding sexual risk-taking behaviors of adolescents. Carol Gilligan’s Theory of Sex Differences in Adolescent Development (which provided a feminist orientation) also guided this study. Gilligan was a colleague of Erik Erikson and Lawrence Kohlberg in the 1960s and early 1970s. She noted that studies on identity formation conducted by Piaget and Erikson had all-male samples, as did Kohlberg’s work on moral reasoning. Gilligan’s early feminist research was related to gender differences in moral reasoning. Her more-recent research interest focused on the identity crisis that girls often experience when they become adolescents (Muuss, 1996). 12

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13 Erikson’s Adolescent Developmental Tasks The developmental tasks of adolescence are derived from Erikson’s psychosocial theory. Steinberg (2002) described these developmental tasks as (a) developing an identity or gaining autonomy and independence; (b) developing intimacy in a relationship; (c) developing comfort with one’s sexuality; and (d) developing a sense of achievement. These developmental processes are reflected in behavioral changes as an adolescent moves from early (age 10 to 14) to middle (age 15 to 17) to late (age 18 to 20) adolescence. Erikson felt that the main task of adolescence is the attainment of an ego-identity. Although concern with identity issues remains during one’s entire life, it is most pronounced during adolescence. Erikson felt identity could be found only in interaction with significant others. By mid-adolescence, most teenagers have had some range of interpersonal and sexual experiences. The range of experiences varies considerably (Erikson, 1968; Muuss, 1996). Piaget’s Theory of Cognitive Development in Adolescence Piaget’s theory of cognitive development underpins the current understanding of how children learn. Piaget described young children as being cognitively egocentric. That is, they are unable to differentiate their thoughts and feelings from those of another person. During late childhood and adolescence, a maturational shift evolves from egocentric to sociocentric thinking, which means that they are able to understand other people and consider another person’s point of view. Piaget maintained, however, that even adults retain some egocentric thinking, especially in new or challenging situations (Inhelder & Piaget, 1958; Muuss, 1996; Piaget, 1980). According to Piaget, children think in concrete terms. Problem-solving must be linked to real-life situations because the ability to think abstractly is not yet developed.

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14 During early to mid-adolescence, a transition occurs from concrete operational thought to formal operational thought. Formal thought allows the adolescent to think abstractly and to problem-solve by considering hypothetical consequences of behaviors (Inhelder & Piaget, 1958; Muuss, 1996). Effects of Cognition on Sexual Decision-Making Delayed or absent cognitive maturity Cognitive maturity, or formal operational thought, is an important ability that can enable an adolescent to consider possible consequences of sexual behavior. For sexually active adolescents, the level of cognitive development is reflected in their decisions regarding partner selections and relationships and the use of protection from STIs and pregnancy. Recent research has determined that formal operations may develop much later in life than previously determined by Piaget. Brown (2000) reported that the ability to think in formal operations requires nurturance at the appropriate times or it will never fully develop. Only 50% of the late adolescent and adult population may actually attain the full stage of formal thinking (Baumrind, 1987; Brown, DiClemente, & Reynolds, 1991; Grant & Demetriou, 1988; Muuss, 1996; Sachs, 1987). Delay or lack of development of formal thought may contribute to greater sexual risk-taking behaviors. Even in adolescents who do achieve cognitive maturity, the ability is considered domain-specific and many areas of cognitive immaturity remain (Brown et al., 1991; Muuss, 1996; Turiel, 1989). Irwin (1989) proposed that inexperienced cognition may be responsible for adolescents failing to perceive negative consequences to sexual behaviors.

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15 The personal fable or perceived invulnerability to risk Elkind’s construct of the personal fable (as cited in Steinberg, 2002) has long been used to explain the excessive risk-taking behaviors of adolescents. The personal fable may be expressed as “it can’t happen to me.” Elkind proposed that adolescents believe they are unique, indestructible, and invulnerable to risk (Steinberg, 2002). Therefore natural laws that apply to others do not apply to them (Quadrel, Fischoff, & Davis, 1993). The personal fable is no longer accepted as a uniquely adolescent construct, although some researchers feel that this aspect of egocentrism peaks in adolescence (Steinberg, 2002). Research on risk perception in adults (Cohn, Macfarlane, Yanez, & Imai, 1995; Weinstein, 1982, 1984; Weinstein & Lachendro, 1982) shows that adults also are optimistically biased, and think their own chances of experiencing health and safety problems are less than the chances of their peers. Unrealistic optimism is conceptually equivalent to perceived invulnerability (Whaley, 2000). Some studies show a relationship between increased perceived susceptibility to HIV and safe sex, but other studies have failed to document a behavior change even when there is a perceived risk (Moore & Rosenthal, 1991; Whaley, 2000). Furby and Beyth-Marom (1992) proposed that unconscious thought components may contradict a conscious thought. For example, an adolescent girl may admit she is vulnerable to STIs if she has unprotected sex, but she may still unconsciously feel that “it can’t happen to me.” “Hot” cognition Individuals often make decisions about sexual behaviors when they are physically and emotionally aroused or in the heat of the moment, a term called “hot” cognition (Kipke, 1999). In these situations, adolescents (and adults) are far less likely to exercise their capacity for abstract, formal reasoning (Eyre, Read, & Millstein, 1997; Irwin, Igra,

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16 Eyre, & Millstein, 1997; Sachs, 1987; Sandler, Watson, & Levine, 1992; Gerrard, Gibbons, & Bushman, 1996; Halpern, Joyner, Udry, & Suchindran, 2000). As early as 1972, Gilligan, Kohlberg, Lerner, and Belenky described a significant decline in moral reasoning in dilemmas involving sexual situations with which adolescents could identify, as compared to other situations in which they were more detached. Kaplan and Shane (1993) used the term “motivated reasoning” to describe the same concept. The motivation for sexual activity at the time may be more immediate and stronger than the motivation to avoid an STI or pregnancy. If one perceives a conflict between having sex and practicing safe sex, then one is likely to reason that there is no need for safe sex or is likely to minimize the risk (Kaplan & Shayne, 1993). Gladis, Michela, Walter, and Vaughan (1992) also found that denial or minimization of perceived risk or “motivated denial” is influenced by emotional states. Gold, Karmiloff-Smith, Skinner, and Morton (1992) referred to self-justifications (which were used by adolescents during sexual activity, to enable a desire for unprotected sex) as “cognitions of convenience.” Monsen, Jackson, and Livingston (1996) also found that protecting oneself from STIs may be irrelevant during the emotional stress of sexual activity. Developmental Theory Applied to Adolescent Sex, Intimacy, and Relationships The theoretical constructs of Erikson and Piaget have been used to explain the meanings that adolescents may attach to romantic relationships throughout different developmental phases. Young adolescents form relationships from an egocentric cognitive perspective that Stevens-Simon (1993) described as narcissistic in nature. Erikson believed that the experience of falling in love for a young adolescent was an attempt to test the developing ego-identity in relation to the opposite sex rather than because of sexual desire. He felt that the physiological urge for sexual activity did not

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17 emerge until mid-adolescence (Muuss, 1996). Brown (2000) also observed that although romantic relationships during early and mid-adolescence are intense, they tend to be brief because the partner usually fails to match up to the ideal image. Although most early to mid-adolescents are not promiscuous, a pattern of serial monogamy is common (Stevens-Simon, 1993). Erikson believed the capacity for establishing intimacy occurred in midto late adolescence. He felt older adolescents were able to put a greater emphasis on mutuality and reciprocity in their relationships. The need for intimacy and meaningfulness in relationships, along with a physiological urge for sexual activity, causes many adolescents to initiate sexual intercourse (Biro & Rosenthal, 1995; Rosenthal et al., 2001). Often adolescents report that sexual intercourse is considered the norm in relationships, especially after partners have gotten to know each other (Keller, Duerst, & Zimmerman, 1996). Duerst, Keller, Mockrud, and Zimmerman (1997) reported that by the age of 16, 42% of adolescents had at least one episode of sexual intercourse; and by the age of 18, 71% of adolescents were sexually active. Burke (1987), however, maintained that relations among adolescents lack the intimacy and depth that Erikson identified in his adolescent stage. She stated that initiation of sexual intercourse may signify an important rite of passage that represents becoming grown up, but these attempts at intimacy most often achieved only a pseudointimacy. Grant and Demetriou (1988) stated that true intimacy must include a feeling of commitment that is important in determining STI protection. Many adolescents engage in sexual intercourse before achieving a developmental level of maturity in which they can establish commitment; and this fact increases their risk of acquiring STIs.

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18 Jadack and Keller (1998) remarked that it requires greater intimacy to talk about sex than to do it. Often adolescents find it difficult to discuss concerns with a partner, such as a desire to refrain from sexual activity, or to use protection during sex, or to honestly disclose their sexual history that may include previous STIs. Gerrard et al. (1996) stated that communication problems could be so overwhelming for adolescents that they can sabotage the best intentions to practice safe sex. Risk perceptions may not be powerful enough to overcome barriers of embarrassment or an uncooperative partner (Burke, 1987). Adolescent Girls: Identity Formation and Meaning of Relationships Erikson proposed that gender differences exist in adolescent psychosocial development. He believed that adolescent girls confront a more complex task in forming their identity than boys do, because girls are concerned with their own sense of self, and also with the impact of that self on other people who are significant in their lives. He determined that identity formation must occur before the ability to establish intimacy in relationships in adolescent boys. This sequence, however, is reversed in girls. Identity formation may either follow the ability to establish intimacy or it may develop at the same time. For some girls, the development of identity formation and intimacy may even be “fused” (Muuss, 1996). Gilligan (1977) extended Erikson’s work and described distinct gender differences in interpersonal and sexual behaviors and approaches to decision-making. She referred to these differences as the masculine and feminine voice” that represented different ways of seeing and understanding the world, oneself, relationships with other people, and moral issues. The male voice is individualistic and speaks of logic and justice. The female voice is relational and speaks of caring and concern for others and avoiding hurt and violence.

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19 Both genders are able to speak with either voice; but men usually speak only with the masculine voice, while women more often speak with both voices (Gilligan, 1993). Gilligan (1993) determined that young girls (and women) define themselves in the context of relationships. A sense of connection to others is an essential aspect of the psychological development of girls. Adolescent girls deal with identity formation, and also often face an identity crisis. According to Gilligan, age 12 to 13 is a pivotal time for adolescent girls. By this time, girls are aware of societal expectations that women should be nice, unassertive, and pleasing to others. Adolescent girls struggle between their desire to freely and honestly express themselves in their relationships and their fear that they would hurt or even lose relationships if they did express themselves. Others have suggested that girls often choose to suppress their thoughts and opinions and thereby “lose their voice” (Brown & Gilligan, 1992, Gilligan et al., 1992; Jadack & Keller, 1998; Muuss, 1996). This loss of voice causes some adolescent girls to become confused and troubled (Jadack & Keller, 1998; Muuss, 1996). Several researchers have reported that depression in adolescent girls can lead to less effective safe-sex behaviors (DiClemente, Wingood, Crosby, Sionean, Brown, et al; Laraque, McLean, Brown-Peterside, Ashton, & Diamond, 1997). Adolescent girls are often confused about their sexuality and how to incorporate it into emotional relationships (Rosenthal, Lewis, & Cohen, 1996). They often equate sexual intimacy with emotional intimacy (Rosenthal, Lewis, Succop, Burklow, & Biro, 1997; Rosenthal et al., 2001), and they more often talk about love or commitment as motivators for sexual activity, whereas boys more often talk of pleasure and fun (Taris & Semen, 1997).

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20 Moore and Rosenthal (1992) found that romance was important to adolescent girls and was a frequent precursor to sexual intercourse. Romantic views of sex, however, may promote risky behavior. A girl may romanticize casual sex to be a meaningful relationship and interpret her partner as being faithful. She may conclude that it is not necessary to practice safe sex (Rosenthal et al., 1996). Practicing safe sex can be interpreted as turning love into just sex. The loss of voice, as described by Gilligan (Brown & Gilligan, 1992; Gilligan et al., 1992), also makes it more difficult for girls to talk about potentially embarrassing or sensitive topics (Jadack & Keller, 1998). Adolescent Girls: Gender, Power, and Relationships Relationship Factors Crosby, DiClemente, et al. (2000) advocated the study of sexual behavior within the context of relationship factors. They noted that the strength of couple identity in decision-making may be more important than individual decision-making, and also may be stronger than peer or family influences. Although female peers may influence adolescent girls, they rely more strongly on their male partners in sexual decision-making. Many authors (Furby, Ochs, & Thomas, 1997; Hughes et al., 2001; Kalof, 1995; Whittington et al., 2001) also have indicated that further understanding of behaviors of women and their sex partners is necessary to reduce the risk of reinfection in women. Whittington et al. determined that repeat STIs in young women were due to resumption of sex with untreated partners rather than having a new sex partner or other sexual behavior risks. Hughes et al. found that the high rate of reinfection in adolescent girls was independent of the number of sexual partners. This indicated that a high reinfection rate was not a result of frequent changes in sexual partners.

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21 The Theory of Gender and Power Connell’s Theory of Gender and Power (1987) described power imbalances, such as issues of authority, control, and coercion in male-female relationships. Lear (1995) stated that sexual relations reflect a struggle between “the exercise and acceptance of male power and male definitions of sexuality and of woman’s ambivalence and resistance” (p. 1314). Wingood and DiClemente (2000) used the Theory of Gender and Power to explain how power imbalances in issues of authority and control in relationships influence safe-sex practices. In Connell’s theory, cathexis refers to the social relationships women have with their sexual partners, and dictates appropriate sexual behavior for women. This may mean, for example, that a woman may chose not to negotiate safe sex or condom use because she may feel it is improper, or that it could undermine trust and intimacy in the relationship. By having sex without condoms, a woman may deny the implications of sexual infidelity for herself or her partner (Wingood & DiClemente, 1998, 2000). Sobo (1995) used the term “monogamy narratives” to describe stories that inner-city African-American women told in order to maintain a denial of unfaithfulness of their partners and rationalize low levels of condom use. The amount of power that a woman feels in her relationships has been linked to her ability to make sexual decisions (Biro & Rosenthal, 1995; Rosenthal et al., 1996; Rosenthal et al., 2001). Studies indicate that adolescent girls have even less control in their sexual relationship than do adult women (Wingood & DiClemente, 2000). Therefore the context of adolescent girls’ relationships also must be considered in terms of gender roles and power differentials that may increase their risk for STIs. Wingood and DiClemente noted that factors that increase a girl’s chance of getting an STI include having an older male partner, a high-risk steady partner, or a partner who disapproves of

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22 practicing safe sex. Interestingly, they also found that the sexual attraction that partners have for each other, as well as imbalances of power in the relationship, affect the practice of safe sex. Adolescent girls are likely to have sex to please their boyfriends without actual enjoyment of sex. A study by Sionean, Wingood, Cobb, and Davies (2002) found that 24% of adolescent girls age 13 to19 years old had engaged in some form of sexual activity when they did not want to do so. Rosenthal et al. (2001) found that younger girls often describe partner pressure as a reason for having sex. Even those girls who stated they had voluntary sex said they did not particularly desire it. Sionean et al. and other researchers (Biro & Rosenthal, 1995; Rosenthal et al. 1996; Rosenthal et al., 2001), contend that adolescent girls (as well as adults) may choose not to refuse unwanted sex, especially unprotected sex, because refusal may cause their partners to feel insulted or suspect infidelity that could damage or even cause loss of the relationship. Furby et al. (1997) reported that 50% of the girls in their study related nonuse of condoms to concerns that their partner might react negatively. They felt that girls’ concern that their male partners may not like prevention measures (such as condoms) reflected gender power imbalances. Sturdevant et al. (2001) found that the sex partners of adolescent girls are key factors in determining condom use. More condom use was reported with nonsteady partners than with steady partners. In this study, the male partner averaged 4 to 6 years older than the adolescent girl. The authors felt the age difference may impose a power differential that exacerbated a younger girl’s lack of ability or authority to insist on condom use.

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23 Many women report being coerced by the men in their lives. They have sex with men they do not know well, because of force or threats of force. They do not use condoms because their partners object, sometimes with anger and other forms of emotional coercion (Biglan, Noell, Ochs, Smolkowski, & Metzler, 1995). According to Taylor-Seehafer and Rew (2000), adolescent boys often report pressuring a girl into sex by getting her high, by lying, or by physical threat. These authors feel there must be equalization of power in relationships in order for the sexual risk-taking behaviors of girls and the young men in their lives to change. Champion and Shain (1998) found that 25 to 50 % of women with STIs have been in abusive relationships. Fear of violence or fear of losing a relationship may prevent a woman from asking her partner to use condoms or to obtain treatment for an STI. Further, a girl may find it difficult to tell a partner she was diagnosed with an STI because it would be improper to question the male’s role in STI transmission. State of the Research During the past 20 years, a vast amount of research has been published on sexual risk-taking in adolescence. We have learned some valuable information from this prior research. These studies provided important information on epidemiological aspects of STIs, including demographic data; and identified specific variables and certain trends in behavior and STIs. The direct relationship between behavior and STI acquisition is well established. Holland and Ramazanoglu (1992) rightly noted that the acquisition of an STI was related to risky sexual behavior rather than to membership in a high-risk group. Two behaviors that are considered both necessary and sufficient to effectively reduce rates of STIs in sexually active adolescents are have been identified as consistent use of condoms and

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24 choice of sexual partners who are at low risk for STIs (Ramos, Shain, & Johnson, 1995). Research that found that previous STI are not associated with a change in behavior had important implications for this study (Rosenthal, Biro, Cohen, Succop, & Stanberry, 1995a, 1995b). Studies cited in Chapter 1 showed a high rate of repeat STIs in adolescents. Other studies (Crosby, Leichliter at al. 2000; Gunn et al., 2000) have reported that the strongest predictor of a subsequent infection of gonorrhea or chlamydia is a recent history of gonorrhea or chlamydia infection. It is apparent that adolescent girls who already have an STI are engaging in unsafe sexual behaviors and are at high risk for acquiring further reinfections of STIs. Despite concerted efforts through research and health education and prevention programs during the last few decades, the rate of STIs among adolescents remains high. Levitt, Selman, and Richmond (1991) have provided a framework that helps to explain why prevention efforts have not been very effective in reducing STI rates in adolescents. These authors developed a conceptual psychosocial model through which the components of adolescent risk-taking behaviors may be understood (Figure 2-1). According to this model, decisions about risk-taking behaviors are determined by three main components: (1) knowledge of health risks; (2) interpersonal skills to manage conflict about risk behaviors; and (3) the personal meaning of risk taking. The components in the model are assumed to operate at different developmental levels and undergo developmental transformations through adolescence. Levitt et al. and other researchers (Biro & Rosenthal, 1995) have stressed the need to include developmental aspects when risk behaviors in adolescents are studied.

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25 Three Generations of Adolescent Risk Behavior Research Levitt et al. (1991) described three generations of research and psycho-educational prevention programs that have dealt with these components. Many first and second-generation programs have been widely researched and published. The first generation First-generation programs assumed adolescent risk-taking behaviors resulted from lack of knowledge about health risks and therefore implemented educational programs to impart knowledge about STIs, but they did not prevent adolescent high-risk behaviors as expected. Although some studies found a relationship between increased perceived susceptibility to STIs and behavior change, other studies failed to document a behavior change even when there was a perceived risk (Moore & Rosenthal, 1991; Whaley, 2000). Research also failed to show a direct relationship between knowledge of STIs and behavior (Anderson-Ellstrom, Forssman, & Milsom, 1996; Biro, Rosenthal, & Stanberry, 1994; Boyer, Tschann, & Shafer, 1999; Jemmott, Jemmott, Spears, Hewitt, & Cruz-Collins, 1992). Although knowledge is necessary, it is not sufficient to determine behavior. Adolescents who have high levels of knowledge about STIs continue to practice unsafe sex (Jadack & Keller, 1998). Even in girls who previously had an STI, Shrier, Goodman and Evans (1999) found that their knowledge about condoms was high but was not associated with condom use. The Project RESPECT Study Group reported that even when there were misconceptions about STI prevention, they were not related to increased unprotected sex or increased incidence of STIs (Crosby, DiClemente et al., 2000).

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26 The second generation Second-generation programs focused on the social context in which risk-taking behaviors occurred and attempted to provide adolescents with the social skills to avoid high-risk behaviors. Varied success rates of various risk reduction behavioral interventions are reported in the literature. Many interventions and prevention programs designed to change attitudes and behavior have not been successful, especially in sexually active adolescents (Paradise, Cote, Minsky, Lourenco, & Howland, 2000). A recent metanalysis of controlled studies of behavioral interventions for HIV prevention in adolescents showed improved communications with sexual partners as a result of interventions, but only a modest increase in condom use (Johnson, Carey, Marsh, Levin, & Scott-Sheldon, 2003). This review reported few data available that could link skills acquisition with a change in sexual behavior or a decreased incidence of STIs. Research also found that condom carrying was not associated with condom use or the prevalence of STIs (DiClemente, Wingood, Crosby, Sionean, Cobb, et al., 2001), and that no relationship existed between a demonstrated high ability to apply condoms and the practice of safe sex or the acquisition of STIs (Crosby et al., 2001b). The third generation Levitt et al. (1991) also described a third generation of research and prevention programs that the authors felt were needed more than a decade ago and are not well utilized today. Third-generation research incorporates an understanding of individual developmental capacities of an adolescent and the personal meaning of risk-taking behaviors to an adolescent. Levitt et al. (1991) conceptualize personal meaning as the primary filter through which all information, skills, and experiences related to risk-taking behavior must pass.

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27 Within this framework, personal meaning is understood as a function in the development of personal autonomy and in the achievement of significant relationships. To determine what personal meanings a risk-taking behavior has for adolescents, it is necessary to consider the inner, subjective life of individual adolescents, each of whom has a unique set of hopes, problems, and life experiences. Other researchers note a lack of understanding and research about what adolescents think about sexual risk-taking behaviors from the perspective of the adolescent (Duerst et al., 1997; Keller et al., 1996; Jadack & Keller, 1998). The need to understand how adolescents value the possible consequences of various options in a given decision situation is also recognized in decision theory (Furby et al., 1997). Monsen et al. (1996) reported that even though adolescents expressed a negative view about unprotected sex, it was still their most frequent sexual choice. Choosing a risky behavior may be rational if the choice reflects core values and beliefs of the adolescent (Beyth-Marom, Austin, Fischhoff, Palmgren, & Jacobs-Quadrel, 1993). Understanding the adolescent’s thoughts and feelings associated with sexual activity and reasons for unprotected intercourse is critical in order to provide effective prevention measures. However, according to Monsen et al. (1996), most interventions do not address issues important to adolescents. A grounded theory study of 10 women who had a history of repeat STIs (Redfern-Vance and Hutchinson, 1995) determined that sex was rooted in the context of male-female relationships. They concluded that the impact of an STI was minimal, as long as it could be treated with medication and corrected within a short period of time. They stated that until a woman personally felt the cost, there was little meaning for the woman with the STI experience, no matter how many STIs she acquired.

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28 Figure 2-1. Conceptual model of adolescent risk taking behavior. Levitt, M. Z., Selman, R. L., & Richmond, J. B. (1991). The psychosocial foundations of early adolescents’ high-risk behavior: implications for research and practice. Journal of Research on Adolescence, 1(4), 349.

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CHAPTER 3 METHODOLGY Narrative Inquiry as a Fit for the Study Levitt et al. (1991) stated that research on risk behaviors must consider the inner, subjective life of the adolescent. They suggested that risk-reduction research efforts or applied interventions may fail because no consideration is given to the personal meaning or significance of the risk-taking behavior. These authors proposed that research, which was focused on understanding the personal meanings in behaviors, is needed to pick up where previous research, which was focused on knowledge and social skills, left off. The reasons that an individual may not use protection against STIs can be internally consistent and logical to that individual (Barbour, 2000). Understanding the personal meaning of behaviors may provide insight into why particular interventions are successful or unsuccessful. Qualitative methods for STI research have proven useful because the nature of the involved behaviors is intensively personal and private (Power, 2002). Narrative inquiry, in particular, was ideally suited to frame this research. Narrative stories are one of the clearest ways for learning about the inner world of a person and that person’s experienced reality (Lieblich, Tuval-Mashiach, & Zilber, 1998). By learning about the relevance of personal meaning systems in the girls’ lives, I felt I could gain a new perspective on why some girls repeatedly acquire STIs. I also felt the narrative approach would be effective for a study involving adolescents since the issues of identity formation are so important during this period. We 29

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30 discover and know our selves through our stories. We present our inner reality to the outside world when we share our stories with others (Lieblich et al., 1998). Many authorities in sociology and psychology agree that personal narratives, in content and form, actually are people’s identities. According to Mishler (1995), many psychologists view the construction of a personal narrative as central to the sense of one’s self, or identity. A research narrative is a form of reflection on a particular event (Aranda & Street, 2001). This self-reflection is expressed in the narration as a “dialectic between the narrative of one’s life and identity formation” (Mishler, 1992, p. 35). Telling one’s story is a way to create identity and reformulate reality as life experiences are woven together. A narrative approach is also an effective method for adolescents because the interview focus is on their stories, which are real for them. Research shows that many adolescents operate at the level of concrete thought (Baumrind, 1987; Muuss, 1996; Sachs, 1987). When adolescents tell their stories, they do not need to think in more abstract or general terms that would require formal operations. Further, research has shown that decisions about sexual behavior often occur in the heat of the moment (Kipke, 1999). Through telling a story, an adolescent may recall and identify actual thoughts and feelings that may have affected risk behavior at the moment that otherwise may not be apparent to them. Fischoff, Downs, and Bruine de Bruin (1998) noted that when adolescents are allowed and encouraged to express themselves in their own terms, they reveal complex beliefs regarding topics that concern them. Storytelling can provide rich descriptions of the personal meanings that acquiring an STD may have or what it may mean to an adolescent girl to negotiate with a partner for condom use. Storytelling is also a way that

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31 people can make sense of an experience, especially a difficult or traumatic experience. People will often discuss experiences in their lives where there has been a breach between their ideal and real self or between the self and society. Narrative studies have shown that lives can be transformed by the very act of storytelling This makes it a good fit for research that is focused on adolescent girls who acquire sexually transmitted infections. Narrative Theory All qualitative inquiry is rooted in the hermeneutic or interpretive tradition. Narrative inquiry is one of many methodological approaches within the qualitative paradigm. It has long been used in the social sciences and humanities, but it is a recent development in nursing research (Frid, Ohlen, & Bergbom, 2000). Sandelowski (1991) conceptualizes narrative inquiry as a framework for understanding the human being as a subject of nursing inquiry, conceptualizing the interview, and analyzing and interpreting the data. Some scholars (Bailey, 1996, 1997) place narrative inquiry as an extension of ethnography, and they describe it as the “systematic study of stories found in ethnographic interviews” (Bailey, 1996, p.187). Other scholars place narrative inquiry within the context of phenomenology (Emden & Sandelowski, 1998; Benner, 1991). Sandelowski (1991) stated that narrative analysis has incorporated both ethnomethodological and phenomenological techniques. The goal of the researcher within all qualitative methods is to interpret and/or reconstruct meaning. Truth and Reality Within the qualitative paradigm, truth or reality does not exist “out there” in the real world, but reality is subjective in nature (Bailey, 1997). Accordingly, rather than

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32 attempting to establish “the” truth, qualitative researchers acknowledge many different but equal truths (Barbour, 2000). Further, qualitative constructionalist theory proposes that reality is not only subjective, but it is actually constructed by individuals as they interact within a social environment. Everything an individual acts upon or that has an impact on that person first goes through the process of subjective meaning that is derived from a person’s social interactions (Bailey, 1997). Personal Meaning A theoretical assumption of narrative inquiry is that individuals construct and express meaning through storytelling. The purpose of narrative analysis is not to establish truth in experience but to learn how experience is given meaning (Sandelowski, 1991). Stories provide access to an individual’s personal reality at a particular moment in time. Stories not only reflect past experiences, but they also tell how individuals understand and give meaning to those experiences (Bailey, 2001; Riessman, 1993). A person’s story ties the past, present, and future together, and can provide unity and purpose (Plumer, 1995). Through telling a story, individuals make sense of their world and communicate personal meanings (Bailey, 2001). These meanings embody important personal truths, and they are critically important for understanding and providing appropriate health care. Plumer (1995) stated that a story is not simply a description of the life as lived. He stated that storytelling may be a major clue to understanding identity. Identity is represented by the life story. A later identity transformation or identity crisis is presented in a story’s revision. Stories may be one of the most important tools we have for understanding lives and the cultures of which these lives are a part.

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33 Reflexivity Another theoretical assumption in narrative inquiry is that the participant and the researcher mutually construct a narrative. Sandelowski (1991) describes researchers and participants as partners who engage in the “historic and hermeneutic” activity of storytelling (p.161). Objectivity on the part of the researcher is not the goal; rather, narrative inquiry is reflexive and recognizes the influence of the researcher on the data collected (Barbour, 2000). The story is always co-authored directly during the process of the interview and indirectly through research strategies, transcription procedures, and analysis and interpretive perspectives of the researcher (Mishler, 1995). Bailey (1996) describes narrative reconstructions as meaning-making events interpreted first by the teller (participant) and then the analyst (researcher).” (p.187) Participants construct reality in giving meaning to their lives. Interpretations of this reality and subjective meanings of the participant by qualitative researchers are yet other reconstructions (Bailey, 1997; Bailey, 2001; Bailey & Tilley, 2002). The Narrative Self Although stories recount events and experiences of everyday life, they are always reconstructions of the events they describe. Stories are social inventions, fictions, and fabrications, and they cannot be otherwise (Plumer, 1995). The individual actively constructs who she is by what she tells and emphasizes in her story (Bailey & Tilley, 2002; Sandelowski, 1991). The narrative researcher recognizes that storytellers select the components of the stories they tell (reconstruct) in order to convey the meaning they intend the listener to take from the story (Bailey & Tilley). Plumer (1995) stated that some stories may come very close to the life as actually experienced, while other stories are much less so. He states that this does not mean that

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34 people are lying or deceiving (although they could be) because at the moment a story is told we come to own it. People believe in it and its veridical power. Only later may it be understood as a construct. A passage from the Personal Narratives Group, Interpreting Women’s Lives (1989) (as cited by Plumer, 1995), provides more insight into personal narration: When talking about their lives, people lie sometimes, forget a lot, exaggerate, become confused and get things wrong. Yet they are revealing truths. These truths don’t reveal the past as it actually was, aspiring to a truth of objectivity. They give us the truth of our experiences that are neither open to truth nor self-evident. We come to understand them only through interpretation, paying careful attention to the contexts that shape their creation and to the worldviews that inform them. (p. 261) Blumenfeld-Jones (1995) provides additional comment: Even to tell your own story is to invent yourself, to select what you will tell, to suppress what you will not tell, to forget all together what might be of most importance to your listener or even to yourself. (p.32) Understanding this constructive or fictive nature of story does not invalidate them for research purposes. There is no evidence that facts and opinions people write on surveys are any less fictive or reconstructed. Fiction is not opposed to truth, rather, they are truths within the stories that contain them (Sandelowski, 1991). The historical truth of a story is not important. The story must be taken in its own right. “It is the reconstruction of meaning, not truth that the researcher wishes to understand and then interpret theoretically” (Bailey, 1996, p. 187). Narrative as Methodology From Story to Narrative Aranda and Street (2001) quote Wiltshire (1995) in referring to the story as casual and informal. Narratives are constructed from stories told by the girls and become texts

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35 available for analysis. The process of developing the story into the narrative involves conceptual sophistication and structure (Aranda & Street, 2001). There are two definitions of a story defined in the narrative literature, the life story and the first-person story. In the first person story, the researcher looks for limited stories located within larger segments of discourse. In the life story paradigm, all available information gathered in in-depth interviews is considered the unit of analysis. The researcher uses large segments of discourse as the story or reconstructs stories from interview data. These data are reconstructed during analysis to take the form of a story created by the researcher. The analysis focuses on the meaningful threads or themes, as they relate to each other throughout the larger reconstructed discourse segment (Bailey & Tilley, 2001). Data Collection A narrative approach may be used in data collection as an interviewing style, or it may be used as a method of data analysis. Sometimes qualitative studies use a question-and-answer format or structured method of interviewing. In contrast, narrative interviewing is unstructured, which permits participants to structure and sequence their accounts of events with minimal intrusion by the interviewer. Some researchers use narrative interviewing although they do not perform a narrative analysis (Sandelowski, 1994). Data Analysis: Analysis of Narratives and Narrative Analysis Polkinghorne (1995) and Blumenfeld-Jones (1995) have described two approaches to analysis in narrative inquiry: analysis of narratives and narrative analysis. The purpose of analysis of narratives is to generate themes that may be further studied. In analysis of narratives, the researcher reviews a set of narratives and determines what common

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36 themes exist among them. Polkinghorne (1988; 1995) described these themes as “paradigmatic typologies” that reflect a knowledge of concepts. These themes, or concepts, may be derived deductively from previous theory, and they are applied to the data to determine if instances of these concepts can be found. Concepts also may be inductively derived from the data as concepts emerge from the stories. He also states that there is a second level to this type of analysis that identifies the relationships that exist between and among the categories and how they are linked to each other. Narrative analysis, on the other hand, is a focus on an individual as a “story with meaning” (Blumenfeld-Jones, 1995). It is a synthesis of data rather than a separation of data into its constituent parts (Polkinghorne, 1995). Data in research interviews may or may not be in a storied form. Research questions concern issues of how or why a particular action or event happened. The researcher will then look for elements in the data that contribute to the construction of a plot that will eventually form a story. The constructed story will explain how a final outcome may have come about and may provide an explanation to the research questions. In narrative analysis, movement is from case to case rather than from case to generalization. Polkinghorne (1995) stated that analysis of narratives produces knowledge of concepts, while narrative analysis produces knowledge of particular situations. Both types of narrative inquiry can make important contributions to the body of social science knowledge. Sandelowski and Barroso (2003) distinguish between nominal content, or thematic analysis, and interpretive data analysis. A content analysis is used to organize, group, and label portions of narrative data whereas an interpretive analysis includes an interpretive use of concepts or themes to reframe portions of data that may extend the theoretical

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37 framework that had been applied. An interpretive explanation attempts to link themes in order to provide a coherent model of some phenomenon or a single thesis or argument that addresses causality or essence. Study Design I followed the protocol that we developed for the larger state study. However, the dissertation utilized only data obtained from adolescent girls. In addition, I obtained data on gender issues involved in sexual activities that may contribute to STI reinfection in girls. Ethical Considerations Procedures for the protection of human subjects Before beginning data collection, approval from three separate Institutional Review Boards (IRBs) was obtained: the University of Florida Institutional Review Board, the Florida Department of Health Review Council for Human Subjects, and the Centers for Disease Control and Prevention. The process of obtaining approval for the study protocol was frustrating, cumbersome, and took much longer than originally planned. The researchers from all agencies involved in the study met in person and by telephone conferences to draft study protocols and to write informed consents, interview guides, flyers for recruitment of participants, and other documents for submission to the IRBs. Each IRB had different submission requirements and intervals for meeting. In addition, each IRB had different questions or concerns about various aspects of the protocol, and they requested sections to be added, eliminated, or rephrased. In addition to the protocol, the informed consent was redrafted several times before the final informed consent was approved (Appendix A).

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38 Even the flyer that was used for recruitment of participants was revised several times. Language was changed and even the font size reduced to satisfy one IRB that there was no potential for inducement. Each time a revision was made by one IRB, it was necessary to resubmit the changes to the other two IRBs for approval. A few times disagreements arose between the respective IRBs about wording or procedure. For example, Florida statute permits adolescents to be seen and treated in STD clinics without parental consent. The adolescents could therefore participate in the study without consent since it occurred during the course of their medical care. The CDC in Atlanta granted a waiver of parental consent only after extensive explanation and documentation were provided that such procedures were not required in Florida. After the Health Insurance Portability and Accountability Act (HIPAA) became effective in 2002, the University of Florida required submission for an additional Informed Consent specific to HIPAA regulation for approval (Appendix B). Participants after that date had to sign two Informed Consent forms. As stated in the original protocol, we used a unique identification number on any documentation that could link the participant to the data. We protected the anonymity of the girls by use of a pseudonym, which they selected, to be used in the taped interview and the written transcript. During the study, all information (tapes, forms, documents) was stored in a locked file cabinet in accordance with Florida Department of Health security policies and procedures. Following completion of the final analysis, all linkage documentation will be destroyed, and unique identifiers will be removed from the data files. Data presented at scientific meetings or published in any manner (including peer-reviewed journals) will not identify individual participants. Also, all researchers had a

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39 security clearance and background check in accordance with Department of Health regulations, and they signed the State of Florida Department of Health Confidentiality and Security Statement of Understanding. Post interview counseling and follow up We did not anticipate that there would be emotional consequences related to the discussion of personal experiences, yet many girls told of life situations and experiences that were traumatic, involving child abuse, sexual abuse, and rape. After the interviews where it was appropriate, I asked the girls if they needed referral to community agencies for counseling and support. We had assembled a referral list of crisis services and other agencies that provided services for adolescent girls before we began the interviewing phase of the study (Appendix C). Each girl received a copy of the referral list. No girl elected to obtain referral during the study; however, I advised all the girls they could contact any researcher listed on the Informed Consent form, if they changed their minds, at a later date. Several girls, in particular, had been in circumstances that as a researcher I felt there was a particular duty to insure that any criminal acts against them had been legally addressed. For example, Priscilla’s mother, who permitted Priscilla to be molested and raped for pay, was not criminally prosecuted, but Priscilla was removed from her custody by the (Florida) Department of Children and Families (DCF) when she was 12. The man who raped and impregnated her was not prosecuted either, although DCF did determine the paternity of her daughter. Priscilla seemed angry because it was her perception that DCF was protecting the rights of this man, while she was trying to get custody of her daughter. We discussed her right to still seek legal remedy but she only was concerned with gaining custody of her daughter and said her future mother-in-law was helping her

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40 with this. Priscilla was also the victim of a date rape when she was fifteen. She did file charges, but in the end did not appear to testify against her assaulter. I gave Priscilla the referral list and strongly urged her to obtain counseling. I also made sure she had my mobile number that was also made available to all participants, but did not hear from her. I also attempted to contact her after the time when she was due to deliver her second child to see if she would speak to us again. The Disease Intervention Specialist (DIS) staff also assisted in this attempt to locate her, but our efforts were unsuccessful. Keisha experienced a date rape by a man when she was 14. She stated she had prosecuted him, and he had gone to jail. When Keisha was 16 she became involved in a relationship of escalating domestic violence in which she was battered, threatened, and finally her boyfriend made an attempt on her life. She obtained a restraining order against him. She says they talk occasionally. After the interview we spoke about the cycle of domestic violence and she said she is aware of the need to protect herself. I also made sure she knew my mobile number to call and had a hot-line number for domestic violence. I did not hear further from her. Rose had been sexually abused by an uncle while she was 6 years old. When she told her aunt, the aunt not believe her and returned Rose to the foster care system. Rose said that DCF was aware about the alleged abuse, but nothing was ever done. She was also given the reference list and urged to follow up with counseling and support. One girl, Jenny, had appeared particularly depressed and tearful when we spoke. She described her feelings of isolation and hopelessness because of being a mother and not having help and child care services. It was ethically necessary to also consider the safety of the small children of these girls during the course of the research project. After

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41 the interview, Jenny and I discussed parenting classes and the availability of temporary respite care if she needed it. We discussed resources that might assist in helping her to complete her education. I also made sure she had my mobile number, but did not hear from her again. I also attempted to contact Jenny several months later for a follow up interview, but was not able to make any contact with her. Study Population Eligibility Eligibility for the larger state study included male and female adolescents, but this study was limited to adolescent girls between the ages of 14 and 19 years old who attended the Duval County STD Clinic at least once during the study period, and who had been diagnosed with at least one reinfection with gonorrhea or chlamydia. Reinfection was further defined as any gonorrhea or chlamydia infection that occurred at least 30 days from a prior infection, but not more than 2 years after another gonorrhea or chlamydia infection. Most of the girls we interviewed had two STIs within a 2-year period. Several girls had up to four STIs within a three-year period, but each subsequent infection was still within the two-year required time period. Recruitment The research team formulated a detailed plan for recruitment in the original state protocol. However, we soon found it was impossible to implement our recruitment strategy. The original plan necessitated review of clinic records of all adolescents who had attended the Duval County STD Clinic within the past two years. However, when we were ready to do a record search, we learned that most of these records were archived in an inaccessible location. The protocol was then revised to have clerical staff identify all adolescents between the ages of 14 and 19 who came for a clinic visit. They would then

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42 refer them to the DIS staff to search the STD*MIS (Sexually Transmitted Disease Management Information System) for any STI records on that adolescent. The STD*MIS is the database where all positive tests for gonorrhea and chlamydia are reported to the Florida State Bureau of STDs by the laboratories performing the testing. The STD* MIS is referred to simply as the MIS by professionals in this field. If the DIS staff determined the adolescent was eligible and was interested in participation in the study, the DIS staff then referred that adolescent to the researcher. This was a workable strategy in theory, but not in practice. When I examined clinic data after the study was completed, I found that during the study period more than 1,000 adolescents visited the clinic and more than 150 adolescents met eligibility requirements for the study. However, we were able to enroll only a total of 17 adolescents, 12 girls and 5 boys. Many factors contributed to the small number of participants we were able to recruit. There was often inadequate clerical staffing to handle the usual telephone calls and paperwork common to patient registration in a very busy clinic. The request for the clerical staff to observe for clients who met certain preliminary requirements and then to make sure the DIS staff saw them to verify eligibility was just one more task to do. There was a certain indifference or lack of motivation on the part of some clerks to see that this was accomplished. The DIS staff was also very busy, and some staff members were in the field daily. Some eligible adolescents just fell through the cracks. In addition, we had originally planned to have a researcher present in the clinic four days a week. One researcher unexpectedly withdrew from the study, and we were able to be present in the clinic only two days a week.

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43 We provided an incentive of coupons to several stores we felt would appeal to teens. These stores included Wal-Mart, Publix, Wendy’s, and Subway. They were able to select a coupon for one vendor or to mix them for a total value of $30. Enrollment We interviewed 12 girls. Although we had originally estimated the enrollment would be higher (approximately 20 to 25 girls), we feel that relevant themes were identified and saturation of information was achieved in the sample we obtained. We used a convenience sample of girls who met the criteria and agreed to talk to us. We wanted to enroll girls who wanted to communicate and share information with the interviewer, rather than being primarily motivated by the incentive. The girls who enrolled in the study were interviewed at the time of their clinic visit in a private place at the STD clinic or given the option to return at a time of their choosing. Data Collection Conducting the interviews Our raw data were generated from interviews with 12 girls. We used in-depth qualitative interviews to obtain our information. The purpose in narrative interviewing is to produce a thick description of experience. Hutchinson, Marsiglio, and Cohen (2002) stated that they were confident that they had obtained quality data when the participants provided rich, detailed information, especially about behaviors that may not reflect positively on themselves or that were socially unacceptable. I wanted to collect data on the same topics from all girls to better enable us to compare and aggregate the findings. But, just as important, we wanted to obtain rich data on the meaning of risky behaviors and the experience that repeat STIs had for the girls individually. We (the research team) developed an interview guide to help ensure that

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44 certain broad content areas of interest were included during the interview (Appendix D). However, we intended that the guide would not structure or dominate the interview. We purposefully wrote the guide to be general and open-ended. We also included detailed prompts under each topic that the researcher could refer to if needed. Interview topics included such suggestions as: “Tell me about yourself”; “Tell me how you feel about yourself”; and “Tell me about your experience with sex.” General areas of interest: (1) What it means to girls when they acquire an STI; (2) What having multiple STI’s means; (3) How the girls describe their relationship dynamics (such as reasons and patterns of partner selection and issues of power and control in the relationship); (4) How the girls cope with STIs within the context of their sexual or romantic relationships; and (5) What explanations girls give for having unprotected sex. Before beginning the interview, I obtained full informed consent and reassured the girls about maintaining their anonymity and confidentiality of any information they shared. This process was sometimes more time-consuming than expected because it was clear that the girls did not understand the Informed Consents as written, and so verbal explanation was necessary. Each interview was unique. I did not ask each girl all of these questions. The questions were not phrased in the same way or asked in the same phase of the interview. The interview topics flowed in whatever order they occurred as the conversation with the girl proceeded. I interrupted as little as possible to allow the girls to tell their story in their own way. Sometimes it was not possible to include all content areas in the interview because a girl was so intent and focused on relating a particular aspect or events of her life story that it did not seemed appropriate to redirect her to another topic. I attempted to

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45 use additional prompts only to get more experiential detail or when a girl would indicate she needed more structure to adequately relate her experiences. I also assured each girl that she did not have to answer any uncomfortable question. I found, as have other researchers, that there was tension between the desire to structure the interview and the desire to allow it to remain unstructured. Maintaining structure permits obtaining specificity needed in order to densify concepts, while allowing freedom to “tap the type of ‘top of the head’ information” (Furby et al., 1997, p. 783) could reveal unexpected findings. The interview guide was helpful in some ways, but as Hutchinson et al. (2002) noted, I also found that it could limit spontaneity or alter the flow of the interview. In the end, it proved to be more successful to follow the girls’ internal prompts rather than to use ours. During the interview, the experience of having multiple STDs was contextualized within the girl’s life history, family history, sexual, and relational history. The interviews were intense and rich. Most girls were not hesitant about sharing intimate and sensitive areas of their lives. We discussed their lifestyles, household and family situations, their image of themselves and their hopes and dreams for the future. We discussed their ideas about risk and control in sexual encounters, their concepts of trust and betrayal, and the meaning they assigned to multiple STI acquisition in their lives and relationships. We occasionally touched on areas that had involved illegal activities, but the girls were not reluctant to talk about these topics. Each interview lasted 45 minutes to one hour. I conducted the interviews in a private exam room at the STD clinic. Some problems arose with attempting to conduct this type of intimate interview in a busy clinic. The overhead intercom sometimes disrupted the flow of our conversation. Even though there was a sign on the door, clinic

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46 staff would sometimes knock or open the door for various reasons, which compromised privacy issues and which also interrupted the flow of the interview. Sometimes I tried to interview while the girl was waiting to be seen by the medical staff. A few girls would ask what time it was and would become anxious because they did not want to lose their place in the process. Sometimes I attempted to conduct the interview after the clinic visit was completed, but often there were transportation issues or the girls had to get to school, work, and pick up children. The wait time at the clinic was sometimes very long. I personally interviewed all the girls except two. A research assistant who participated in the early part of the study for a brief time conducted those two interviews. All interviews were audiotaped and then transcribed verbatim. Transcribing the interviews Sandelowski (1994) observed that the transcript, considered the researcher’s raw data, is already partially “cooked” (p. 312). She commented that the transcript is the product of the research interview, and also a particular interpretation and reduction of that interview into words. As such, the transcript is already transformations away from the original experience it is intended to preserve. To maintain as much recollection of the nonverbal aspects of the conversation, such as gestures, expressions, and other body language, I attempted to transcribe each interview as soon as possible. Most interviews were transcribed within 48 hours of when it was completed. I personally transcribed each of the interviews. I found, as did Pope, Ziebland, and Mays (1999) that a single interview generated 20 to 25 single-spaced pages of text. The transcription process was very time-consuming and tedious. A one-hour interview sometimes took eight hours to transcribe and another eight hours to analyze. I found the

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47 quality of the taping was adequate, but the dialect of the girls was often difficult to understand. At times, their voice was barely audible as they spoke. Sometimes the intercom at the clinic interfered with hearing small portions of the interview. At times street language or jargon, either reflective of the adolescent culture or the African-American culture, was used, and I could not understand either the spoken words or sometimes the meaning of those words. Therefore, after I transcribed each interview, an African-American DIS staff member at the STD clinic did a second reading, comparing the audiotape to my transcription. He was able to “hear” most portions of the taped interview that were not clear to me because of certain patterns and ways of speaking that are common in the African-American culture. He was also able to explain some of the cultural expressions and jargon used. The primary investigator in the larger state study also reviewed all written transcripts, and we discussed coding and interpretation of some of the themes in the interviews. In addition, she also reviewed some of the taped interviews and compared them to the transcription for accuracy. Transcribing the interviews was a valuable experience because it improved my interviewing skill for future interviews, such as learning to keep girls on track or asking them to clarify topics during the interview. I agreed with Barbour, Featherstone and the Members of WoReN (2000) that doing my own transcribing also enabled me to become quickly become familiar with my data, which may have made analysis proceed more quickly. Data collection and analysis proceeded simultaneously. I was able to modify subsequent interviews based on early findings. This improved the quality of later

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48 interviews because more questions could be refined and new or unanticipated areas of interest relevant to research questions could be included in subsequent interviews. Data Analysis After reviewing various approaches and reviewing these with my advisor (the senior investigator in the study), we decided that a combination of the two types of analysis described by Polkinghorn (1995) would be useful to analyze our data. We first performed an analysis of narratives, followed by narrative analysis or development of case studies of three girls who could represent the range of girls seen at the clinic who had repeat STIs. Analysis of narratives I used a modification of a five-stage framework described by Pope et al. (1999) to do the analysis of narratives. The authors stated that this approach was developed for policy-relevant research in which the objectives of the investigation are set in advance and formed by the information requirements of the funding body. However, emergent concepts from the participants were also identified and included in the analysis. I began the analysis by what is called “immersion in the raw data” as a whole, sometimes called familiarization. This required listening to the tapes and doing an exhaustive reading and rereading of each transcript to gain a sense of the overall meaning of the story each girl told. I then read each transcript line by line to identify meaningful phrases in the stories. Morse and Field (1995) describe this process as a systematic search for descriptive expressions at the center of the experience. Next, I identified a thematic framework (index) that consisted of all key issues, concepts, and themes by which the data could be analyzed or coded. Coding, sometimes called indexing, consisted of applying the thematic framework (index) systematically to the data. Barbour et al. (2000) described

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49 coding themes, which were introduced into the interviews from the interview guide as pre-coding, and themes that were introduced by the participants and emerged spontaneously as open coding. All data were searched theme by theme to verify and qualify it. I experimented with several techniques of coding. First, I worked with a qualitative software program called Nvivo.The program was complex and difficult to apply and was eventually abandoned. Next, I experimented with annotating transcripts with numerical codes from the index by pen and paper and card sorts, as it was done before computer programs, but this process was slow and difficult to keep organized. In the end, I used my own method of coding by working with the transcripts on the computer and using the Windows application to apply appropriate sections of text directly to the index. Indexing the data was a lengthy process, requiring reading and rereading search transcripts. There was often repetition and overlap in the identified themes. Within a single passage of text there were often multiple themes, each of which required coding. The next step in the data analysis was to rearrange the data according to the appropriate part of the thematic framework to which they relate. This process did not consist of simple cut-and-paste methods that group verbatim text, but it also included distilled summaries of views and experiences. Thus, the process included a large amount of abstraction and synthesis. The last phase of the analysis was to interpret the data to define concepts and find associations between themes. The goal was to form explanations about the findings that could be used as a basis for clinic intervention. Narrative analysis Various approaches to narrative analysis are described in the literature. Reissman (1993) commented that there is no standard set of procedures for narrative analysis as

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50 there are for some other forms of qualitative analysis. McCance, McKenna, and Boore (2001) also noted that there was no clear guidance on the processes involved in narrative analysis. Emden and Sandelowski (1998a, 1998b) also observed that Polkinghorne (1988, 1995) provided only minimal guidance about how to create the story. Mishler (1995) provided general guidance about story formation. He stated that researchers retell their participants’ stories through analytic redescriptions. Problems he identified that qualitative researchers face are that participants do not tell their lives in temporal order, they may digress from a specific storyline, or they may make general comments without clear temporal markers. Therefore, in the transcript, story events are not necessarily in order, characteristics of the participants are dispersed throughout the narrative, and all narrative content is filtered through some perspective. Mishler states that the researcher must reassemble selected episodes from interviews into a chronological ordered sequence. This becomes the narrative for further analysis. He defines the story as the narrated events, abstracted from their disposition in text and reconstructed in their chronological order together with the participants in these events. Evaluation What does it mean to do good qualitative research? The research community is still debating what it means to do valid research in qualitative inquiry. In the 1980s, Lincoln and Guba (1985) proposed what they considered four equivalent terms for quality in qualitative research that would parallel those used in quantitative methods. Internal validity was replaced with credibility, external validity with transferability, reliability with dependability, and objectivity with confirmability. However, many qualitative researchers today feel that since the positivist and

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51 interpretative paradigm are epistemologically divergent, the transfer of quality and credibility from one perspective to another is not reasonable (Bailey, 1996). Bailey (1996) and Sandelowski (1991, 1993) noted that story elements change from telling to telling. Attempting to evaluate stories for repeatability, consistency, or verification by test-retest and interrator reliability kinds of measures demonstrates a lack of understanding of the concept of narrative truth. In order to evaluate quality in qualitative research, especially narrative analysis, many interpretist scholars agree that the concept of validity as the process for validation must be reconceptualized (Angen, 2000; Bailey, 1996; Creswell, 1998; Kvale, 1996; Sandelowski, 1993). Ethical validation Creswell (1998) and Kvale (1996) have stated that the way to distinguish good research lies in a reformulation of validity. Creswell proposed that moral soundness should be the basis for validity in judging interpretive work. Kvale also proposed that moral and pragmatic concerns are the most important considerations for evaluating research. He contends that the principal of beneficence should be the essential guide to planning and implementing research agendas. Ethical validation requires research to provide some practical answers to the question of “so what.” Ethical validation requires that we ask if the research is helpful to the target population, if there are alternative explanations than reported in the research, and if we are more sensitized to or enlightened about the human condition because of the research. These issues are much more important than a criteria-based process of evaluation that occurs after the research is completed (Creswell, 1998; Kvale, 1996).

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52 Substantive validation The substance of the inquiry is also important in evaluation of interpretive research. The written account of the research must clearly outline the research and represent the findings so that fellow researchers and consumers may participate in evaluating the researcher’s analysis (Koch, 1998; Angen, 2000). Barbour (2000) described this as making the processes involved in the analysis transparent, while Frenkel and Devers (2000) refer to it as data archiving or creating an audit trail. Barbour suggested that a transcript be included as an appendix to the study so that readers can return to the original text to verify that conclusions are grounded in the data. I will further comment on evaluating this study in the discussion section.

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53 Table 3-1. Demographics and STI history of adolescent girls in study MIS STI history Study name Age Children/ Pregnancies STIs at Interview New STIs Ashley 15 1 child, 3 mo old 4/4/02—GC 11/2/01—GC Poo 16 8/25/02—GC 1/10/01—CT, GC 1/8/04—GC Tarianna 16 10/8/02—CT 2/7/02—GC Priscilla 16 1 child, 3 y old PG, 3 mo 5/14/03—CT 1/26/03—CT Maurteeonna 17 9/13/02—CT 7/30/02—CT 4/19/02—GC 4/30/01—CT Jenny 18 1 child, 17 mo old 8/6/02—GC, CT 10/5/00—CT 6/18/03—CT 2/3/03—CT Tosha 18 1/9/02—CT 11/20/00—CT 3/1/03—GC Princess 18 1 child, 1 year old PG, 4 mo 9/1/02—CT 7/29/01—GC, CT Nicole 18 1 child, 2 y old 1/26/03—CT 10/12/01—CT 1/27/00—CT Keisha 19 3/3/03—CT 4/29/02—GC 7/23/01—CT Rose 19 2 children, 3 y and 5 y old 2/20/03—CT 2/11/02—GC 5/17/00—CT 9/3/03—CT Shan 19 5/6/03—CT, GC 2/3/03—GC 3/5/02—CT 7/22/03—CT

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CHAPTER 4 NARRATIVE ANALYSIS OF STORIES TOLD BY TWELVE GIRLS I interviewed 12 girls. Their ages ranged from 15 to 19 years old. All girls were African American, with the exception of one girl, Priscilla, who was Caucasian. Six girls were mothers. From the other six girls, four girls had never been pregnant, one girl had a therapeutic abortion, and the other girl had a questionable pregnancy that may have resulted in an early miscarriage. Two girls were pregnant at the time they were interviewed. For both girls, it was their second pregnancy. Eight girls had two incidents of STIs at the time they were interviewed, three girls had three STIs, and one girl had four STIs. Four girls acquired another STI subsequent to the interview, and one girl later acquired two STIs. I begin by providing a brief profile of demographics of the girls relating to their STIs, beginning with the girls who are mothers and then the girls who are not yet mothers (Table 4-1). Then I present the narratives constructed from life stories told by each. Profiles of Twelve Girls Girls Who Are Mothers Ashley, the youngest girl we interviewed, was 15 years old. She has one child, a boy, Xavious, who is 3 months old. She has had gonorrhea twice, both times acquired from her boyfriend who is also the father of her baby. She contracted gonorrhea the first time she had sex with him that was diagnosed on November 2, 2001. Ashley became pregnant when she was 13 years old. Her second infection was diagnosed during her pregnancy on April 4, 2002. She is still in a relationship with this boyfriend. 54

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55 Priscilla was 16 years old. She has one child, a daughter, Elizabeth, who was 3 years old, and Priscilla is three months pregnant with her second child. Pricilla first became pregnant when she was 12 years old as a result of an ongoing rape by an adult man known to her family. She self-reported an incident of PID during that pregnancy. She was hospitalized for PID, as well as two later incidents of PID for which she was treated on an outpatient basis. Those incidents are not documented in the MIS, possibly reflecting that there was no actual STI diagnosis at that time or simply that one was not reported. Two incidents of chlamydia are documented in the MIS. The first incident was diagnosed on April 4, 2002. Priscilla was 15 years old. She acquired chlamydia as a result of a date rape. Priscilla was recently diagnosed again with chlamydia on November 2, 2002, during the fourth month of her second pregnancy. She denied any exposure for this episode. Since her first diagnosis of chlamydia, she has only had sex with her fianc who was a virgin at the time their sexual relationship began. The staff at the hospital emergency room advised her that her prior chlamydia infection may not have been completely cured. Rose was 19 years old. She has two children, a 5-year-old boy and a 3-year-old girl. She was 13 years old when she became pregnant the first time. She self-reported an incident of chlamydia in 1997 during that pregnancy that is not reported in the MIS. She became pregnant again when she was 16 years old. She acquired chlamydia from the father of the baby that was diagnosed during her pregnancy on May 17, 2000. Her next STI was gonorrhea that was diagnosed on February 11, 2002. Rose was not sure from whom she acquired this infection because she was having sex with the father of her daughter and also a casual partner at that time. Her last STI was chlamydia, which was

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56 diagnosed on February 20, 2003. She is certain that this infection was acquired from her current partner. Jenny was 18 years old. She has one child, a boy, Exavier, who is 17 months old. She has had two sex partners. She first had sex when she was 16 years old with her boyfriend whom she had been dating for 2 years. She became pregnant from her second partner. She has had two episodes of chlamydia, both acquired from the father of her baby. The first episode was diagnosed during her pregnancy on October 5, 2000, and the last episode was diagnosed on September 5, 2002. Nicole was 18 years old. She has one child, a son, who is 2 years old. She first had sex with her boyfriend when she was in the eighth grade; and became pregnant by him when she was 16 years old. Since she delivered, she has had two other boyfriends and possibly three or four casual partners. She has had three episodes of chlamydia. The first episode was acquired from the father of her baby, and was diagnosed on January 27, 2000, during her pregnancy. The second episode was acquired from her second boyfriend that was diagnosed on October 12, 2001, and the third episode was acquired from her third and current boyfriend, which was diagnosed on January 26, 2003. Princess was 18 years old. She has one child, a son, who is 1 year old; and she is now 4 months pregnant. She has had four partners. She first had sex when she was 16 years old, with a boyfriend. She became pregnant from her third partner and acquired her first STI from him. On July 29, 2001, around the time she was to deliver, she had a dual diagnosis of gonorrhea and chlamydia. Princess is now pregnant from her fourth partner, and acquired her second STI from him. She was diagnosed with chlamydia on September 1, 2002, when she was seen in the emergency room for bleeding and cramping.

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57 Girls Who Are Not Mothers Tarianna was a 16-year-old girl. She first had sex when she was 14. She has had four partners. She has had two episodes of chlamydia that were diagnosed on February 7, 2002, and October 8, 2002. She acquired both these infections (and one infection with trichomoniasis) from her third partner. Poo was a 16-year-old girl. She was 15 years old when she first had sex. She has had two sex partners to date, both of whom are boyfriends. She has had two STIs. She acquired chlamydia from her first boyfriend on January 10, 2001. She was hospitalized for PID on August 25, 2002, at which time she was diagnosed with gonorrhea that she had acquired from her second boyfriend. Maurteeona was 17 years old. She first had sex when she was13 with a boy she met at a party. Since then, she has had five other partners, who she described as boyfriends. Her first STI was chlamydia, diagnosed on April 3, 2001, that she acquired from her third boyfriend. She contracted gonorrhea from her fourth boyfriend; it was diagnosed on April 19, 2002. She acquired trichomoniasis from her fifth boyfriend. Now she has a diagnosis of chlamydia on July 30, 2002. She does not know how she may have gotten chlamydia again, but she relates it back somehow to her chlamydia in 2001. She is certain that it did not come from her current partner. Shan was 19 years old. She first had sex when she was 15 years old. She has had 11 sex partners, 6 of whom were boyfriends. During the last year she has had sex with five partners that she does not consider boyfriends. She was 16 when she had her first STI, gonorrhea, which was acquired from her third boyfriend. She was 17 when she acquired her second STI that was chlamydia, also acquired from the same boyfriend. Shan said her third boyfriend kept giving her chlamydia and trichomoniasis but could not specify the

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58 number of times or when they occurred. She said her current partner gave her an STI in May, and she currently has acquired another infection from him. She was diagnosed with chlamydia on July 22, 2003, the date of her interview. Shan described more STIs than what was reported. The MIS showed that she had chlamydia on March 5, 2002, gonorrhea on February 3, 2003, and a dual diagnosis of gonorrhea and chlamydia on May 6, 2003. Tosha was 18 years old. She was 16 when she first had sex. She has had five partners. She was interviewed on April 24, 2003. She self-reported that she had two STIs. The first was a pelvic infection on April 24, 2002. The second infection was gonorrhea. She was treated for both STIs. No date was given for the gonorrhea infection. The MIS showed two episodes of chlamydia on November 20, 2000, and January 9, 2002. Keisha was 19 year old. Her first sexual experience was a date rape that happened when she was 14 years old. She first had consensual sex when she was 16 years old. She has had about 10 boyfriends but only two serious relationships. She did not say how many of her boyfriends were sexual partners, but admitted that she had 15 sex partners during a brief time while she was prostituting to obtain survival money. She has been diagnosed with chlamydia twice on July 23, 2001, and April 29, 2002; both STIs were acquired from her current boyfriend. Several interesting findings emerged from looking at this limited data. Half of these girls were mothers. Rose was the only girl who had two children. Two of the girls, who were already mothers, were pregnant again. All the girls who had been pregnant only once had an STI diagnosed during that pregnancy. Rose, who had been pregnant twice,

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59 reported an STI in each pregnancy. Further, the two girls who were currently pregnant had been diagnosed with another STI during pregnancy. Overall, most girls reported their first sexual experiences were with a boyfriend. However, there were four girls whose sexual initiation was non-consensual or was associated with violence. Pricilla was raped by a “family friend” when she was 11, and became pregnant from that experience. Keisha was victimized in a date rape when she was 14. Rose was sexually abused and “fondled” by an uncle when she was 7 or 8 years old. Maurteeona, although not forced into having sex, was manipulated by an older man who took advantage of her young age of 13. Narratives of Life Stories Told by Twelve Girls The first six stories are those of the girls who are mothers, followed by the six stories of girls who are not mothers. They are presented in the same order as in the profiles. Ashley’s Story: Told on October 10, 2002 Ashley is a 15-year-old girl with a 3-month-old son named Xavious. Her worldview as presented in her story consisted of several phrases that she repeated over and over: “I was mad,” “he lied,” and “he cheated.” When Ashley was 11 years old, she began dating the boy who later fathered her baby. Her first sexual experience was with him on the day before she turned 14. She does not recall this experience because she was drunk. She explained that she did not drink alcohol at that time, but unknown to her or her boyfriend, his friend slipped something into her drink. All she can remember is that her first experience with sex was unpleasant and she got gonorrhea the first time she had sex.

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60 After Ashley contracted gonorrhea, she stopped having sex for a “long time.” During this time, however, she did have sex with two other people, “and one of them was only one time . . . before I got pregnant.” She and her boyfriend eventually began to have sex again. She began to hear from other girls who would call her house and tell her they had sex with him. She said that “made me mad, because he lied and I used to believe him. . . . He just lie and lie and lie and lie about everything.” Ashley explained she used condoms “with everybody but him . . . because he takes them off. . . . When we first started having sex, we always used them, but when I got pregnant from him the first time, we stopped, and then, after that, we just use them like every blue moon. I guess whenever he thinks he have something, he uses them.” When she began to experience abdominal pain, she went to the clinic, thinking she had another STD, but they told her she was pregnant. When she told her boyfriend she was pregnant, he said she was “lying” and did not believe her until she showed him the papers. Ashley was “mad” when she found out she was pregnant. She was too young to have a baby, but she and her mother did not believe in abortion. Ashley was then 14 years old. She was “mad” because her boyfriend wasn’t there for her during the pregnancy and then he denied he was the father of the baby. “I was mad . . . real mad. It hurt when somebody do you like that. . . . Now he didn’t say it in my face but he’ll, like, tell his friends that.” During her pregnancy, Ashley was diagnosed and treated for gonorrhea again. She and her boyfriend stopped having sex until after she delivered. Ashley still has many negative feelings about her recent delivery. She said it was hard because “everybody gets to look at you naked. Everybody came in on me. Just put

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61 on a glove and stick their whole hand in me. Like they were molesting me or something.” She said, “Un huh [shakes head no], I ain’t having no more kids.” Ashley and her son live with her mother who is HIV positive. Her mother is her primary support system and helps with her baby as much as she can. Ashley is very close to her mother and protective of her. She blames her father for her mother’s infection. My mom got it from her husband, and I know because me and my momma are like this [crosses two fingers]. Everything she tell me, everything I tell her, everything. And I know she ain’t never cheat on my daddy. She didn’t do anything but work. Work, clean up, cook . . . she was a wife, a real wife. And he cheated on her, he gave it to her. Ashley has two brothers. According to Ashley, her brothers are just like her father. They are all promiscuous, deny personal responsibility, and blame their female partners for having STIs. Her older brother gave his girlfriend “three diseases” before she left him. He used to always do the same thing. “It must have been you. . . . It must have been you. . . . I know I ain’t been doing nothing.” And be lying knowing he been doing something. My little my baby brother, he ain’t nothing but 13 and his girlfriend a virgin. But he done had sex with all her friends . . . her cousins, her sister, all of them. All of them lie, my daddy, my brothers. Ashley resumed having sex with her boyfriend after she delivered. She came to the clinic today for a checkup because she just found out again that her baby’s daddy was having sex with another girl. She said, “It made me mad [shows lots of facial expressions]. He lied and lied and lied, kept lying to me, saying he wasn’t . . . and I had the girl on three-way [phone call]. Even knowing about her boyfriend’s promiscuity and having acquired two STIs from him, she continued to have unprotected sex with him. He don’t like them [condoms]. . . . He just don’t put them on . . . or like if he put them on, he will take it off, and like if I tell him to put on one, then he will get mad at me [and] say, “What? You been messing with somebody else?” Or something like that.

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62 Ashley’s boyfriend brought her to the clinic today and denied cheating. She said he “talking ’bout you think I gave you something. . . . You so stupid. You’ll see, you’ll see.” While she was at the clinic, her boyfriend called on her cell phone. She answered the phone and started yelling at him, telling him that he was a liar and that he gave her an infection. She kept on saying, “I’m not lying.” She eventually hung up the phone and told the interviewer: Now he telling me I’m lying, I’m lying, I’m lying. Like he . . . I mean every time he gives me something, he always be like, “I ain’t had sex with nobody, it must be you.” And I know I don’t have sex with nobody. Ashley currently attends a school for teenage girls who are pregnant or who have small children. Even though her mother, the mother of the baby’s father and the baby’s father also help care for the baby, she finds being a mother is “hard.” She does not have anything to say about her baby. She is on Depo Provera [a contraceptive], but her boyfriend does not want her on birth control. She said, “He don’t want me to be on it cause he want me to get pregnant again.” Ashley expressed very strongly that she does not “want to get pregnant from nobody. I don’t care how much money you got . . . I can’t do it. It hurts, it’s miserable, it’s embarrassing.” Ashley explained why she stayed with her boyfriend: Because I don’t want to have a lot of sex partners. Well, a lot of boyfriends. I try to, like, hold on to a relationship. . . . I can’t do it no more. Because he don’t want to be truthful. . . . I don’t have a relationship no more this time. . . . He just can’t keep doing that to me. It’s nothing he can do this time. Because he lied. I really thought he was gonna change but. . . . Ashley looked sad and resigned to ending her relationship. She said she was going to practice abstinence, “just like her mother” has: I don’t know what can happen, that’s why I’m leaving him alone. I’ll have AIDS next. . . . I just want to be alone. I don’t want nothing. I’ll just be alone. My mom can do it, I can do it. . . . I don’t like having sex anyway . . . it hurt.

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63 Priscilla’s Story: Told on March 6, 2003 Priscilla is a 16-year-old Caucasian girl with a speech impediment—a lisp that is more apparent when she is talking about emotional issues—especially when describing herself as “a teen-age mother.” She has a 3-year-old daughter, Elizabeth, and Priscilla is now three and a half months pregnant. Priscilla’s story was very lengthy and complex, and it was difficult to condense into an abbreviated form. Her childhood was extremely traumatic. Her parents divorced when she was 3 years old. At first she said there “is nothing to tell” about her mother. But as she began to talk, she became very emotional and her story poured out. Her mother was very neglectful and abusive. Priscilla’s uncle played an important role in her life, but her relationship with him often had not been good. Priscilla is a wonderful storyteller, and her story is best told in her own words. Since we’ve [Priscilla and her sister] been little . . . my mom—she would drop us off at his [uncle’s] house, just to leave with her boyfriends, from the time we was about 5 years old, and [she] never really took care of us. . . . As I was growing up, my mom’s ex-boyfriends, they would molest me and my sister. . . . Well, my daughter [Elizabeth], she was a child that came from a rape. . . . And when I was pregnant with her, I didn’t really know it was the guy who raped me, which was my aunt’s ex-boyfriend. . . . I went for about a good year and four months with him raping me. He’d started raping me ever since I was 11. . . . Come to find out, my mom, well, she knew about the whole rape thing. . . . She was having her father to pay her—just for me to get raped . . . because she was low on money and she didn’t know what else to do. And at this point I really hate my mom for that torment and me getting beat up by her father and everything just because I was pregnant, and it was like, people was innocent. . . . And it hurt me really bad because my mom, she was allowing it, and she wouldn’t do nothing about it. . . . Until this very day, my mom doesn’t like my daughter. And now I figured it out why because of the fact that my daughter is the evidence of me being raped and my mom knowing about it. . . . I wanted to give her [Elizabeth] up for adoption because I didn’t want her. But I couldn’t do it when she was born because she had attached [laughs] me somehow, you know? So I kept her. I took care of her by myself from the time I was 12 years

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64 old, and she got tooken away from me. . . . My family . . . wind up calling HRS [Health and Rehabilitative Services] on us. . . . They wind up putting me into it, and wind up making me lose my daughter. . . . We were taken out of my mom’s custody when I was 13. . . . And we moved in with my uncle when I was about 14. And we’ve been staying with him ever since, but me and my uncle, we never got along. . . . As I was growing up and living with my uncle, I started thinking that he was the one who’s causing all this, and I hated him for it, but then when I moved out of his house, I realized it was more of everybody else doing it and not my uncle. . . . But my daughter, she really grew up to be a good girl. I mean, she’s smart, she’s honest, she knows everything. . . . My uncle, he’s got temporary custody so I get her [Elizabeth] back pretty soon, I hope. It’s not easy to forgive her [mother] because of what she did. And it’s something that’s gonna take awhile, so, I mean, there’s nothing I can do there until I feel that it’s right to forgive her, then I’ll forgive her. Priscilla had a sketchy relationship with her father because her mother interfered with his contact for most of her childhood. I had some contact, but . . . my dad would come over to visit me and either my mom or my uncle or my aunt, they wouldn’t let him in the house to see me, so it was kinda hard for me and my dad to actually see each other when I was little. . . . My mom had kept us apart for about five years . . . I come to find out he [my dad] had been trying to contact me, but my mom never let me know. So I went five years without seeing my dad, and he found out about two years ago that he had a granddaughter, and now he’s trying to be in me and my daughter’s life, and he’s wanting to be in this baby’s life too now, so . . . we just finally started talking, and I went up there to visit him, and everything turned out great. Priscilla was confused about the paternity of her baby because during the period she was being raped, she also had a single consensual sexual encounter where she felt rejected. Well, I had sex—one night, one time—and that was on my birthday. . . . I never really felt comfortable around men until I met my ex-boyfriend, which was Frank, and we was together for [a] good six months. And we finally had sex, which was the night of my birthday because I figured, you know, everything’s gonna be OK. Well, it really wasn’t because when I thought he was the father of my daughter, he wind up moving all the way to California. . . . [He] didn’t want nothing to do with me, didn’t want nothing to do with her.

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65 During the year and a half she was repeatedly raped, Priscilla said she had three incidents of PID. She was hospitalized for one episode that occurred during her pregnancy, and treated as an outpatient twice. After Priscilla had her baby, she eventually began to date again, and had another sexual experience in which she experienced feeling rejected. Well, I had a lot of boyfriends . . . but just none of them I would sleep with . . . except when it came to my boyfriend, ex-boyfriend, Dustin. . . . When I finally slept with somebody, which I thought it, you know, there was something there, that he cared about me. . . . I thought I trusted him. When I gave myself up to him for the first time again, afterwards it was like he didn’t want nothing else to do with me. When her daughter was 6 to 7 months old, Priscilla learned with certainty the identity of Elizabeth’s father. She unsuccessfully attempted to regain custody of her daughter. Still thinking her uncle was the cause of her custody problem, she moved back in with her mother. While she was living with her mother, a neighbor named Roger raped her. She related this experience in great detail. In September, I wind up getting raped again, and I was just torn up because I didn’t want to be pregnant again by another rape, and I didn’t want to go through the horror that I went through with my daughter’s father because it was all horrible. . . . Well, it was September the 16 th , and I had a bad feeling about that day, I just couldn’t do nothing about it. . . . The guy across the street wind up calling me and my sister over, and, unfortunately, I went. I used to drink . . . and that night I was really pretty much messed up. My sister left and I tried to leave. And he grab me by my sweater, and wind up forcing my pants off me, and I didn’t want to take them off so he unfortunately slapped me, and he just started raping me. . . . I was literally shooken up, I can’t do nothing. I literally got pissed off at the cops because they were trying to put it as [if] it was my fault and I didn’t see it thata way. I mean, yeah, I went over there, and I had a few drinks, but they [police] were trying to tell me well, you could at least screamed or something like that. I was like, truly, I said, “I was in shock.” I knew what was going on, but, but I can’t do nothing. I mean, he was a big guy and you know there was nothing I could do. I mean with me being in shock, and trying to figure out what to do, it was like, I couldn’t do nothing. . . .

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66 And it finally got to the point of them taking me downtown to Shands to get me checked out. Next day they called me up, and they found his DNA in me and they matched up the teeth mark that was on my breast where he had bit me at. Because I tried to struggle, and he had bit me. So that’s what took them to the point of actually believing me. Priscilla acquired her first infection of chlamydia as a result of this rape. The first time I got diagnosed with it, it was about four months after my rape, and I haven’t been with nobody other than being raped by him. So I had told them who it was, and at first they was gonna put the blame on me because of the fact I didn’t use protection. I said, well, being raped, you don’t know what you’re doing because the guy can use protection and the guy couldn’t. And like this guy, he didn’t use protection. Well, they wind up giving me some pills to take for the chlamydia, and I went to see my regular doctor to see if it was all cleared up, and they told me it was. Around the time this last rape occurred, these same neighbors had introduced Priscilla to Brandon. This young man became her boyfriend and father of her next child. Brandon and Priscilla have been together for almost five months. Well, at the time I was staying with my mom, the guy across the street, which was the one which raped me last year, him and his dad introduced me to Brandon. . . . It was about a week later after I called him, he asked me if I would go out with him. So he came over to the house, I introduced him to my aunt and my mom and my other aunt. . . . And ever since then we’ve been dating, being boyfriend and girlfriend. . . . And now I’m pretty glad I did meet him because he’s been everything I was waiting for . . . he’s a great guy, well, boy, he’s 18. . . . He’s been with me through thick and thin. You know, he loves my daughter and he’s actually allowing her to call him “dad.” Priscilla filed charges against her neighbor for raping her. She missed her first two depositions. At her third deposition, she “started tearing down” when she saw her neighbor in the courtroom and her aunt had to help her out to the lobby. The judge set a trial date for a month later. Priscilla did not feel she could show up for trial. She was having flashbacks and nightmares. When I went to court and I seen him, and I just started having nightmares. Luckily, I had my fianc because he was there to help me, he comfort me. And he actually let me squeeze his hands [laughs] when I had the nightmares even though I wanted to break ’em [laughs]. You know it was kinda hard for me.

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67 Priscilla then decided to go to Oklahoma to visit her father, hoping that getting away would help her feel better. While she was in Oklahoma, she discovered she was pregnant and called Brandon to tell him her news. And he shocked me because, I figured, well nobody’s gonna be her father and he’s gonna wind up leaving me sooner or later. Well, I went to call him up a week later, and his mom told me that he’s out working . . . and trying to make the money to get us in a bigger place before the baby comes along. . . . And we’re going to be getting married July the 4 th ! [smiles broadly] Priscilla developed lower back pain while she was visiting her father. When she went to the emergency room to be checked, she was once again diagnosed with chlamydia. While I was up there, I come to find out I had chlamydia. . . . They were trying to put it on him [Brandon] but I wasn’t going to let them because it wasn’t his fault. . . . They thought it was from him, and I told them that he was a virgin until he met me. . . . Well, labor and delivery told me that there could’ve been the possibility that it was not all gone because sometimes doctors can look over something like this. . . . And she [the doctor] told me more likely, it was not all cleared. So, that’s how I wind up getting it this time. . . . They told me, since I have it, he probably more likely has it so he had to go get checked. So, we’re here to get him checked. I asked Priscilla if she and Brandon are using condoms now. Well, right now, we’re not really having sex because we don’t want to get a chart back and lose the baby because we were told that chlamydia can kill your child. So I ordered him not to do it [laughs]—for us not to. And he understands that. So I’m happy [laughs]. Despite what Priscilla has gone through during her childhood and early adolescence, she seems remarkably resilient. She is happy about her renewed relationship with her father, and she has accepted her relationship and established some boundaries with her mother. I really couldn’t talk to my mom, me and her, we have a bad relationship right now, for a mother and daughter, and it’s not easy to forgive her for it because of what she did. And it’s something that’s gonna take awhile, so, I mean, there’s nothing I can do there until I feel that it’s right to forgive her, then I’ll forgive her. . . . My mom don’t know how to change. She is still the same person that she has always been,

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68 and she will always be the same person. . . . She already knows that I don’t want nothing to do with her or having her do anything with my baby. Priscilla has formed a relationship with her soon-to-be mother-in-law and has shared much about her past with her, and feels accepted and supported by her. She knows about most of it, I told her . . . because I don’t want her thinking that I’m trying to control her son, or I blame her son for anything that went on in my life so thataway she won’t hate me for anything. . . . My fianc’s mother is helping me get my daughter back. . . . She has helped me out a lot since I found out I was pregnant. . . . If it wasn’t for her, I wouldn’t be, like, trying to get on food stamps, and WIC [Special Supplemental Nutrition Program for Women, Infants and Children], and stuff like that cause she’s taken me everywhere. Priscilla has not used alcohol since her last rape and does not drink anymore. Brandon also does not drink, and neither she nor Brandon use any other drugs. She admits she has not totally healed from her rape experiences. Earlier she related that she told a policeman that she had not received any counseling because she “finally got over it after a while.” Now she has realized she may need counseling. I’m scared of the night now . . . and I gotta get used to my fianc leaving me at night. . . . I gotta do something, but it’s gonna be kinda hard. . . . I’m supposed to be in a group therapy class . . . and I was ordered by my attorney to get in therapy, but I didn’t have no Medicaid so I had to wait. So now I got to go back in therapy [laughs]. . . . Priscilla expressed a desire to complete her education. She dropped out of school in the 7 th grade and Brandon dropped out in the 9 th or 10 th grade. They are planning to return to school together to get their GEDs (General Educational Development tests). Priscilla would like to become a secretary because she is “good with computers.” Priscilla is presently happy and wants to let go of the past. She has much hope for her future. Well, from now everything’s been great. I mean, my daughter she’s still growing up, I have my fianc, and then I’m gonna have this baby. So I think everything’s great. You know, it’s not exactly the way I planned to start out, but like my mother

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69 in-law says, “Everything get better the further you go.” So everything’s going great now. Rose’s Story: Told on March 10, 2003 Rose is 19 years old. She has two children, a 5-year-old boy and a 3-year-old girl. Rose has had a very difficult childhood and adolescence. She has very ambivalent feelings about her mother who was not there for her. My mother, we don’t have a mother-daughter relationship. We argue all the time. She was never there for me when I need her, but we speak on occasion. I don’t hold the things she did to me against her. . . . She never had custody of her kids. . . . They gave her chances to visit her kids and to do what she had to do to get us back, but she never did it. She always violated the things she was supposed to do so they terminated her rights. She couldn’t see us. I still saw her though. Like I told them, you know, “That’s my mom. . . . She did her wrong-doings, but that’s still my mother. She gonna always be my mother.” And they can’t stop me from seeing her. . . . Like if I was on the run, I’d stop by and see her. . . . I was in foster care my whole life. I just recently got out last year. . . . As soon as I turned 18 years old, I exited the foster care system. . . . She [mother] was on drugs real bad; she’s still doing it. I try not to hold it against her, but when I think about it, it starts an argument, you know. . . . Her father was not there either. Rose is somewhat defensive about his absence. Me and my father have no contact. I saw my daddy once when I was 7, and I never saw him again. . . . I don’t feel bad cause, I mean, I could see if he was in my life and then he just walked out. I don’t feel bad at all. It’s a lot of people out there who never had a father. Life in foster care was very difficult, as Rose explained. She was sexually abused as a young child. As she got older, her behavior caused her to be ordered by Juvenile Court to a level four program. Rose explained this program as being “a low risk program for delinquent children who get in trouble with the law.” She was later ordered to a level six program that was a highly structured residential program for delinquent adolescents. I was, at the age of 4, in a very good foster care placement. And then, when I turned 6, my aunt got custody of me. And her husband went to molesting me, so I told her. She didn’t believe me, and she gave me back to the foster care system. . . . And ever since she gave me back, I was getting in trouble, constantly getting in fights in

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70 school, getting suspended, getting in trouble with the law. I mean I was getting in trouble constantly. I was running away. . . . I was on the run. . . . I did, like, a year in a level four program, and I got out and I was doing good for a while. I was going to school, making good grades, and I started hanging around some girls that I went to the mall [with] and was stealing. And I end up getting in trouble again. And I caught another charge, and they sent me to a level six. Rose discussed her first pregnancy and her brief relationship with the father of her son, who was also in foster care. I was 13 when I first got pregnant. I had my son at 14. . . . Nearly the whole time of my pregnancy, I was on the run. And when it was time for me to give birth to my son, that’s when HRS stepped in again, and they saw that I was on the run and everything. And I was constantly getting in trouble with the law. . . . The most problems I had, I was fighting or running away . . . and a few petty theft charges. But it was basically I was getting into a lot of fights. . . . I never had a drug problem. I think about the way my mother was with us. . . . Once you’re in the foster care system, they automatically take custody of your child. . . . I never was able to raise my son. He’s 5 now. . . . He stays with my grandmother. . . . And once they get in the system, it’s very hard to get them back. . . . When I had gave birth to my son, and I’m trying to get my custody of my son back and I saw him [father of her son] not trying to do right. . . . I left him alone right after I gave birth to my son. . . . I see him once in a blue moon. We can’t stand each other. We don’t talk, we don’t speak to each other cause he was never there for my son. . . . He never did anything for him. Rose acquired chlamydia while she was pregnant with her son. She said, “It had to be my son’s father. . . . He was the only one I was sleeping with at that time.” He went to the clinic with me and everything. But that’s any male. I feel they think they just can’t have one partner. That’s any male. And that’s something every female has to accept. All males are gonna cheat and sleep around. I accept that. Rose became pregnant again when she was 16. She met the father of her daughter at school. He was the first serious relationship she ever had. They had a very intense relationship and although they later broke up, she still has strong feelings for him. I loved him dearly. I still do. I mean, we’re not together now, but I love him dearly. . . . He didn’t care about me being in foster care, he didn’t care what I went through, he was always there for me. . . . He didn’t hold anything against me. He accepted me for who I was and what I was. . . .

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71 Rose was diagnosed again with chlamydia late in her second pregnancy. It was during this pregnancy that she spent four months away in a level six program. I probably had it before I was in my program. But I can’t say if he slept with someone [else] while I was in my program and that’s how I got it. . . . So I coulda had it before I went or I coulda got after I came home and slept with him again. So I couldn’t say. . . . When I told him about it, he swore me up and down he didn’t have sex with no one [else] when I was in my program. . . . He even cried when I told him I had it, and the things it could do to my daughter. He even sat and cried and swore me up and down he didn’t have sex with nobody [else]. So I kinda believed him. But then again, I don’t know, I can’t say . . . it was from him cause I never, I have never cheated on any one of my kids’ fathers while I was with them. I was only with him . . . I know he percent. He was the only one out there. As Rose continued to tell this part of her story, it was apparent that she is still very emotionally involved with him. We just recently broke up, after her first birthday. We got back together, we just broke up again. It’s an on-and-off thing with us. . . . I’d take him back anytime because he’s a good father, he’s a good person. He has a good heart and good personality. It’s just that we can’t get along. . . . But her father’s the only one I really care about. . . . He’s mad at me now because . . . we split up. He mess around, he had another baby from someone else and I won’t accept that. He wanted to get back with me, like, last month sometime, and I can’t accept that. I probably could accept him sleeping with someone else better than I could accept him having another child from someone else and that’s the reason we’re not together today. Rose began to have casual sex after she and her daughter’s father broke up. She has now had about 10 partners. She also continued to have sex occasionally with her daughter’s father after they broke up. During this time, she was diagnosed with gonorrhea. What made me start sleeping with other people, I mean, I’m the type. I like to get revenge. . . . This was right after me and my daughter’s father had broken up. And I used to check. I still call his phone and I hear other girls on his voice mail, and I knew, for a fact, he was sleeping with someone else then. So I guess to get that off my mind, I’ll go out and sleep with someone else . . . whoever. . . . It wasn’t no relationship-type thing. What we did, we did, and it was it. . . . We used condoms. . . . The time I got the gonorrhea in February, we didn’t use a condom. . . . It’s just something that happened. . . . It wasn’t planned, and we didn’t use a condom. I know who I had

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72 sex with that night. . . . I could say he gave it to me, but I don’t know, because I, also, in February slept with my daughter’s father, which he was sleeping around also, so I couldn’t say. Rose is now living in her own apartment with her daughter. She went to court and fought to keep her daughter. This time she won her case because she had matured, had a job, and was going to school. She calls herself a “stay-at-home mom” and loves taking care of her “kids.” Actually she has custody only of her daughter although she clearly grieves the loss of her son and wants to gain custody of him. I’m trying. . . . It’s hard. There are parenting classes. They want me to work, and school, and I have no help with my daughter. . . . It bothers me a lot. . . . I have pictures of him all around the house . . . so I look at him every day. I talk to him on the phone. Just by him knowing I’m his mother, that makes me feel a little better when I’m down and thinking about me never being there for him. . . . Rose wants to go back to school to complete her GED (General Educational Development test) and become a nursing assistant. But she cannot do anything until next year when her daughter starts school. Like I say, I have no help with my daughter. I mean, her father does for her, he takes care of her with the materialist things, but . . . when we’re mad at each other, he don’t do anything. He don’t help me on my rent, he don’t bring her things she need. So right now, at the moment . . . that’s the situation I’m in. He’s mad at me so he won’t help me with my rent and do for her, none of that. Rose is now in a “stable” relationship with a new boyfriend. They have been together for four or five months. However, she is not in love with him. As a matter of fact, she still is involved with the father of her daughter. Rose: I care about him [new boyfriend]. I’m not in love with him at all. I’m not in love with him. I have feelings for him, but I’m not in love with him. . . . Me and my daughter’s father have . . . it’s like, twice, twice when I was with him. . . . We only slept together twice. Cheryl: Does he [new boyfriend] know that you’ve had sexual relations with him [daughter’s father]? Rose: No. He know I still care about him though. He do know that.

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73 Cheryl: If your baby’s father came to see you, would you still have sex with him? Rose: No, well, I feel I won’t, but I can’t say something might just happen. But no . . . I feel he’s doing a back-and-forth thing with me and his other baby’s mother, and I’m tired of it. When he’s mad at her, he want to come to me, and when he’s mad at me, he want to go back to her. . . . But our main problem is his other child. That’s it. When I asked Rose about her use of condoms with her current boyfriend, I was surprised by her answer. We then had an unexpected and confusing dialogue about her desire to have a baby with this boyfriend, especially in light of her previous remarks about him. Rose: When we first start, when we first met, he used condoms. And as we went on into the relationship, we was together, like, I guess it’s like three months, that’s when we stopped using condoms. . . . I’m not on no birth control. I don’t take birth control. Cheryl: Are you wanting another baby? Rose: I want one. I do want one. I don’t want one from him. I mean, when the time is right, I want another one, but not from him. If I got pregnant from him . . . that would, it would be nothing I could do. I wouldn’t get an abortion. I wouldn’t cause, you know, the baby didn’t ask to be here. But I’d do my best I could do to take care of him. If it was to happen, there would be nothing I could do. . . . He want one from me, but I don’t want one from him. . . . I was gonna make an appointment to see if I’m sterile because I do believe I’m sterile. I want another child bad and I have been trying for the longest. . . . Cheryl: And yet you say you really don’t want a baby with this person. . . . Rose: Not from him, right. . . . I mean, I want another child, but not with him, but if it happens, it happens. . . . I’m gonna love it, just the same, and I’m gonna love him because he gave me my child. I really don’t want one with him, but if I have one there’s nothing I can do. Rose has recently been diagnosed with chlamydia again. She is sure she has acquired it from her current partner. She is matter-of-fact about it. Rose: Oh, I know for a fact I was only sleeping with that one partner. . . . Whoever he slept with I don’t know, but I know for a fact, I got it from him. . . . He’s here . . . he’s gonna get treated today. . . . I been told him about the first time I came here. . . . He, he’s young, so he’s . . . the first thing I found out about was the Trichomonas

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74 so I told him about that. He played about that at first, but I told him it was serious. He didn’t know anything about it. . . . But he’s gonna get treated today, though. Cheryl: It sounds as though even if you found out that he was sleeping around, you’d be able to accept that? Rose: Yeah, I mean, I’d be mad about it for a minute, but I can’t hold it against him cause I did it. Having repeat STIs has not significantly impacted Rose. Cheryl: Now that you’ve got chlamydia again, how do you feel about it? Rose: Well, I got it before. It bothers me, but it don’t bother me too much because I know it’s something that can be cured. Now, say if I had HIV, that’d be a different thing. . . . It really don’t bother me as bad as HIV would. . . . Cheryl: If you got chlamydia from someone, what about the possibility of them also being HIV infected? Rose: When it’s that time, you don’t think about things like that. You don’t think about things like that until it’s done. I don’t think about it until I’m getting tested. That’s the time it bothers me the most. Cheryl: Do you feel motivated to try to protect yourself . . . from any infections in case you do become pregnant? Rose: Yes, I do. . . . Yeah, now if I know for sure he’s sleeping round, oh, he’s gonna definitely use condoms. Note: Rose was diagnosed with chlamydia again on September 3, 2003. Jenny’s Story: Told on September 17, 2002 Jenny is 18 years old. She has one child, a boy named Exavier, who is 17 months old. Jenny and her son live with her mother and her 13-year-old sister. She is very close to her mother and is able to confide in her. She says her mother helps her financially and helps to care for the baby when she can. She also depends on her mother to take her where she needs to go because she doesn’t drive yet. Jenny also has two older sisters and two brothers who live close by, and she sees them frequently. She never mentioned her father.

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75 Jenny is happy with herself as a person, but she is very unhappy with the circumstances in her life right now. She appears depressed and does not seem to feel she has any control over her circumstances. She began to sob during the interview and we had to stop talking until she composed herself. She wants to better her situation but things are “hard.” She offers the following explanation: [For example:] going to school. I can’t because [of] my son and I don’t got no childcare. And I hate that because I want to go to school. There’s a lot of girls that don’t care, but I want to go and it’s like I can’t go, and I ain’t never been in no situation like this where I can’t go to school [begins to cry]. And it’s something I really want to do. And it hurt. Cause I get tired of sitting in the house. Jenny was attending Job Corps but recently dropped out because she could not find childcare for her son. Since she left Job Corps, she feels very isolated because she has no friends and is home all day caring for her son. She is unhappy because she cannot take Xavier to most of the places she would like to go, especially to clubs. She blames the baby’s father for her circumstances because he is not present and is unwilling to help her. Jenny started having sex when she was 16 because she felt pressure from her cousin who was also her best friend. And she adds, “Everyone else was doing it.” Yep. She [her cousin] had gone done it so she wanted me to do it. We was like two peas in a pod [laughs]. We done like try to do everything together. Her first sexual experience was with a boy she had been dating for a year and a half. They had discussed the possibility of sex for some time. Then one night “it just happened.” He did not put any pressure on her to have sex. Rather, it was she who put pressure on him. She was curious to “see what the feeling was like.” The boy that I had sex with the first time, he wasn’t really in for it. You know what I’m saying? But he done it. Because I felt like I was ready, he felt like he was ready. You know what I’m saying? . . . Just everybody else around us, everybody else around us was doing it. So we just went ahead and done it.

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76 They talked about having sex for some time before they did it. Jenny said, “Then all of a sudden . . . it just happened.” Even so, they did use a condom “the first time and every time” she had sex with him until they broke up. Because they were using condoms, she never thought about becoming pregnant or acquiring an infection. Their relationship ended several months later after they started to have sex. After we had sex, it was like the relationship . . . it wasn’t like it supposed to be, like it was before we had sex. You know what I’m saying? We could talk to each other before. But afterwards, it was like we was hiding stuff from each other. . . . It wasn’t working. Jenny has now had two sex partners. She met her second partner around the time she broke up with her first boyfriend. They met after school one day when he returned to pick up his little sister. Jenny had some reservation about him at first, but he was able to allay her fears. He told her he was 18, and after dating for a while, he let her know he had a son. About four months into the relationship, they discussed their intention to have sex. He told her that he had never had an STI. At first they used condoms, but then they stopped. Her boyfriend was agreeable to using condoms, and he put no pressure on her not to use them. Jenny was so focused on finishing school that she didn’t think about either pregnancy or STIs. Although Jenny said she “trusted” him, she had some nagging doubts. Jenny: There’s something in my heart still telling me, “You shouldn’t do this, you need a rubber.” You know what I’m saying? But I was not listening to what my inner self was telling me. . . . It was condoms available and they was just not used. Cheryl: Do you think there was any part of you that wanted to become pregnant? Jenny: No . . . I didn’t want no accident. I wanted to finish school. . . . I wasn’t even thinking about none of that. I was just thinking, “I can’t get pregnant. If I get pregnant, I can’t go to school.” . . . The only thing I was thinking on was . . . I got to finish school. I got to be something. You know what I’m saying? So . . .

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77 pregnancy and STD wasn’t even on my mind. When I found out I was pregnant, I couldn’t believe it. When Jenny became pregnant, her boyfriend admitted that his true age was 20 because he was afraid of being “locked up.” Several weeks later, he experienced symptoms of burning when he urinated, and he told Jenny he had “syphilis.” They went to the STD Clinic where they both were diagnosed and treated for chlamydia. Jenny had not had sex with anyone other than her boyfriend. They talked about how he had acquired an infection. He was like, he don’t know. That’s all he kept saying, “I don’t know. I haven’t been having sex with nobody [else].” And I knew I hadn’t been having sex with nobody [else] so it had to come from him. . . . I was hurt. I stopped messing with him but I started back. Her boyfriend continued to visit and bring her small gifts for the baby while she was pregnant, but Jenny did not have sex with him because she was still hurt. Furthermore, she had no desire for sex during her pregnancy. After she had the baby, he continued to visit to see their baby, Xavier. Jenny also began to take Xavier to his house to visit. When the baby was 4 to 5 months old, they had a moment where they “caught eye contact,” and it was “over.” Again, he put no pressure on her to have sex, but her attraction to him made her want to have sex with him again. Jenny was on Depo Provera and was not worried about pregnancy. But she had some concern about STIs since she had already contracted chlamydia from him. He reassured her that he was not infected and that he loved her. Although she had some doubt about believing him, she decided to have sex anyway. I was like, “You better not be having sex with nobody else.” And he was like, he ain’t having sex with nobody else, and if he do, he’ll use a condom. And . . . I was

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78 like, “Well, you ain’t going to be having sex with me if you planning on having sex with other females.” And he, like, “Well, I’ll be faithful. I’ve been faithful before in the past.” [I said,] “No, you have not in the past. You done gave me a disease in the past. Do you remember that?” And he said, “Yeah, but that was then, this is now. I love you and ain’t nothing like this gonna happen again.” But look at me. Then . . . now. It’s the same thing. Same person. So you know what I’m saying? I put my trust in him and he still, you know, messing around with other girls. I ain’t gonna mess with him no more. Cause the first time, I kinda like accepted it. I forgave him and stuff, but the second time . . . I mean . . . he didn’t care. Jenny does not understand how she processes her experiences and makes decisions based on them. But she attempted to describe a dialogue that occurs within parts of her “inner self.” Jenny: I guess . . . my baby’s father . . . I guess I might had done gained . . . I got that trust. I trusted him again for some reason when I knew deep down inside he can’t be trusted. Still, I didn’t pay attention to that. Cheryl: Can you think about why? Jenny: Because I guess the temptation . . . that other side, it says, “Go ahead and go with it.” But the good side [says] like, “No, don’t do it, don’t do it.” Then there’s another side that saying, “Do it, do it.” I always go with the voice that says go ahead with it. Why, I don’t know. And afterwards . . . I be feeling so guilty, so guilty. And [I say], “Oh Lord, please don’t let nothing be wrong with me.” [And] . . . don’t let this, don’t let that, I can’t die at no young age. Then I be thinking about if I get AIDS [and] that means I ain’t going to be able to see my son grow up, and all this stuff like this. I want to see my baby grow up. . . . I supposed to be stronger than that. I supposed to go with the good side, not the bad side, but I always fail. Why, I don’t know. There’s something inside of me that’s, you understand, making this happen. You know what I’m saying? There’s something that makes me do it. What is it, I don’t know. And I been realized that it’s a problem about that. But I can’t figure out the problem. Cheryl: Well, what about the side that says, “Go with it, but go with it with a condom”?

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79 Jenny: [Laughs] You don’t listen to that side. Why, I don’t know. But it’ll be like, “You need a condom, you need a condom, you need a condom.” But you listen to that other side. That’s with me, I don’t know what other people do, [but] that with me. While Jenny wrestled with her feelings, she continued to have unprotected sex with her boyfriend on an irregular basis. The last time they had sex was a week after a date she had with him at a club. She attributed this last occurrence to being under the influence of alcohol although she also stated she “really” does not drink. I went out to the club. He was drunk. I was drunk [laughs]. That’s how that came about. We was under the influence then . . . and I don’t even drink. That stuff is nasty. How I got drunk, I don’t know . . . usually sip out of my cousin’s cup. But Thursday I had a cup by myself and I was messed up. When Jenny began Job Corps, she had an STI exam and was diagnosed with gonorrhea and chlamydia. She had no symptoms. She maintained that she had not been with anyone [else] but the father of her baby. This time she feels more guilt and places responsibility for the infection on herself. Jenny: I feel bad. That’s what I get for not having a rubber and having unprotected sex. It’s kinda my fault more than it is his fault because I could prevent this just as well as he could by not having sex with other people without rubbers. . . . This time it’s more my fault. It hurts me because I trusted him . . . and I feel like even though we don’t have sex anymore . . . when he come back we do have sex. I shouldn’t have to get nothing when he know I’m not having sex. And if I were, I’d know to use a rubber because I am having sex with you unprotected. . . . And I feel like he should think like that, too. But I don’t think he thinks like that all, to tell you the truth. Cheryl: Are you aware, you just sort of take it for granted that he is having sex with other women other than yourself? Jenny: I’m aware and I don’t take [it] for granted. . . . He knows this is the last straw, right here. You can only do so much to a person, a person can only handle so much. This is the second time, and it shouldn’t be no second time. The first time should be the last time. That how I feel about the situation. Well, no need of me even thinking about even having more sex with him cause of the fact he ain’t caring about his health or mine. You know what I’m saying? He putting my life in danger, as well as his, so there’s no need.

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80 Although Jenny maintains she will not have sex again with the father of the baby, she is open to the possibility of future sexual relationships. Before I have sex with them [other partners], I’m bringing them to the clinic. . . . And I’ll get checked, too. . . . Then we can have sex . . . with protection first. . . . If you marry me, you can have unprotected sex with me. Note: Jenny was diagnosed with chlamydia on February 3, 2003, and again on June 18, 2003. Nicole’s Story: Told on March 10, 2003 Nicole is 18 years old. She has a 2-year-old son. As a young girl, Nicole alternated between living with her mother and her father, but she has lived with her mother from the time she was 12 years old. While Nicole was pregnant, she either lived with her mother or her mother’s friend who provided her with support during this time. Her relationship with her mother is “OK,” but she does not have the best relationship she feels it could be. She sees her father frequently and has good rapport with him. Nicole currently lives with her son in a house that her grandfather left to her mother. Her mother recently moved out the house into an apartment with Nicole’s brother and sister. Two other siblings live with their grandmother. She sees her mother and siblings frequently. She has been “on her own” since the end of her 17 th year. Her parents do not help. Nicole: I stay by myself, so . . . I don’t really get, like, too much help or anything. I’m just by myself right now. Cheryl: You say neither one of them is helping you out at all? Nicole: No. Anything I get I have to get on my own. And most of the money I make, I make by doing hair. . . . I like to do hair. That’s my major. Nicole first had sex when she was 15 years old with her boyfriend whom she met in middle school. He was a year older than she was. She became pregnant about a year later

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81 when she was 16 and in the ninth grade. They used condoms at first, until she became pregnant. Cheryl: So you used condoms up until the time you got pregnant. What changed? What made you decide to stop using condoms? Nicole: Experience. I wanted to experience something new. Try something new. Cheryl: You mean you wanted to see if it felt differently or. . . . Nicole: Yeah. Cheryl: Did you discuss the possibility of, well, if we don’t use any protection, I could get pregnant? Nicole: He pulled the line that everybody else say, “I’ll pull out.” [The] next thing, you know. . . . Cheryl: So did you want to get pregnant at that time? Nicole: Mmm. [Shakes head no]. . . . After Nicole became pregnant, her feelings for her partner changed. I just quit talking to him, like, when I was pregnant. I really didn’t like him then. . . . I don’t know, he was just, he seemed like he just irked my nerves. I don’t know how, but that’s what happened. After her baby was born, she continued to see the baby’s father as a friend only—without any sexual involvement—until eventually they had no further communication. He does pay child support but “that’s about it.” When her baby was about a year old, Nicole began to date two young men who were introduced to her by friends. One of those men went to jail a few months after she met him, but she continued to see the other man. She is still in a relationship with him that she describes as “OK,” and added, “We’re doing all right.” Her boyfriend treats both her and her baby well. Nicole said she is a “senior” in high school, but then corrected herself. She explained she had just stopped going to her classes a week ago and had missed her final

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82 exams. Now it is too late for her to graduate. She would like to attend Florida Community College at Jacksonville (FCCJ) to get her GED and get a license to “do hair.” Because she has a young child, Nicole relates her difficulty in attempting to complete her education. Between the time I was turning 16 and I got pregnant, I was in the ninth grade. Ninth grade I quit going to school, ninth grade. . . . Then I had him in June, and I started going back to school. . . . And I got in my 12 th grade year, and it seemed like it got harder. And I was, like, having a baby, like four years straight, and trying to go to school, and it just got harder and harder. . . . It’s hard to try to concentrate on school and a baby. And try to get a job to pay the bills. . . . I wasn’t getting enough rest. And he [the baby] had to be up by 4:30, and he be playing at night so he don’t hardly get that much rest . . . then, trying to study and take care of him at the same time. It’s not easy. Although she would like to be in school, Nicole is now looking for a job. She has worked at McDonald’s, but she did not like it. She hopes to get a job in a grocery or clothing store, but now she just needs a job . . . any job “to pay bills.” Nicole admitted that she drinks and also smokes cigarettes and marijuana, but does not use other drugs. Neither does her partner. She does not feel her alcohol use contributes to her sexual activities. “I don’t be that drunk, not just to have sex with anybody. . . . I don’t get, like, tore up drunk.” Nicole has had chlamydia three times. During the course of prenatal care for her first pregnancy, she was diagnosed with chlamydia. She knew the boy who gave it to her. Nicole: Baby’s daddy . . . that was the only person I was having sex with, like since the first time I had sex, so it had to come from him. Cheryl: Did you talk with him about it? Nicole: Yeah, . . . he was like, “Well, how you got it?” I was like, “How you mean, what you mean, how I got it?”

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83 So he went to thinking . . . say, “You had to be with somebody cause you was the only.” There he go, now he thought I was lying when I said he was the only person I’d been with. Cheryl: Well, what about him? Did he say he was with anybody else? Nicole: Naw, he say he wasn’t with nobody else. Nicole said her second episode of chlamydia was diagnosed several months ago in January 2003. She was confused when prompted about another episode of chlamydia reported in the MIS that occurred in October 2001. At that time, she had been seeing the other man who then went to jail. She recalled she was receiving Depo Provera at a clinic and had an abnormal Pap smear at that time. But she said that she was not told that she had chlamydia, and could not recall if she was treated for it. She told me, like, second time, she said I had something. What she said I had? Trich, and I was, she say I had, like, the yeast infection, something like that. I had that, but she didn’t say I had chlamydia. . . . I never knew I had it . . . in October. Nicole is certain that she acquired this chlamydia infection from her current boyfriend. They did not use condoms. Nicole suspected that her boyfriend had been having sex with someone else because he had been acting “different” for several months. She tried to talk to him about it, but he made a joke of it. “I was mad cause he lied to me about having sex, period . . . about having sex with anybody else.” Although she knows he is not being honest with her, she anticipates that when she tells him that she has chlamydia, he will blame her just as her first partner did. Cause I asked him, I was like, “Well, who you having sex with?” He claim nobody. Now, it got to be somebody if I came here and got tested. . . . He swear he not having sex with nobody else. . . . If I go home and say that now, he’ll just be like, “Who you was round here having sex with?” . . .

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84 Cause he’ll think that I’m lying and I was out having sex with this person, that person. And I had already told him that he was the only person I was having sex with. So it must be him. Having another chlamydia infection will change Nicole’s relationship with her boyfriend but she will stay with him. Nicole: It’s gonna change a whole lot . . . [no] sex with him. Period. . . . Cause the lady [DIS staff] was, like, that you probably can’t have no more babies if you keep getting chlamydia. And she was like, “It’ll mess up your whole insides. . . . You have a hysterectomy or something like that. . . .” I don’t need all that. . . . Cheryl: Do you think you will stay with him? Nicole: I’ll probably talk to him, but I can’t have sex with him like that. Princess’s Story: Told on October 28, 2002 Princess is 18 years old. She has one child who is a year old. Princess is four months pregnant with her second child. She is currently living with her grandmother. She has never gotten along with her mother and has always been back and forth between her mother and paternal grandmother. Princess’s grandmother has taken care of her most of her life. My mom used to get in fights. She used to put me out cause she didn’t like my attitude. I used to talk back . . . and so I felt like I was on my own. And that’s how it all started. . . . And then I moved in with my grandmother. I was back and forth. When I got upset with my mom, I’d go to my grandmother’s house. Princess’s father is in prison. She does not see him and does not want to see him. We’re close, but before he went back to jail, or when actually he got out the last time, he told me he wasn’t going back. I didn’t really believe it so now he’s in jail. It’s like . . . oh well . . . that’s what he wants to do. Princess was 16 when she started having sex. To date, she has had four partners. She feels that the reason she had sex early was because of her bad relationship with her mother.

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85 My grandmother’d tell me, “You need to slow down. You need to listen to your mom.” But I let it go in one ear and come out the other cause she didn’t know my momma that good so. . . . And that’s how it started. Her first sexual experience was with a boyfriend who was “unfortunately” 20 years old. She had been with him for two years before they had sex. She said, “I was scared a little bit, then we waited. Then when it actually happened, I was like, ‘Oh Boy !’ [laughs]. It hurted but after I got used to it, we started having sex more often. . . . We used condoms. Not all the time.” Her second partner was someone she had sex with only one time. Her first serious relationship was with her third partner who fathered her son. The course of her relationship with him was greatly influenced by his involvement in dealing drugs. Princess said he put no pressure on her to have sex. At first they used condoms and then stopped. He stayed in my neighborhood. He used to bug me every day, trying to get my phone number, want to talk, want to go here, want to go there. We started talking, then we started having sex. . . . He asked me and I told him “no,” and he was like, “OK.” And it had to be about two or three weeks later, and the question came up again. And I thought about it for a while, and we finally did it. . . . He wore a condom the first time. Actually he wore a condom a lot of times, but I think that one time we didn’t use a condom, I think I got pregnant [laughs]. . . . When I found out I was pregnant, he was in prison. And when he found out I was pregnant, he was to be released a month, no two months, before I had my baby. Princess continued to be sexually active with him during her pregnancy. They did not use condoms. She did not see anyone else during that time, but she sometimes suspected that her partner was seeing other women. Sometimes I did, sometimes I didn’t. . . . He was in the streets running here, running there, going here, going there. I actually thought he didn’t have time to be involved with anybody else. But he always hung around females. He never had any male friends because he thought they were all trouble. So he always hung around. He had a lot of female, lady friends, but I didn’t think of anything like that.

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86 Princess found she had an STI when a routine culture was done in late pregnancy. She was diagnosed with gonorrhea and chlamydia. Now, that gonorrhea, I didn’t know about at all. They didn’t tell me about the gonorrhea. They told me about the chlamydia, but they didn’t tell me about the gonorrhea. . . . I cursed him out. I told him he could have infected my baby and I asked him had he been having sex with any other people. He told me, yeah. And I asked, was it without protection, and he told me, no. I told him he was lying because he infected me. Princess could not locate her boyfriend when she went into labor. He wasn’t there, of course, when I did have the baby. He didn’t even know that I was in the hospital. . . . He was at my house every day. I don’t know what happened that one particular day when I was in labor. . . . I called his cell phone, [but] it was turned off, for what reason I do not know. I guess he didn’t pay the bill. And after I came home with the baby, I was outside the same day. And he rode past, and he stopped and he was like, “Well, what’s wrong with you?” I was like, “What you mean?” He was like, “Well, what happened to your stomach?”. . . He was like, “You had the baby?” I was like, “Yeah.” He was upset cause he didn’t know. They continued their relationship for a while. He came every day to visit and spend time with the baby. Eventually he stopped coming. Princess explained why. After I found out I had the sexually transmitted disease, we started having sex with protection. Then after a while he didn’t want to have sex anymore because he didn’t want to use condoms. I was like, oh well. So we broke up and, but we still got along fairly well. . . . I’d see him in the neighborhood. We’d stop and talk, hold a conversation, and that was about it. The last time he came to my house was in April of this year, and he asked me, did I want to have sex. I told him no. He asked me why, I said cause I don’t know who you’ve been with and I hadn’t seen him in about a good three or four months. So really . . . and he was all right with it. He was like OK. Her son’s father was killed four months ago when he was shot in a drug deal. She told of his death in a very matter-of-fact way and showed no emotion.

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87 This was June 13 th of this year. . . . He was dealing with drugs and this, but we weren’t together after I had the baby. . . . He was like back and forth, back and forth. I see him, if I saw him, I still see him, if I didn’t, I didn’t, oh well. And someone brought him a cocaine package by his apartment, and they shot him. He died before, well, actually, he died before he got to the hospital. That’s all . . . didn’t make me a good year for 2002. . . . It’s gonna affect me in the future because I have to actually sit my child down and tell him that his father is no longer living and I have to explain it. . . . I saved the newspaper and the obituaries, and maybe that’ll make it a little more easier. . . . About a month before the father of her baby was killed, her sister introduced her to Harry, who is now her current boyfriend. They have been together about five months. Harry is 26 years old, is in the military, and has a 4-year-old daughter. Princess became pregnant almost immediately in her relationship with Harry. They used condoms at first and then stopped. Harry is “happy” about her pregnancy, but she is not convinced. Princess: After we stopped using condoms, I went on the birth control pills. I guess that I was, I forget to take one this day, I forget to take one that day, skip a day [laughs] . . . and doing, between that, and doing all that, I got pregnant. So, I guess after this baby, I’ll just have to get on the shot cause the pills really don’t work. Cheryl: How do you feel about that, being pregnant again? Princess: Not good. But then again when you think about the baby, it’s all right. . . . He’s happy. I don’t know what for cause it’s my second child, and I wasn’t planning on it, but . . . I don’t believe in killing babies so I’m gonna have to carry it, I guess. Their relationship is tenuous. Princess feels he is supportive and fun to be around “half” the time, but at the same time she also has a certain amount of doubt or indifference toward him. Cheryl: Do you think of him as being in your future? Princess: Sometimes. Cheryl: But you don’t see him as someone you might be looking toward marriage or a real long-term relationship with? Princess: No. Not yet. I don’t see it.

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88 Cheryl: Do you feel like he’s going to continue to support you through the pregnancy and help take care of the baby? Princess: I feel like he’s gonna support me sometimes. Sometimes I don’t. Last month Princess went to the emergency room because she was cramping and bleeding. The doctor told her it was “all part of being pregnant.” The doctor put her on bedrest and gave her a shot, but did not tell her about the possibility of an STI. She then received an “urgent” letter from the STD Clinic advising that she needed treatment “for something,” and she came in right away. They tell me I have chlamydia, which is not good, but it can be treated . . . which, she [DIS staff] said I’m not the carrier, my partner is the carrier. So . . . he has it and whatever he been doing, he got it from whoever he did to. . . . It’s not good, by me being pregnant. It can infect my baby. Princess suspects she acquired chlamydia from Harry, but she is not concerned that he may be seeing anyone else. Princess: He’s very supportive although he did give me a sexually transmitted disease, and let’s say, he’s just, it, it’s all right, for the time being. Cheryl: Do you feel that he’s seeing anyone else at this time? Princess: No. Not really. If he’s not with me, he’s on the phone with me. If he’s not on the phone with me, he’s at my house. So, I mean, it doesn’t bother me. I’m not thinking about that right now. . . . I don’t know what to think right now at this moment . . . unfortunately . . . so we’re gonna find out today. . . . He’s gonna know. . . . He’s gonna get it [laughs]. This is not my day. When Princess was asked what it meant to have chlamydia for the second time, she said she does not want to have sex at all because it “always comes out bad.” Princess: [Humph]. To me, stop having sex. Protected or unprotected. Cheryl: Think he’ll go along with that? Princess: He has no choice [laughs]. He’s not going to have a decision, no opinion whatsoever [laughs]. Cheryl: So if you told him that you want to wear a condom, would he give you a hard time about that?

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89 Princess: No, he wouldn’t give me a hard time. Princess is overall happy with her life now and, in fact, is having “the best time in her life.” She has arranged her life in a satisfactory way for now. She is a senior in high school and has only two courses to complete. She will graduate in May. Her son is in a day care program for the entire day. He is picked up and brought home. This arrangement gives Princess ample time to go to school and free time to do what she wants to do, which is usually watching TV or talking on the phone. She plans to go to college and is waiting to hear about her acceptance to a local university. Her grandmother and boyfriend are a good support system. She added, “I’m getting public assistance, my Social Security for my other child is pending. So basically, I’m doing fine right now. . . .” Tarianna’s Story: Told on June 2, 2003 Tarianna is 16 years old. She is pretty, vivacious, and confident. She often flashes a brilliant smile as she tells her story. She is eager to share herself and her academic successes. I’m a very outgoing person [and] open-minded. I like to have a lot of fun with friends and . . . help my mom and my grandmom. . . . So I’d say I’m a very delightful person, you know. . . . I like to go the right way, do the right thing. So if a accident happen along the way, I’ll just have to find some way to fix it . . . that’s how I am. I just help my family out more than anything. . . . They was there for me so now I’m there for them. . . . I had them giving me the inspiration that I needed to get through school. . . . I just graduated high school at 16 years old. . . . I have a scholarship to go to UCLA Technical Engineering. I was a straight A student from elementary all the way up to high school. That’s how I got the scholarship I have. And I was very popular. But I never paid attention to any of the other kids in class and stuff. I always paid attention to my studies and my lessons so I could go ahead and stay a straight A student and get through school. . . . Tarianna was not leaving for college this fall but decided to wait a year. She explained why she was going to wait, but it seemed as if she was almost looking for reasons not to go. No, I leave next September. . . . That give me a little time to study, have everything done that I need to do here. . . . That way when I go up there, I have nothing to worry about down here. . . . Right now, I’m helping my mom out with my little sister a lot, you know. I don’t want her going down the wrong path. . . . I want her

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90 to be better than me and my mom. . . . I want her to get through school first most of all. . . . I’m actually gonna go get a job for a little while . . . probably going and working with computers . . . so I’ll have experience with it before I go to college . . . [rather] than get up there and be like I don’t know what I’m doing. . . . I’d just get lost in the system. I don’t want to be like that so I’m going to get some experience with computers. Then once I go off, I won’t have no trouble. Tarianna lives with her mother and younger sister. Her older brother is “locked up at the time being.” Her grandmother lives right down the road. My mom, she’s always been a strict person. That’s why I am who I am today. She’s always there on our butts about school and doing the right thing. She always kept us in church. . . . My grandmom, she’s been a big part of my life. She’s been there since day one. She’s been helping my mom out with us, and, you know, it just my grandmom and my mom, they, those the only two that I really know. Tarianna’s parents divorced when she was 5 years old, but her father lives near her. She is not happy with her relationship with her father. My dad, I really can’t say too much about him. . . . I barely know my father. We do not have a father-daughter relationship, which was pretty tough. . . . He was there when I really did need him. I love him, he loves me. Don’t get me wrong. That’s the unconditional love, but me and my dad, we just don’t see eye-to-eye. . . . He hasn’t really been there for me most of my life, you know. He’s been there, but he hadn’t. And that’s why our relationship is like it is today. . . . I’m not saying it’s screwed up or not saying it’s a great relationship. It’s probably in between. . . . Tarianna was 14 years old when she first had sex. She has now had four partners, Christian, Tyrone, Robert, and her current boyfriend, Alex. Tarianna tells her story as a grand romance. She is an excellent storyteller although she frequently became confused about details, such as sequencing and what actually happened with each partner. She would frequently go back and correct herself. My first love, Christian . . . he was 19 years old, and I sorta lied to him about my age. You know, he took my virginity, I took his. I was his first love, he was my first love. We was together from when I was 11 years old . . . from the age of 11 to 14. I guess it was just, you know, everybody around me wasn’t virgins. . . . And at this time I was in love with him. . . . I wanted to lose my virginity, and I say, who’s the

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91 best person to lose your virginity to than your first love—if you don’t want to wait to get married. So . . . see, Christian’s Italian. . . . I was too young to get married at the time. But he wanted to be with me, so, me and him and his friend talked about him getting married to her . . . so he could be U.S. citizen by getting married to one. . . . We talked about it and then I said, “No, that don’t seem like a good idea because I wanted to be your first wife.” I said, “Don’t do it.” So what he did was he went behind my back anyways and did it. . . . He was doing it for us, you know. They wasn’t together or anything. . . . I got mad at him. . . . I don’t care if it was his best friend. It made me feel bad. . . . So I broke up with him. I told him that I couldn’t deal with it anymore. . . . So he got a divorce from her, went back to Italy, then he finally met somebody he liked. . . . After her romance with Christian, she went through a brief relationship with Tyrone. My next boyfriend, well, we only had sex one time. We was together for about five months, and then after we had sex, he just up and left so I was like, “Whoa.” You know he waited that long to get it, and then just left. I don’t honestly know why he would wait five months to have sex with me and just up and leave once he got it. . . . Some people do that. That’s why now days you have to be careful. And that it’s best to wait even longer now because, you know, you never know what’s gonna happen afterwards. Tarianna’s third partner was Robert. She acquired both her STIs from Robert. I have been diagnosed with, besides gonorrhea, with chlamydia and Trich. And I got those from my ex-boyfriend . . . that was the one before Alex. He was the one who gave me everything. . . . Robert slept with, well, this is what happened . . . and I didn’t find this out until after we had sex. . . . There was this lady and her daughter, this lady was what, 33 years old, her daughter 16. And he was doing the daughter and the momma, both, and the momma and the daughter was there and pulling tricks. So after I found out all that, that’s when I decided to come get tested. And that’s when I found out I had stuff. So I clicked on him, threw the dining room chair at him, I threw irons, coat hangers, shoes, everything that I could find. . . . That was the first time I ever had anything, and when you first get that news, honestly, the first thing that goes through your head is “I’m gonna kill him” . . . and I had to kick him to the curb, you know. I ain’t dealing with that disease stuff. But [laughs] it was hard to kick him to the curb cause I did have feelings for him. But he never went and got checked. . . . He

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92 refused to go to the clinic. He refused to believe he had anything. . . . So I told him that I couldn’t be with him. Tarianna was first diagnosed with gonorrhea in February 2002 and then diagnosed with chlamydia in October 2002. She feels that she was also infected with chlamydia in February. I was by myself at this time. I wasn’t seeing anybody. . . . When I came here [in February], they didn’t detect that I had chlamydia. So they just gave me a shot for gonorrhea . . . and then they called me back. And I don’t know what took them so long. They said, well, this has been found in your bloodstream, and you need to come in. And I came in, and they treated that too. . . . Tarianna is now in a relationship with Alex who is 20 years old. She told the story of their relationship. Now I’m with Alex. . . . November 3 rd was the day we got together. . . . It’s pretty cool thing. . . . He knew me when I was still a baby. He was one of the first people with my mom and them to hold me, you know. . . . And I’m like, “Aghh” . . . kinda weird when you think about it. He held me when I was small. Oh my God, now we’re together. . . . His family moved away. We haven’t seen each other for about 10 years, and we bumped back into each other on November 3 rd . . . . He’s actually a pretty nice guy. . . . He believes strongly in the Lord, and he has me going to church now, which is pretty good. And he does not lie at all. . . . I like that about him because at least I know I can trust him. We have that trust level with each other where we can tell each other anything and everything. . . . We wasn’t having sex at first, we was just friends. Then we became cuddy buddies where we would just hug and hold each other, and sleep in the bed together, and stuff, but we never have sex. . . . We just getting real close. . . . But at this time, why I’m here is because, he actually, before we got together, he was seeing a friend of mine. . . . I couldn’t say anything about that cause we was just friends. . . . He didn’t cheat on me because we had an understanding to where, you know, we’re not having sex, we’re not fully, fully together yet. . . . You do your thing, I do my thing. . . . Even though I never slept around with anybody [else], he slept with her. . . . It was just a one-night stand and he used a condom on him and it popped. . . . He never seen the girl again or anything like that. Well, when he first found out, he say that he was burning and stuff down there, this was way before we even had sex. . . . So I went to the doctor with him and everything. . . . They gave him some pills to clear it up.

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93 So after a while, about two weeks, all the symptoms went away. He wasn’t burning anymore. His wee-wee wasn’t hurting, you know. Everything seemed fine with him. . . . Then after that we went a little bit further with things, and that’s when we started having sex. . . . Now it’s different. Now we’re together, together. And there’s no way [laughs] that he can do that now. . . . Alex is a very Christian person. . . . He’s a man now, don’t get me wrong, he’s gonna want it, but now he’s with me, literally, he’s just with one person, and he stays with that one person. And I’ve known him to be like that, you know, since we were small, growing up. . . . I know he’s not going to do it because of the fact of the way he was brought up. And if you actually sat down and talked to him, you would see that he’s one of the most respectful young men that you would ever know. . . . I can believe in him and everything. And he’s in church, [and] for the mere fact that he got me back in church, I know that he’s not going to do it. He’s not going to cheat on me. Tarianna talked about her pattern of sexual partners. She used condoms with Christian and Tyrone every single time, but she did not use condoms consistently with Robert or Alex. I’ve done only had four guys from the age of 14 to 16. And all four of them, I have long-term relationships with. . . . I don’t just move from male to male to male to male because there’s too much stuff out there. . . . And, in my cases, there was accident, and then, I should’ve used my head and been like, you gotta put this condom on. . . . Well, Robert, I don’t know, it just [thinking] we used condoms, but not every time. And then the first time the condom popped . . . it was like, OK, you know. . . . It’s popped. . . . I know I should have used them anyway to prevent pregnancy, but at this time, I was on birth control, so I wasn’t worried about getting pregnant. Tarianna is not using any method of birth control now. She continued on about her use of condoms with Alex. At first we did, but then, let’s just say one night he got drunk, he pulled the condom off, he stuck it in. I slapped him in the face doing it! But then we just went on ahead and did what we did. You know, it’s already too late. He already stuck it in and wasn’t nothing I could do about it. So ever since that day, we just went at it without a condom. . . . I knew I didn’t have anything cause I didn’t have any symptoms. I didn’t, wasn’t burning, wasn’t nothing, and it’s been months that’s done gone by since the last time I had sex. Last person I was with before him was Robert so I knew I didn’t have anything. . . . Maybe because, you know, how people say you can’t feel

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94 anything. . . . That’s probably what it was. . . . He just want to pull it off cause he couldn’t feel nothing through the condom. I don’t know. We talked about the possibility of her becoming pregnant. With the plans for her future lined up, she was risking a lot by having sex without protection. Actually, just the other day, me and Alex talked about that. And so we decided that I was gonna get back on the Depo, you know, and then also use condoms. . . . If me and him end up breaking up, I’m going to stay out of relationships for a while. A good, little while, probably till after I finish school. . . . You know, get my job and stuff . . . and, I guess, move on with my life. But right now while we’re together, we gonna make things work, try to make the best of things . . . staying in church, being there for each other. . . . About the time her partner was drunk and pulled off the condom, I asked her, “What if you had become pregnant from that?” Her answer was surprising and somewhat perplexing. Well, there would have been nothing I can do, but just deal with it, you know. And I have a very good family that supports me, you know, my mom. And I’m pretty sure my dad would have been involved in the baby’s life most likely since he wasn’t really involved in mine, he would’ve. You know, everything that he didn’t do with me, he would have did with that child, so. Poo’s story: Told on September 16, 2002 Poo is 16 years old. She is an only child and lives with her mother and stepfather. Her home life is stable. She did not talk about her stepfather, but there did not appear to be any conflict with him. She is in the ninth grade and makes “good grades.” She has never been pregnant. Her mother knows that she is sexually active. Poo said, “She makes comments every now and then, but she don’t sit up there and just keep talking about it and make me seem very depressed. . . . She don’t do that.” Poo indicated that her mother keeps close watch on her. Regarding a boy coming to Poo’s home, she said, “He’s the first boy that my momma ever let me, come get me, like pick me up in the car and go off or whatever like that, it’s the first person.”

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95 Poo was 15 when she lost her virginity. She has had two sex partners who were boyfriends. She had known her first boyfriend for a “long, long time,” and had been with him for a year when they had sex. He was 18 and “kinda wild.” She says having sex “just happened.” I don’t know, it just happened, I think. He never really talked to me about it and ask me would I have sex with him. It was never really sudden. He never really pressured me or anything. It just, it just happened, like, we was together one night by ourselves and had sex [laughs]. . . . Poo and her boyfriend used condoms at first, but then they stopped. After they had unprotected sex two times, she began to have abdominal pain. She saw her doctor and was diagnosed with chlamydia. Poo was upset and very depressed about the infection. She not only told her boyfriend she had chlamydia but also told his family. Her boyfriend’s family then confided to her that he had other sexual partners. Poo ended her relationship with him not so much because she had contracted an STI from him, but because of his “flirting” and sexual involvements with other women. I really don’t want to believe nothing he said. I stopped talking to him. I told him. . . . I had a real close relationship with his mom and dad and sister, all of them. I had told them and they was like, well, truth’s like, he had been talking to other people so more than likely he probably did, and I just stopped talking to him. Now Poo has a new boyfriend whom she has been with for about five months. He lives with his mother and is a senior at Northside Skills Center, a vocational high school; he also works part-time. She described him as a “respectable young man” and jokingly added, “somewhat decent.” Poo and her current boyfriend used condoms when they first had sex, but just as it happened in her first relationship, they later stopped using them, and now they have

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96 unprotected sex. They stopped using condoms because of “complications.” That is because the condoms hurt her. Well, it wasn’t something planned. It started off we were using condoms, and then, the last two times, we didn’t. . . . Personally, I don’t really like to have sex at all sometimes cause condoms hurt, it really do hurt. . . . They, like, it rubs up against you. That is very irritating, it hurts. So that was basically it, main reason. Their decision not to use condoms was mutual. Poo and her boyfriend talked about the possible risk of STIs and pregnancy. I don’t know . . . having a child is a big responsibility, but I like kids. I guess I like kids cause since I’m an only child. I don’t have no sisters or brothers like everybody else. So I don’t know. I guess if it happened, it just happened and if it didn’t, it didn’t . . . he’s the same way. He, he’s not really trying to be a father, but he said if it happened, you know, it was something he had to deal with. They were not as concerned about STIs, but several weeks ago Poo was diagnosed with PID and was hospitalized for three days. Her culture results were positive for gonorrhea and were reported to the Health Department. The STD Clinic called her when they got the results. The clinic treated her again just to be certain she had received the proper medication at the hospital. Although her boyfriend knew she had PID, he did not understand that it was related to having an STI. So he does not yet know of her diagnosis of gonorrhea. She is processing issues of trusting him. This is all a shock to me. . . . I don’t know whether he didn’t know it, he might not have known. He was messing with a young lady that stays around in this neighborhood area before he was talking to me . . . that was messing with another dude while she was messing with him so I don’t know. . . . There’s no telling. He says that he went and he got tested before but he’s probably lying. . . . I really don’t know. He might lie, he might not lie. I don’t know. I really don’t know. . . . Although Poo contracted gonorrhea from her boyfriend, she still cares about him, and wants to remain in the relationship with him if he will be tested and if condoms are used. At first Poo said she would not have sex “even with a condom,” but then immediately corrected herself and said she would have sex if a condom was used.

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97 I’m just going to tell him [laughs]. . . . I had already asked him, was he sure he didn’t have anything. He said no, he didn’t think he had anything, you know. And when I was in the hospital, I kept making jokes with him. I was like, well, if these people come back and tell me . . . what you gonna do, cause I ain’t trying to be with nobody who ain’t with me and don’t want to go and get tested. So if he don’t go, oh well. . . . If he ain’t gonna try to get no help, then I don’t need to be with him at all. And I feel like that more than likely he will. . . . The experience of having an STI for the second time has caused her to change her attitude, but it is not clear how much. Although Poo says she will use condoms, she still does not know how she will handle it if the condoms irritate or hurt her. I really mean it this time, I do. I just don’t know. I guess I just have a whole different attitude. But not too much of a whole different attitude, but a little bit I do. Boys and stuff, not, not a major thing on my mind no more. . . . I don’t even know. I don’t know what to say on that one, so. . . . It just makes me not even want to have sex no more. . . . The simple fact, you just can’t trust people at all. Poo’s Story Continued: Told on February 27, 2004 Poo agreed to have a second interview with us about a year and eight months later and continued her story. She was then 17 years old and was turning 18 years old the next month. I’m still with the young man who was going to the Northside Skills Center. . . . We had stopped for a while . . . then we kinda started back, like, the middle of this year, not this year, but 2003 year. He’s currently has graduated last year. He’s a merchant seaman now . . . and we’re still together, happy. . . . I’m in school, finishing my last senior year. That’s it . . . working. During the time that she and her boyfriend had not been together, she had not had sex with anyone else although her partner had. I had other boyfriends, you know, just friends that I would talk to, but I didn’t really want to talk to anybody else, like, on a serious level . . . during that time. . . . Him and his ex-girlfriend had started back talking . . . him and his mom was going through something. . . . He moved out of his mom’s house and moved in with his ex-girlfriend and her mom. And during that time, he had sex with her, she had got pregnant, and she lost her baby. Well, that was the story that was told to me, and I don’t know the facts of that. . . . I was hurt, but I got over it.

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98 Poo was concerned about the possibility of contracting another STI. When they first starting having sex, they used condoms, but then they stopped. Yes, I was . . . we were using condoms, we’re using condoms. . . . It had became a natural thing to where we would always just pull out one . . . all the time every time. . . . Well, no . . . until recently. After he went to merchant seaman school . . . well, when he came back, we started having sex again which that led to us having unprotected sex. . . . We were in that situation to where we just both wanted each other at the moment and we just went for it. . . . We were kinda wanting to be with each other so much that we didn’t even really think about it. Last month Poo had some symptoms that caused her to think she might be pregnant. She came to the STD Clinic to be checked and found that she had gonorrhea. I . . . found again that he had gave me something, and I was like, “Who you been having sex [with]?” Well, the lady had already told me when I went to go get checked, or whatever I did, cause I thought I may have been pregnant. She was like, “I understand he’s gone on a ship . . . you gotta understand, when he goes to other cities . . . there are women who are willing to do anything for those type of men and they pay for it. . . .” Well, come to find out, when he was across seas, at one of the places that he went, he had let one of the women give him a favor and he paid for it. . . . So, that put me in a tough situation now . . . gonorrhea again. . . . We talked about it and he was hurt about the situation. . . . I ask him all the time, be like, you ready to go to the doctor? He be like, yeah . . . he wanted to go, but he didn’t want nobody to take him but me. . . . I’m like, well . . . anybody can take you, you just want to be stubborn, so he’s just been waiting on me to take him. . . . Poo has again found her boyfriend to be very resistant to going to the STD Clinic to be treated. But at this time they have “broken up” again, and they are not sexually active. They broke up over an incident totally unrelated to Poo acquiring another STI. That argument was because we had a little incident. . . . I was leaving from dropping his brother off and he was in the middle of the road, and . . . my side mirror hit him on his arm, like, tapped him on his arm. And he turned around . . . but I didn’t notice the mirror had hit him on the side of his arm, and my back tire run over his foot when he turned his body around. So he got mad, and I tried to apologize. . . .

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99 He picked up a sharp object and threw it at my mother’s car. . . . Like, there was like a dent. On the side of her car was a big dent. He had thrown, like, a metal pipe piece about that long [gestures about six inches] about that wide [gestures about three inches] at it. . . . Mmm. . . . and I was very furious. I was cussing to the top of my . . . screaming [sighs] . . . and his friends just was holding me cause I was trying to attack him, I was, like, how am I supposed to explain this to my mother, that you just put a dent in the side of her car for some foolishness. So, we didn’t talk after that for two weeks, and he seen me, and I guess I was just looking so cute and stuff . . . he called me that night . . . and then that’s when we had talked everything out. . . . We talk now on a regular basis. We don’t say we go together, but nothing’s changed at all. . . . We still socialize and conversate, and then . . . for Valentines Day, he still bought me my teddy bear, and he bought me some nice Burberry gift, perfume set, and a teddy bear, we went out to eat, Applebee’s, and talked and stuff, and that was it. Poo spoke further about the possible future of their relationship. I’m just kinda stuck on him. I don’t know why. But we had a long talk, and I was like, “Well, I think we just need to put this relationship on hold so that you can learn how to grow up and make more smart decisions about things. And I said, “As well as I do too.” And he was like, “Yeah, you’re right.” And so we just decided to be friends for a while. That’s it. . . . I don’t trust him as much no more. I talk to him now more as a friendly wise . . . [thinking] I mean in the future I may want to still be with him, but right now I just, no, I just don’t want to be with him with now. I’d just rather be by myself. . . . I’m just being more involved with myself right now. Poo showed more maturity in her thinking now than was present a year ago. Although she said again that she did not feel differently having a repeat STI than she did the first time, she was giving more thought to protecting herself. No, it wasn’t any different, I don’t know. Maybe I didn’t think about it. I just didn’t think about it like that. The next time was just. . . . I just pushed it to the side. . . . I just went on. . . . Using condoms is one of the best thing that you should be doing, and . . . reasons why you don’t want to use them . . . like in my case, a spur of the moment thing . . . trying to have babies . . . for the feel of it. . . . They’re not good reasons to prevent you from using them.

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100 Poo was able to recognize that pattern of condom use with her current boyfriend was the same pattern as with her first boyfriend. Cheryl: I know that you had used condoms at first with him . . . and then had stopped the first time. . . . Do you feel sorta like the same thing repeated itself again? Poo: [Both laugh] Yes, yes it did, it did, it did, it did, it surely did. Cheryl: Are you going to have sex with him . . . after he gets treated? Poo: It’ll be a real big thought and it would definitely have condoms involved. Poo’s maturation is also seen in her decision to practice birth control. Regarding her plans to become pregnant, she said, “Oh, not for a long time, not for long time, not for long time. . . . Right now I’m on the Ortho Tricyclen pill.” Condoms do not bother her as much anymore. She will be graduating from high school in a few months and looking toward her future. Well, next month I turn 18, and I plan on trying to get me a more stable job since I’m 18 then. And then I just plan to work for the summer and then go to school, probably in August. . . . I want to be an accountant. . . . I think my first year I might just go to FCCJ [Florida Community College at Jacksonville]. Maurteeona’s Story: Told on November 11, 2002 Maurteeona is 17 years old. She is attractive, well groomed, and very animated. She wants to make the most of her life. She loves to eat, loves to joke, and loves the phone. She enjoys the “finer things in life,” such as jewelry, clothes, shoes, and getting her hair and nails done. She wants to get married and have a baby, a big house, and a car. Although Maurteeona and her mother have their “times” and “some disagreements,” their relationship is “cool.” She has “two” fathers. Her biological father is “out of the picture.” She does not have any contact with him at all. She calls her other

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101 father her “real” dad because he raised her and she was named after him. Her mother is now separated from this stepfather, but she sees him frequently. I know of him [biological father]. I don’t know him. I know him, but I don’t know too much about him . . . because when I was born, this [“real”] dad took responsibility for me. He’s on my birth certificate and everything. Maurteeona has been living with her aunt and her family for the past three months. I was getting in a lot of trouble where my mom stays at so I moved over there, and now I’ve been doing fine over there, but I go over to my momma’s house on the weekends. . . . I wouldn’t go back home right away. The next step, like, I move into my auntie’s house, will be in my own place. Maurteeona dropped out of school in the eighth grade. She thought she was not “going to be anything,” but now she feels that “it’s slowly coming to me to succeed.” She is currently attending Job Corps to get her GED and to get a trade. She credits Job Corps with “getting me up there.” It’s like once you into the program, you have entered success for a lifetime. . . . It’s helping me catch up with things in life, like, if it’s you last chance, like it is for me. This is my last chance in life . . . zero tolerance, you know, no fighting, no, none of that. . . . Maurteeona’s self-image is that of a “nice nasty” person. I’m a very, very kind of a nasty, mean person, a nice nasty. . . . I don’t get along with many people. . . . I’m very insecure. . . . I can be nice to everybody but if people take advantage of me, I can get real nasty. So that’s what I mean by “nice nasty.” I’m a very jealous-hearted person. I like people to notice me, you know. I like attention and if I don’t get it, I can get real jealous. . . . Maurteeona has a boyfriend called Bootnick. She is very much in love with him. She met him at Job Corps and has been with him for about a month and a half. She tells him everything. He came to me, he noticed me. And we started talking, and as the months has flown by, it seems like we’ve been together for years. We don’t want to just jump on and get married now. We’re trying to see how long it’s going to last. But we do want to marry each other, we are definitely in love. . . .

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102 He’s a very special person. He’s not only my boyfriend, he’s my best friend. I talk to him about everything. Like, I told him about, well, when I have changes, you know, I tell him everything. Like stuff girls wouldn’t tell, you know, some girls just sleep with everybody and they have something. You know, if I have something, I tell him when I find out stuff . . . talking about an infection. I ain’t never had HIV. I’ve never been HIV positive. So infections . . . I talk to him about them. He sit down and talk to me about it and everything. Maurteeona is very eager to have a child and hopes that she may be pregnant now. I want a child. I’m 17 now. I want a child. . . . I always wanted a child . . . hopefully, not, well not hopefully, but today hopefully I’ll find out I’m pregnant. Hopefully I am. . . . I want one of my own, something I can say that’s mine. . . . That’s just something I want as proud and joy, that’s just a piece of life that I want. Bootnick would also like to have a child and hopes that she is pregnant. He would be so happy! Very happy! . . . He already had one but she died. I can’t really tell you much about that story because I don’t really know much . . . because he can’t never just sit up straight and say it. He have to cry. Maurteeona was 1 3 when she first had sex. She did not know her first partner at all. She met him when she went with her older sister to a party. He was “older” than she was, but she did not know his specific age. It was at my friend’s house and a boy noticed me, so if you ask me my first was like, he was, I didn’t know him. I didn’t know him at all. . . . So I walked down there and the boy was talking to me and was telling me he really liked me and stuff and I kind of freaked out. . . . And one thing jumped from another and it happened, and we used protection, but. . . . Maurteeona continued to see him after that night and continued to have sex with him. She did this of her own accord. She said, “ . . . he did not force me at all. Nobody ever, never forced me to have sex.” Maurteeona has had about a “million” boyfriends, but had sex with only four before Bootnick. After her first partner, she was then with Randy, then Lindsey, then Maurice, then John, and now Bootnick. Her relationship with Randy was OK, but he lied to her. “He told me he was Black and he was really a White mix.”

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103 Her relationship with Lindsey was abusive and they used to fight. Maurice cheated and John also cheated. Bootnick is the only boyfriend who has not cheated on her. You can put “cheated” next to all of them . . . except Bootnick. . . . John cheated. I just not too long ago broke up with John. John cheated. And now I’m with Bootnick and we’re happily together. . . . John cheated too. . . . I just don’t believe in getting cheated on because I don’t cheat. So I had to leave them. I left all of them. Maurteeona related she has had three STIs. Except for Trichomonas, she had no symptoms of having an infection. They were discovered only when she had a vaginal examination. Never with all three of these, well except for Trichomonas. It was something about that one that had me going. . . . I was itching and everything, and it was burning and I started bleeding for no reason, so that’s what made me just come get myself checked. And with Lindsey and Maurice, I had no problems. It’s just that every year I get myself checked just to be sure. . . . When I found when a boy cheated on me, that what really made me want to go get myself checked because you’re doing me, you’re doing her, you know. Lindsey brought me back the first time I had chlamydia. . . . Maurice brought me back gonorrhea . . . last year. . . . John brought me back Trichomonas, and that was this year, this July. . . . And John, John wait until after we had sex, and told me he had Trichomonas when he was in New York, and then he don’t know if he could still have it or not. . . . So that’s what made come get checked. . . . Maurteeona is confused about an incident of chlamydia that was documented in the MIS for July 2002. She cannot recall having chlamydia in July, and she is also not sure how she acquired her current chlamydia infection diagnosed in September 2002. However, she is sure it did not come from Bootnick. In fact, she is concerned that she may have given chlamydia to Bootnick. I’m trying to figure out how all this chlamydia from 2001 can reflect back here. I don’t know. . . . But you know what? That’s why I’m here, to take a [test] . . . to get . . . know what’s going on because first a lady told me that my results had come back positive by chlamydia, and then next they was negative. So I’m really not understanding, to tell you the truth. . . . He’s [Bootnick] straight. Now if I have chlamydia today, he has it. That’s from me. . . . He is aware by chance that he has it, and he’s going to get checked.

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104 Maurteeona explained how “trusting” her boyfriends played a role in her decision-making about condom use with them. She is disillusioned and bitter about all her previous relationships and regrets her earlier choices. Well, to be honest with you, all of them I used condoms with them, but after a while, it was like trust. It was supposed to be trust. And you know what I’m saying? It was a trust thing. It’s supposed to be a trust. If you trust me, we can have sex without a condom, you know, I gave you some time to think about it, so. . . . But in the end, I always be the dummy and end up doing it. . . . With John, I stopped using them because I wanted him to be with me because there was always a thing about him leaving . . . and I felt that I had to be with him. I had to. But as I see, I didn’t need him. . . . Lindsey was a tough boy that I thought I had to be with too because everybody wanted him. And with Maurice, he wasn’t really, he was a nobody. . . . Randy was a nobody. . . . I don’t know where, I just know he cheated, I didn’t know exactly with who. . . . To be honest, where you might be getting is that it don’t make any sense because after each boy, I always had a disease [quiet for a while]. Nothing I can say to that one. I feel real stupid because I’m tired of being up in the clinic about a disease. I feel real stupid, and I’m only 17 years old. If I could turn back the hands of time, Lord knows I would. I want to be a virgin all over again. Because the simple fact is, at 17, I don’t think a person should have as many infections as I had. Maurteeona feels that Bootnick is different from all her other boyfriends. She is certain he does not cheat and is honest. However, she admitted that she was not completely honest with him. Maurteeona: He has trust, we have trust in each other. He still has trust in me even though when I came and told him yesterday. . . . I rushed to have me tell him yesterday, and I sat down and I told him. I said, I haven’t been completely honest with you, but I have had a couple of infections. Cheryl: Do you think if you had told him in the beginning, would that have affected anything in terms of the relationship? Maurteeona: No, to be honest, no.

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105 Maurteeona’s Story Continued: Told on February 17, 2004 Maurteeona agreed to a second interview a year and three months after her first interview. She was then 18 years old. Circumstances in her life had changed a lot. Cheryl: Sill no children, no pregnancies or anything that you lost or anything like that? Maurteeonna: No, no. Maurteeona was no longer living with her aunt. She had returned home and was living with her mother and sister again. Everything was going fine with her mother. I felt that empty space, like, sometimes I wasn’t wanted there, but it was never, like, said that I was not wanted. It was just that I was so used to my mom and everything and it just like, crowded space, so I felt that I needed to go back home. She had also had an unexpected visit with her biological dad. Her words reflected that she still feels a certain loss because of the absence of their relationship, but she has a good relationship with the dad who raised her. She spoke in a flat tone: Just a couple of weeks ago . . . I had talked to [my biological dad]. . . . He came up to my job, and I let him meet my boyfriend. To me, that was special on my part even though I don’t speak of him much. . . . My stepdaddy is my real daddy. My real daddy [biological dad] . . . is just there, I mean just . . . there. Maurteeona did not finish her program at Job Corps that she had earlier described as her “last chance in life.” She is working as a cashier at Church’s Fried Chicken. Oh, [sighs loudly] no, I didn’t, unfortunately I didn’t [finish Job Corps]. . . . I got into a fight and I got kicked out . . . he say-she say. . . . That’s how it was, he say-she say. . . . And I just found out I could have pleaded my case, you know, could’ve went and told my side of the story. But hey [shrugs] . . . I am gonna go back to school, but it was just that I took a long vacation from school, which is, I know it’s wrong. But I am currently gonna go back. I’m gonna do night classes at FCCJ . . . and get me a GED. . . . And then I’m gonna go back to FCCJ and I’m just gonna take all classes for RN, a registered nurse. Maurteeona was no longer with Bootnick. They had broken up several weeks after we had first spoken.

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106 Yeah, Bootnik . . . at that point in time I thought he was Mr. Wonderful, I guess. . . . I really thought he was Mr. Wonderful. . . . And then things don’t go your way. I mean he wasn’t . . . I guess, like, when I broke up with John, I was just, instead of just being to myself a little bit, I just jumped into another relationship and that was with Bootnik. And I liked him, and I thought I was in love with him, but then as time went on I seen that . . . you know, he wasn’t the one. So . . . at first it was all smooth and everything till I guess I got on the rocky side, and he just started getting kinda crazy to me, like, being demanding and I, no, I can’t take it, so I let him go. . . . I think . . . what kinda brought me and him together because we both had dead kids. Cheryl: Cause you both what? Maurteeonna: We both had, you know, I had a miscarriage . . . when I was about 15. I thought I mentioned it in here. I didn’t? Are you sure? [Looks over the transcription of the initial interview.] I thought I mentioned it. . . . There’s not really nothing to tell . . . because it’s not on record saying that I was pregnant. You see what I’m saying? I took a home pregnancy test and I just took it from there. . . . Then one day I guess I was under just so much stress and everything. One day I just went to the rest room, and I never have seen a period in months, and when I just went to the rest room, a big blood clot came out in the toilet and, you know, I started bleeding, and I started coming back on my menstruation. . . . So I just figured that was the miscarriage right there. . . . It was devastating. . . . I don’t sit around like most people do and cry about it because crying is not going to bring him or her back. You see what I’m saying? So I don’t really mention it. I don’t like talking about it at all. After saying that, we continued to talk a little more about the circumstances of her miscarriage. The father of the baby was Maurice. He know. . . . Maurice went to jail for a long time, and his family told him that I had an abortion. And it was a lie, but . . . it was my word against theirs. . . . They thought I just really didn’t want to have nothing to do with them, so . . . I lost the baby. . . . That’s when John came in the picture, even when I was still pregnant. He didn’t know it, but I told him after I lost the baby. . . . And he was, like, even if I would have had the baby, even though it wasn’t his, he would have took responsibility, too. Soon after Maurteeona left Bootnick, she and John reunited. John has a job in a warehouse. Maurteeona is very much in love with him. She spoke of their relationship as being continuous, not acknowledging her relationship with Bootnick in between.

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107 I was to myself for a couple of weeks, then me and John, we got back to talking. . . . We talked, we started back off as friends, and then we worked our way back up to lovers and everything. . . . Me and him have been together almost two and a half years. Friday it will be two years. . . . Oh God [rolls eyes] . . . he’s wonderful. I mean, even though he did bring me back Trich [Trichomonas] about two years ago . . . besides that, we been OK. I think it was God’s blessing to put us back together because we’re happy and everything. I mean, he’s a good person. I can’t sit right here and say he’s a bad person and he’s not. I mean he’s just unexplainable. . . . He’s just like the perfect, perfect person. He get with no drugs, no drink, no alcoholic problems, no clubbing. Just work, home, and me. We spoke about the possibility of her boyfriend still cheating. Cheryl: How do you think his relationship, in terms of being faithful to you, is now? I know that before you said: “You can put “cheated” next to all of them.” Maurteeonna: They all cheated. Cheryl: They all did. What about now? Maurteeonna: Well, he’s not cheating. Man, only way I can mark that up because all his time and his focus and everything is on me. We see each other nonstop. We go out nonstop, so if, I mean, from my point of view he’s not cheating, but if he is cheating, he has a nice way of showing it, you know. . . . I don’t know. When Maurteeona and John first got back together, they used condoms. But now since she trusts him and does not feel he is cheating on her, she is comfortable having unprotected sex with him. Well, when we first got back together, we was using protection and I had started back taking birth control. But birth control kinda gave me a problem, like headaches, and I was missing my menstrual period. . . . So I just stopped it all together. . . . Oh, when we first got together, yes, we did use protection, but as the months went by, we both went and got tested. . . . He went and got tested already before we started having sex, and prove to me he haven’t had anything. And then later on down the month, I went and got myself tested. Just to get tested again. And so when both of us seen that we was OK, you know, we just [shrugs]. . . . If anything happened that she did get another STI, she would be very hurt. It would hurt me deeply because it’s supposed to be about trust in our relationship. That would hurt me, that would just, to me, I been with him. I would be with him

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108 through thick and thin. But I just think that it would be my time to leave him cause that mean he cheated. Maurteeona is not as eager to become pregnant now as she was a year ago. But at the same time, she is not concerned about taking measures to prevent a pregnancy. We talked about whether or not having a baby was still important to her. [Thinks] It is and then it isn’t because we want kids . . . on both our parts. We want kids, but . . . we want our kid to come up. You know what I’m saying? I’d rather get my diploma and stuff first. So that’s not really on my mind right now, like it was. It’s not on my mind right now . . . then it was just then hopes and dreams, just hopes and dreams. Now I feel that I sit back and let stuff happen. Like if I was to become a mom now, I’d be happy because I have the full support from my boyfriend. From my family I have full support . . . I’d be happy. I wouldn’t sit around and cry or regret it. . . . I’d be happy because our baby will come from a stable home, and, you know, got a dad that’d want to do something, and . . . won’t want for nothing, you know. . . . Right about now I’m not using any protection. . . . I’m not taking birth control to try to prevent pregnancy, but we’re not also not real sexually active. . . . Don’t get me wrong. We have sex, but we don’t have it constantly like every day, all the time, around the hour and everything. But John would not mind if she became pregnant. Maurteeonna said, “Oh, he’ll be thrilled! Cause, see, he’s 25 and he has no kids.” Maurteeona and John plan to be married although they have not set the date. She is happy that her mother approves of him. “She love him! The whole family loves him! The whole family. They love him. They treat him just like family!” Maurteeona feels very content with her life now. She is hopeful about her future with her boyfriend, and she is still looking forward to getting married and having a baby—just as she was at the first interview. Although her educational and career goals are on hold, she is still hopeful and trying to complete her education at FCCJ. She laughingly said she still likes the finer things in life. “I do, I still do, I mean, I still do. . . .

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109 He bought this [smiles and shows off a gold bracelet]. He bought this [smiles and shows off another piece of jewelry].” Our conversation ended with a brief return to the topic of STIs. Cheryl: Well, I’m very glad that you’ve not had any more problems with STDs. Maurteeonna: I’m proud of myself. Shan’s Story: Told on July 22, 2003 Shan is 19 years old. She has no children and has never been pregnant. Shan moved into her own apartment a year ago. Although she described her mother as a “nice person,” she and her mother did not get along and argued all the time. She has a much better relationship with her aunt. Her father has been in prison for six years and has one more year to go before being released. She speaks to him occasionally and they have a “good” relationship. At age 16 and in the 10 th grade, Shan was court-ordered to Jacksonville Marine Institute (JMI), a “school for discipline kids.” Her mother was angry with her but got over it. Shan told why she was sent there. Being bad . . . and stealing little stuff, stealing and stuff . . . and fighting and stuff. . . I just wanting stuff, just going and get it. And just say I want it, and I have no money so I take it. Shan remained at JMI for six months and feels that it helped her develop a “contrite attitude” and made her want to “straighten up” and “want to do better.” Until recently, she had a housekeeping job in a nursing home but left after three months because “the management changed.” She is currently looking for a job. Her mother and aunt are helping her financially now because she is unemployed. Shan is planning to enroll at Florida Community College at Jacksonville next month to complete her GED and then hopes to complete courses she will need for the Registered Nursing program.

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110 Shan was 15 years old when she first had sex with her boyfriend who was then 16 years old. He initiated having sex but she was also agreeable to doing it. He put no pressure on her to have sex. She said, “Because, I don’t know, it’s just something that me and him wanted to do it. We wanted to try it and we just did it. . . .” They did not use condoms when they had sex. When asked if they did, she casually answered, “Umm, nope.” When asked if they talked about the possibility of STIs or pregnancy, she said, “We talked about that but I wasn’t even much thinking about all that. . . . I knew about it . . . but I wasn’t thinking about it. Shan and her first boyfriend broke up within a year. She then had a series of other boyfriends. She was sexually active with all her boyfriends. She says that none of her boyfriends ever pressured her to have sex. It was always a mutual decision. She did not use condoms with any of them. She broke up with her sixth boyfriend a year ago because he was “getting on my nerves.” While Shan was with her third boyfriend, she was diagnosed with her first STI. She began to have stomach pain and both she and her partner came to the STD Clinic to be checked. She was diagnosed with gonorrhea. She continued to have sex with him. When asked if they used protection after having gonorrhea, she said, “Nope.” She did not know why she didn’t and only said, “I don’t know. I was young and ain’t have no sense then, but now I got sense. . . .” She acquired her second STI from him when she was 17 years old. She had no other partners. She said, “I kept having chlamydia and Trichomonas. . . .” He kept on giving me stuff. . . . He had to be with somebody else cause he keep giving me this. . . . The first time he admitted it, the second time he’s talking about he ain’t been messing with nobody [else]. But I know he did.

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111 To date, Shan has had sex with about 11 partners, 5 of whom have been in the last year. We talked about the circumstances that may have led to her sexual activity in the last year. Shan: Just being around them and sitting around them, and you know, just wanting to try experience something, and try something. And we tried, like that. Cheryl: OK [silent, thinking], sometimes, are these people that you don’t know really well? Shan: I know them well. Cheryl: And you’ve had sex without condoms also with them? Shan: Um hmm. Sometimes Shan talks to her partners about using condoms, especially one partner in particular to whom she attributes her recent infections. “Man, I just tell him, use protection so I won’t get no disease or nothing, so I won’t have nothing, so I won’t have to go to the clinic.” When asked if this partner was her boyfriend, Shan said, “Nope . . . just a boy who I was talking to, and we been together, and we went and had sex.” When asked if she liked him, she said, “Not no more. I did.” During the last several months, Shan said they had used condoms but they had “popped” twice. The condom popped in May when she had contracted an STI from him and recently it popped again. Shan came to the clinic today because she is having a discharge and she is irritated with the staff. I know what it is. I don’t know why that lady won’t give me the stuff. . . . It’s the same thing. . . . He the one that gave it to me the first time I came here in May, and it had, it popped, and this lady making me get a whole nother thing again, and I already know what it is. . . . I’m back in here now because when we had sex, it popped [again]. That’s the only reason, other than that he was using protection. But me and him not talking no more cause I don’t want to talk to him cause I ain’t got time to be back in here no more.

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112 Shan emphatically denied ever having sex under the influence of alcohol or drugs. She does not smoke cigarettes or marijuana, does not use other substances, and does not go to clubs. She has never had sex for money, housing, or food. Cheryl: So the sex that you have is just. . . . Shan: Cause I want to do it. Cheryl: Cause you want to do it, OK. Why do you think you’re having sex with as many people as you are? Shan: Sexually active. Cheryl: You have sex, you say, because you’re sexually active. . . . Are you just doing it for pleasure or are you wanting more of a relationship to develop? Shan: Just doing it cause I want to do it. Cheryl: What about all the infections that you’re getting? Shan: Yeah, I know, I’m gonna stop, I do, I’m using protection. . . . I ain’t gonna have sex, like, until I find one person I like, and they’re gonna use protection. Cheryl: And the reason you haven’t, really, in the past was. . . . Shan: Being crazy till I got tired of coming here, and I realize and woke up and I smelled the coffee, realized that you can catch AIDS and stuff, but I’m glad my thing say negative cause I could of had something. Note: Shan was positive for chlamydia on the day of her interview. Addendum: Shan was somewhat disheveled at the time of her clinic visit. She was angry with the clinic staff and upset that she had to undergo another examination. I felt she agreed to the interview solely for the incentive. She avoided eye contact and looked down at the floor. Shan was difficult to interview. Although she would give short answers to probes, she did not really open up about her experiences or feelings. Her recollection of times and numbers and types did not match the information in the MIS. She described her first STI as gonorrhea, and said she had gonorrhea three times and chlamydia three or

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113 four times. The discrepancies appeared to be because of inaccurate recall and not an attempt to provide false information. Tosha’s Story: Told on October 17, 2002 Tosha is 18 years old. She has no children and has never been pregnant. She has been on her own since she was 16 years old. Arguments with her mother caused her to leave home. She explained that she and her mother are opposites, as in the phrase “oil and vinegar.” She stayed with her aunt for a year, but she also described many hardships from moving around a lot. I got a mother . . . it’s just that when you around the age [pauses, sighs] . . . that stage where you argue all the time. You feel like you have to leave [and] to keep everything to the point where you can understand each other better. So I moved and I stayed with my auntie for about a year. I went to school, but I still haven’t graduated. . . . I go to school at night and I work during the day so it’s like I try to do things . . . for myself. But it was hard because I stayed from pillar to post for like three years, but . . . you have to deal with it sometimes. Tosha is now living in her own home. She is working full time in a nursing home as an aide. Her relationship with her mother has improved, and she sees her father occasionally. I recently stay by myself, got a job, doing fine, and that’s it. Now, my mom, she help me out now that we’re in separate households. And my father, he’ll come every now and then, but it’s more like . . . I’ll see him every blue moon. I’ll see him, so . . . it’s, yeah, I’ve been getting a lot of support from my family. Tosha was 16 years old when she first had sex. She explained that she became sexually active because she did not have a “father-figure.” I guess . . . not having a father-figure . . . I only had a mother so she played my mama and my father. . . . But it is like I learnt on my own . . . [about] diseases and everything else, I learned on my own. But, I guess, me, from living from here to there, made me start having sex [pauses] at an early age. But if I would have known what I know now [laughs], I wouldn’t have.

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114 Tosha first had sex with a boyfriend whom she had been dating for two years. He put no pressure on her to have sex. It was she who talked him into having sex. I can remember that boy. . . . We had been talking for a while. He knew I was a virgin so it was more like he didn’t push me to. He will wait until I decide. But then when I finally decide, he was like he didn’t want to do it cause he didn’t think it would be comfortable or whatever. But then, you know, I guess I talked him into doing it so we did it. It be curiosity at first cause you hear your friends talking about it. Then sometimes you hear boys talk about it . . . in your mind, like OK, that he talking about this feeling and all this, I’m gonna try it. It was, it was like [pauses] you be scared, but then again, it’s more like you want to know how it feel. You just feel like OK, I’m gonna do it. . . . It take a girl about six months, I could say, at the most to really decide if she want to or not. But once she have been, she experience sex, it will make her go back for more, it like a craving. . . . Tosha has had five sex partners. She always used condoms with her first four partners. Yeah [laughs], I used condoms for a long time. Till I got about 17, going on 18. I stopped cause I probably felt like I was getting wiser so I didn’t use one. And ever since, I didn’t use one it’s like [sighs] things been going wrong. . . . From my first to my fourth, I used the condom every time. Every time. It was more like I was still young and I didn’t want no kids so I used condoms all the time. Tosha is currently in a “one-to-one” relationship with a boyfriend whom she has been with for a year. Their condom use has been inconsistent. She has had two STIs—gonorrhea and a pelvic infection (PID)—both of which occurred during this relationship. Tosha described her experience with her first STI. The MIS noted that she had chlamydia at this time, but she did not refer to it as an STI, but only as a pelvic infection. Well, it was bad because I got real sick. I was cold all the time, and at first I thought I was coming down with the flu. When I went to the hospital, they said it was a pelvic infection. But it’s good that I came right in because if I would’ve waited awhile, it would have been bad. But I came in so they cured it within those little two or three hours that I was in the hospital.

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115 She then spoke about her second infection. This time she had to face the truth about acquiring these STIs from her boyfriend, and she had to deal with issues of faithfulness and trust in their relationship. [Sighs] It was hard cause I was like OK, I got gonorrhea now. . . . I wasn’t doing nothing on, like on the side wise, as in sleeping around. So I knew it came from him. . . . When I go to ask, start asking questions to him, but it was like [he said], “Naw, I didn’t.” So he probably was in denial the first two, three weeks, and then he finally came out and said what was what. I had to accept it because he could’ve kept lying about it, but then he told the truth finally. . . . so I knew where it came from, but it was more like OK, we gonna go get this treated . . . it’s over now, but I just want to know the truth. . . . I was hurt because I asked him, “Why?” He couldn’t tell me why. So I was probably, well, I don’t even want to know why. Just can I trust you not to do it again? And he said, yeah. . . . When we came, it was more like my trust had done went down. But in order for me to still be with him, I have to trust him cause I’m figuring like without trust there’s no need to be together. . . . Ever since it been over, like my trust, a little bit, it keep coming back, keep coming back. Even after having two STIs, Tosha and her boyfriend rarely use condoms. Every now and then, like I say, every now and then . . . I have my moods. Sometimes I feel like he need to put on one. I would, like, well, put on a condom, [and] he’ll be like, OK. He’ll put it on . . . that be me testing him to see will he put on one. And he will. He won’t ask why, he’ll put on one. I guess cause he probably feel like what happened the first time, and then by me asking it should be OK, but he’ll put on one. Tosha is not on birth control. She was asked if she was concerned about pregnancy. The intent of the question was to know if she was concerned about becoming pregnant since she was not using any method of protection. Tosha interpreted the question quite differently than intended. She surprisingly responded that she was concerned about her fertility rather than preventing pregnancy. Yeah, I’m concerned now that I’m getting older. It’s more like once you start getting older, that’s when you start thinking about kids cause everyone . . . but then again that you might be how I’m living . . . cause every person I know is either

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116 pregnant or done had a child. So maybe it’s me, seeing that my friends and people that I know have kids. But . . . yeah, I’m being a lotta concerned about it. In spite of knowing about her boyfriend’s infidelity and having already acquired two STIs from him, Tosha has remained with her boyfriend. Cause I didn’t want to go through meeting someone else and going through that same thing over again, rather than just staying with him and making sure stuff be OK. Things be OK between both of us cause I don’t want to go through nothing else like that, gonorrhea, a pelvic infection, anything. . . . If something else was to happen or to come up for the third time, it’s like it’s over. But she did not actually mean that the relationship would be over. She explained that having sex with him without using a condom would be over. [Sighs] Yeah, probably . . . than just to be by myself, I’ll probably stay with him. But my trust will be so down. Like anything [else] he probably would say, I won’t believe [laughs]. But yeah, I probably stay with him. . . . Every time we have sex, it’ll be with a condom. . . . If the third time is something that I can cure, it’ll be to the point where I have to use a condom every day cause I will have no choice then. I won’t have none, so I will have to use one every day. Every day. Note: When the MIS was reviewed in July 2003, another case of gonorrhea was documented for March 1, 2003. Keisha’s Story: Told on March 3, 2003 Keisha is 19 years old. She has had a difficult adolescence. Keisha did not talk about her father at all. She lived with her mother and sister until she turned 18 years old. Her mother neglected Keisha, paying more attention to her own boyfriends. My mom, she always put her men before us, her children. . . . My momma, she had got evicted out of her apartment cause she was staying with her boyfriend. She put me and my sister out over him. It was like, I just, I don’t know, I just like basically raised myself. She ain’t, she wasn’t no mother-figure to me. I was like, it’s like, basically, everything I learned, I learned on my own. . . . Her mother was financially unstable. She diverted funds that were meant to support Keisha and gambled the money away. Keisha’s family had multiple evictions and other financial problems.

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117 Income tax had came, but she bought her a car. . . . She say her bills was paid up . . . all her money was gone. And . . . the man [landlord] said we had to get out. She [Momma] told me it was because of my sister. He said, no, it’s because you owe me $975. I’m like, “Momma, what is you doing?” I said, “Momma, what is you doing with this man’s money?” . . . I was getting income, I was getting child support, and she was like getting a check for me for my asthma . . . stuff I needed. . . . I said, “Momma, you get my check, that’s $545 a month, plus when I’m working, I’m giving you something for staying there cause I’m 18 now.” Even though she was getting my money, she would never like say, here you go, like $20. Go buy you some deodorant, some lotion and things. . . . She only did it like when she wanted to, not when I needed it. Keisha moved out when she was 18 because she could not handle it any longer. When I turn 18 . . . I was like, “Momma, I can’t help you. It’s time for me to get out there, and do it for myself. . . . You not even trying to help me half way. . . .” We just like been basically when our home is no more, but home is like not saying we ain’t got nowhere to go, but just not having our home. You know what I’m saying? Just us being together as a family, that kind of homeless and, uh [long pause]. . . . I stayed with my momma’s friend, and I stayed with my auntie. I stayed with my friend. I was just staying some of, basically, anywhere I could lay my head at. I was staying there. . . . I love her cause she my momma, but, man, she don’t be doing right by me and my sister. . . . Keisha’s first sexual experience was a date rape that occurred when she was 14 years old. Her date was a 23-year-old man she had just met on a blind date. She was traumatized by this experience. She did not have sex again for a year. I really got raped, I mean. My momma said it was rape cause I told him to stop and I didn’t want to do it. So that’s rape, right? Well, I was with my friend . . . and she was with her friend, and he had a friend, and I went with them. . . . I told him I was a virgin and stuff, and he was trying to have sex with me. . . . I seen him before, but I ain’t never meet him. . . . I had just met him that day. And I told him I didn’t want to do it. . . . He was like, come on, let’s do it, he wanted to do it with me and I didn’t want to do it. So I felt like he raped me, because I told him “no.” . . . Then I didn’t have sex for a whole year cause of that incident, it hurt so bad. He went to jail, too.

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118 Keisha began to use drugs when she was 16 years old. She started with marijuana and advanced to heavy use of cocaine and “pill-popping.” I always liked the smell of weed, and I was, like, I just want to try it and I did. And I got addicted to it. . . . You gotta have a strong mind to quit doing it. You know what I’m saying? I ain’t weak-minded at all, but I just did it because my friends was doing it, so I did it. I was just smoking, and then the smoking went from the joints with the powder in it. Then it went from that to snorting the powder, then from snorting the powder went to popping the pills. . . . Sometimes my heart will bother with me. I know you gotta die one day but, I was like, if I’m gonna die, I don’t want it to be because of drugs. I took a pill one night and it had me feeling like weary, and I was feeling real, real funny. . . . It felt like I was gonna die. I mean I don’t know how it feels for you to die, but I just didn’t feel right. . . . And I was like, God, if you get me through this, I ain’t doing it no more. And I did it again anyways, but I ain’t do it no more after that. One day, everything stopped one by one. It seemed like everything I did at that time. You know what I’m saying? It stopped. When Keisha turned 15 years old, she met her first boyfriend, Tray, who was 21 years old. She was very much in love with him. Although she wanted to have sex with him right away, Tray insisted they wait a year until she turned 16. Keisha related in great detail how the pattern of dating violence and abuse continued in her life. She said almost prophetically, “I had met somebody, and I thought [he] was going to be the love of my life, and he was going to be the end of my life . . . didn’t know that he was trying to do that,” and continued: Everything was so good up till I turned 17. That’s when all hell broke loose. . . . First he started getting mad because it was a boy at my school, he had a crush on me. . . . I liked him a little bit cause he was popular in school. . . . So [Tray] did my head like this [made gesture putting hand on her head and tilting her head]. . . . He pushed my head like that [makes same gesture again more emphatically]. But as their relationship continued, Tray became obsessed with the thought that she would leave him, and became increasingly abusive—both verbally and physically. After these abusive episodes, they would make up, but then it would happen again.

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119 We had stopped talking for about three months when I started off messing with somebody else. . . . He found out, and he was shooting at the boy. . . . We was in the car at the club . . . and he shot at the car. But I ain’t never tell who did it. It was just on the news there was a shooting at the club, something ’bout a car had got shot up. I was in that car. . . . Nobody didn’t get hurt. . . . I called him, I was like, “I’m sorry, I love you. I didn’t mean for that to happen and [sighs].” . . . He was all crying and stuff, and he came over. Then we made up and I started talking to him. . . . But then one day we was in the car, and I gave my cousin my number. . . . And he hit me, he slapped me real hard, he stated his handprints on my face. . . . I was like, “Why you hit me?” And he was like, “Cause you tried me . . . because I’m your boyfriend, you gave somebody your number.” . . . But I didn’t, that was my cousin. So then he bought me like three dozen of roses and sent them to my house. . . . That’s how he had got me back. I started back talking to him cause I was always a sucker for him. . . . Everybody know I was a sucker for Tray. . . . And so I went to bed with him. . . . And he say, “If you do that again, I’m gonna to kill you. I’m gonna hurt you.” Tray’s abuse escalated until a time when he held her against her will at his house, bound her up, and threatened to kill her. She left him after this last incident. She also had an abortion around this time. This was my last time dealing with him, when I was 17 years old cause he tried to take my life. . . . We was at his house, and he was just bringing up all kind of stuff. He was like, “I can’t live like this. . . . Why you lied to me? You said you ain’t gonna leave me. I know you’re gonna leave me.” My best friend was with me over at the house . . . and he was, “I’m fixin to kill ya’ll.” . . . And he was like, he said he was gonna shoot me, but that might be too loud, so he was going to strangle me. . . . I told him I was pregnant. And [I asked], “[You] going to kill me and your baby?” He was, like, stop, he was like, “You’re pregnant?” I was like, “Yep.” [But] come to find out I was pregnant. . . . It was his baby. . . . And I had [an] abortion. . . . And he went crazy. I pressed charges on him. I was like, I don’t want you around me no more, I want you out. . . . And I ain’t messed with him ever since. . . . I don’t want to talk about it [abortion]. It’s gonna make me cry. But I wish I would have never did that, but it’s all right, cause, I mean, if I want me to have a baby one day, I’ll get one.

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120 Keisha has had about 10 boyfriends in her life, but only two serious relationships. “That’s Tray and the one now.” Keisha acquired her first STI, chlamydia, from her current boyfriend. My boyfriend . . . he burnt me. He was cheating on his cousin. I was like, something ain’t right, and at first I thought it was a yeast infection, and it was a smell down there. . . . So I went to the doctor. . . . I was burning for three months before they finally contact these people right here [STD Clinic] and told them that I was burning or whatever. . . . She [DIS staff] sent me a paper in the mail, then my momma told me. She [DIS staff] came to my house. So, I’m thinking, do I have AIDS or something, you know? So then I was all scared. I was crying. She [DIS staff] was like, “Keisha, don’t cry, it’s curable.” Keisha continued her relationship with her boyfriend, but some time later he was sent to jail and was gone from home for four to five months. Keisha was not exactly sure why he went to jail. [Makes sound like “I don’t know.”] He told me he was selling dope no more cause I told him that I’m tired of that. He need to go get a job cause he smart, he got a dadgom high school diploma. . . . He probably sells, deals still, but doing drugs, mmm mmm. . . . He smokes. . . . He does a little alchy. He’s a little alcoholic. While her boyfriend was in jail, Keisha had sex with other men in part because he had been cheating on her, but she was also prostituting herself to pay bills and survive. She said that she was not drinking or doing drugs then. When asked about her total number of sex partners, she said: [Long pause] Umm, I’m trying to count [sigh] . . . about, about 15 partners, 14, 15. Probably less than that, but I done had a couple. . . . Yeah, I mean, I was having sex with other people cause he was cheating on me, and I would have sex for money at times. . . . He went to jail and I had to make me some. I had to pay bills, and I didn’t have no car to get back and forth to work. So I would, like, have sex for money, and that’s how I ended up having sex with 15 boys. I mean, not 15 boys at one day, but I mean like in that period of time, from the day I lost my virginity from to now. After her boyfriend was released from jail, Keisha admitted her sexual involvement with other men, but they continued their relationship. About a year later, she acquired her

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121 second STI from him. He admitted he had been cheating. This time she was diagnosed with gonorrhea. I mean, I kept it real with him. I told him, I said, what was I supposed to do? And he was mad at me, real mad. Said he was gonna leave me but he didn’t go nowhere. . . . Then last year we came here together cause he told me that he had cheated on me. . . He was peeing, he was screaming, and I was laughing at him. I was like, “Somebody done burnt you, huh?” And I said, “We fixin’ to go to the clinic right now because we had sex last night.” . . . And I was like, “Why?” And he was like, “Cause. . . .” He could never tell me why he cheat on me, why. He just don’t know. It’s just something he gotta do. For a while Keisha used condoms with her partner, but they eventually stopped using them again. It’s no big deal to me, using them or whatever. . . . I just prefer one sex partner I like to do it . . . like from last year when he burnt me in April . . . last year when I got gonorrhea, and I had sex with him for three months with a condom on cause I didn’t trust him. And I’m like, that’s a shame, you supposed to be my boyfriend, and I got to lay down and have, I got to use a condom with you. . . . She suspects he may still be cheating on her, yet they stopped using condoms. Keisha is having unprotected sex with him again. Cheryl: And then, you stopped again using condoms? Because? Keisha: Ain’t no reason. Just cause I love him so much. And he was like, “I ain’t cheating no more, I swear to God,” and all this stuff. And I’m so tired of him. . . . Cheryl: Do you think he is cheating on you? Keisha: Yeah. Cheryl: You do? What keeps you with him? Keisha: I love him. I mean, I’m just, I’m a settling-down type, and I know I ain’t the beautifulest thing in the world. But I also know I ain’t ugly, and I’m attractive to a lot of men. And they be wanting me to be their old lady and stuff, and girlfriend, but I always stay with him cause I love him so much.

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122 Keisha then revealed the real reason she stays with him and she is not using condoms. Cause I want a baby bad. Been trying so hard [laughs]. I’m like, I don’t know, can I have kids? But I went to the doctor. [He] say nothing wrong with my eggs. . . . Like one time I was taking birth control pills, and I stopped taking them so I can get pregnant. . . . It didn’t work. Keisha’s boyfriend also wants to have a baby “bad.” For the last four months, Keisha has been staying with her cousin who has been a very positive influence in her life. She has stopped doing all drugs, and has begun to earn some money working out of her house by being a hairdresser for people she knows. She plans to return to school for her GED this summer. She says she is a “changed person.” I’m changed. I’m a changed person. I love my cousin so much, man, I mean I’m changing. And I thank her for it cause by the grace of God and her, I mean, I’m making it. I’m maintaining. I’m doing good, man. She, she a good role model, and I mean, I wish she was in my life then. You know what I’m saying? . . . I’m street smart, I’m not dumb. . . . In May, I start back to school. . . . I wish I would’ve finished school. That’s why I’m going back to school today because I have a talent to do hair. I can do that real good and that’s what I’m taking up at FCCJ. And at the same time I’m working on getting my GED. And I just feel like I’m changed from a lot of things I used to do back when I was young, and stuff like smoke weed and drink, and um, pop pills, snort powder, all that stuff. I don’t do it no more. I changed, but see, he don’t even know I came here this morning cause I told him he got one more time to give me something, and it’s over. Keisha returned to the STD Clinic today to be examined because of sores in her vaginal area. She is now worried that she may have herpes. She is also thinking about the possibility of getting AIDS. Keisha explained “two” plans for what she will do if she has another STD at this time. Her first plan was to leave him, but she also had an alternative plan. Leave him alone. . . . Yep, as much as I love him, I’m gonna do it. I mean I think he tearing down my body by giving me all these diseases. . . . I know when I leave here today, I hope it’s curable. And if it is, I’m gonna leave him alone. At the same time, I ain’t having sex with nobody else without no protection unless I get married. And that’s for real . . . or if both of us come to the clinic and get checked.

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123 That’s the only two ways, right there. I don’t plan on coming back here no time soon. That’s why I always get tested for AIDS and stuff because some of my sex partners and/or my sex partner, or just period. . . . I mean this time when I take my test, I’m just going to get one sex partner cause, I mean [makes grimacing expression], I don’t want to die like that. I don’t want to suffer. Note: Keisha did not have herpes but was positive for chlamydia on the date of her interview.

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CHAPTER 5 ANALYSIS OF NARRATIVES The analysis of these narratives revealed four general themes. First, many of the girls experienced either inadequate or abusive parenting. Second, in spite of many extenuating circumstances in these girls’ lives, the desire and need to form meaningful relationships with a member of the opposite sex was central and took precedence over other issues. Third, many girls were dealing with the role of becoming a mother or already being a mother. Fourth, in spite of past or current circumstances, these girls were survivors. They showed enormous resiliency and they were still very optimistic about their futures. Inadequate Parenting These 12 girls had a range of experiences with and feelings about their families of origin. Overall, the girls received inadequate parenting. Even in cases where they expressed a good relationship with a mother or father, most of the time they still seemed to lack close parental involvement or supervision. Absent Fathers Fathers were noticeably absent in the lives of these girls. The only girl who lived in a two-parent home was Poo, who lived with her mother and stepfather. Poo did not talk about her relationship with her stepfather. Although there did not seem to be any conflicts with him, the amount of fathering he provided was not apparent. She did not mention her biological father. 124

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125 Keisha and Jenny also did not speak about their fathers. It could be inferred from their stories that the fathers were not present in the home or were not involved in their lives. Ashley blamed her father for infecting her mother with HIV because he cheated on her. She is angry about this predicament and has no relationship with him. She said, “ . . . he cheated on her, he gave it to her. . . . All of them lie—my daddy, my brothers.” Nicole alternated between living with her mother and father when she was young, but after she was 12, she stayed with her mother. She keeps in touch with her father and has a good relationship with him. Tosha lived with her mother when she was growing up. She occasionally sees her father. “He’ll come every now and then. . . . I’ll see him every blue moon, I’ll see him.” Tarianna saw her father fairly often but described a distant relationship with him. My dad, I really can’t say too much about him. . . . I barely know my father. We do not have a father-daughter relationship, which was pretty tough. . . . He was there when I really did need him. . . . But he hasn’t really been there for me most of my life. . . . He’s been there, but he hadn’t . . . and that’s why our relationship is like it is today. . . . I’m not saying it’s screwed up or not saying it’s a great relationship. It’s probably in between. Princess’s father is in jail. She does not see him and says she does not care to see him. Her disappointment in her father can still be heard through her nonchalant attitude. Before he went back to jail, or when, actually, he got out the last time, he told me he wasn’t going back. I didn’t really believe it so now he’s in jail. It’s like . . . oh well . . . that’s what he wants to do. Shan’s father has been in prison for six years and has a year to go. They talk to each other occasionally. She says they have a “good” relationship. Maurteeona said she had two fathers. Her biological father was “out of the picture.” She added, “I know of him. I don’t know him. I know him, but I don’t know too much

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126 about him.” She explained her other father was her “real” father because “when I was born, this dad took responsibility for me. He’s on my birth certificate and everything.” When Maurteeona came for her second interview, she had recently seen her biological father. Even though she has a good relationship with the father who raised her, she still had unresolved feelings about her biological father. Just a couple of weeks ago, I had talked to [my biological] dad. . . . And I let him meet my boyfriend. To me, that was special on my part even though I don’t speak of him much. . . . My real daddy [biological father] is . . . just there. I mean just . . . there. Rose summed up her relationship with her father in one sentence: “I saw my daddy once when I was 7, and I never saw him again.” Priscilla did not have a relationship with her father because her mother prevented contact with him for most of her childhood. She is now trying to re-establish her connection with her father, and is she excited about her renewed relationship with him. I had some contact, but . . . it was kinda hard for me and my dad to actually see each other when I was little. . . . We finally got together about two years ago. . . . We just finally started talking, and I went up there to visit him, and everything turned out great. . . . Now he’s trying to be in me and my daughter’s life, and he’s wanting to be in this baby’s life, too. Mothers Supportive mothers Several girls, including Jenny, Ashley, and Maurteeona, described close emotional relationships with their mothers. Jenny and her son live with her mother. Jenny is close to her mother, who is her primary support person and confidant. Ashley and her son live with her mother, who is HIV positive. Ashley is very protective of her mother. They share a close bond. “Me and my momma are like this [crosses two fingers]. Everything she tell me, everything I tell her, everything. Maurteeona was living with her aunt when

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127 we first spoke, but she returned to her mother’s home. She said, “I felt that empty space . . . I was so used to my mom and I felt that I needed to go back home.” Although they have their “times” and “some disagreements”, she feels her relationship with her mother is “cool.” Poo and Tarianna were also close to their mothers, but they particularly emphasized the guidance and supervision their mothers provided. Poo was able to confide in her mother about her problems and said, “She makes comments every now and then, but she don’t sit up there and just keep talking about it. . . . ” She also indicated that her mother keeps close watch on her social life: “He’s the first boy that my momma ever let me, come get me, like, pick me up in the car and go off.” Tarianna lived with her mother and credited her for providing a good upbringing. My mom, she’s always been a strict person, you know, that’s why I am, who I am today, she’s always there on our butts about school, and doing the right thing, she always kept us in church. “OK, but not the best” mothers Some girls described conflicts in their relationships with their mothers. Nicole simply stated her relationship with her mother was “OK, but not the best” association as she would like for it to be. Tosha said that she and her mother are opposites, as in the phrase “oil and vinegar.” Arguments with her mother caused her to move out of her home when she was 16 years old. Things are better with her mother now that they are in separate households. Shan described her mother as a “nice person,” but she and her mother did not get along and argued all the time, so she moved into her apartment as soon as she was 18.

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128 Abusive and absent mothers Three girls, Priscilla, Rose, and Keisha, had mothers who could only be described as “abusive.” Priscilla’s mother was directly responsible for sexual abuse Priscilla endured as a child. The Department of Children and Families removed Priscilla from her mother’s custody when she was 13. As I was growing up, my mom’s ex-boyfriends, they would molest me and my sister. . . . My daughter [Elizabeth], she was a child that came from a rape. . . . My mom, she knew about the whole rape thing. She was having her [Elizabeth’s] father pay her, just for me to get raped because she was low on money and she didn’t know what else to do. So I went for about a good year and four months with him raping me. He’d started raping me ever since I was 11. . . . It hurt me really bad because my mom, she was allowing it, and she wouldn’t do nothing about it. . . . At this point, I really hate my mom for that because she let me go through all the torment and, you know, me getting beat up by her [Elizabeth’s] father. Rose spent her life in foster care because her mother was a drug addict. Rose is ambivalent about her feelings for her mother today. We don’t have a mother-daughter relationship. We argue all the time. She was never there for me when I need her. . . . She never had custody of her kids. All of us was in the foster care system. . . . They gave her chances to visit her kids and to do what she had to do to get us back, but she never did it . . . so they terminated her rights. . . . I still saw her though. Like I told them . . . “That’s my mom. . . . She did her wrong-doings, but that’s still my mother and they can’t stop me from seeing her. . . . She was on drugs real bad; she’s still doing it. I try not to hold it against her, but when I think about it, it starts an argument, you know. . . . Keisha had a very difficult childhood because her mother was very neglectful. Her mother paid more attention to her own boyfriends, diverted funds meant to support Keisha, and then gambled the money away. As a result, Keisha lived in impoverished conditions, and they went through multiple evictions. Keisha lived with her mother until she was 18 years old and then moved out. She has ambivalent feelings about her mother.

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129 My mom, she always put her men before us, her children. . . . My momma, she had got evicted out of her apartment cause she was staying with her boyfriend. She put me and my sister out over him. . . . I just like basically raised myself. She ain’t, she wasn’t no mother-figure to me. . . . It’s like, basically, everything I learned, I learned on my own. . . . I love her cause she my momma, but, man, she don’t be doing right by me and my sister. . . . Grandmothers Princess and her son live with her grandmother. She never got along with her mother and made it clear that her grandmother, not her mother, took care of her most of her life. She is still not close to her mother. Although Tarianna had a good relationship with her mother, her grandmother was also very important to her. My grandma, she’s been a big part of my life, she’s been there since day one, she’s been helping my mom out with us, and, you know, it just my grandmom and my mom. Those the only two that I really know. They was there for me, so now I’m there for them. Aunts and uncles Priscilla’s uncle played a unique role in her life. When DCF removed Priscilla from her mother’s custody, she and her daughter were placed in the custody of her uncle. We moved in with my uncle when I was about 14. And we’ve been staying with him ever since, but me and my uncle, we never got along. . . . I started thinking that he was the one who’s causing all this, and I hated him for it, but then when I moved out of his house, I realized it was more of everybody else doing it and not my uncle. . . . He was just trying to care for us, like he’d been doing. . . . since we’ve been little . . . my uncle, he’s got temporary custody, so I get her [Elizabeth] back pretty soon, I hope. Tosha stayed with her aunt for a year after she moved out of her mother’s home. Shan also described a much better relationship with her aunt than her mother. Both her aunt and mother help her financially because currently she does not have a job. As previously mentioned, Maurteeona also had moved in with her aunt for several months although she did return home.

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130 Trust and Betrayal of Trust in Intimate Relationships The most common theme in the stories of these girls was their need to establish and maintain a relationship in which they could develop intimacy. However, these attempts were not often successful. An important aspect of intimacy for the girls was faithfulness from the male partner, but they usually found that their partner “cheated” on them. Each girl wanted to trust her partner, even after repeated STIs indicated many betrayals. There were several variations in their stories about men cheating and various reactions to it. Men Cheat and Lie about It Several girls described a similar plot about cheating and betrayal in their relationships: The girl did not cheat in the relationship, but her partner did. However, her partner denied he was cheating. Jenny contracted chlamydia from her boyfriend while she was pregnant. He was like, he don’t know. That’s all he kept saying, “I don’t know, I haven’t been having sex with nobody [else].” And I knew I hadn’t been having sex with nobody [else] so it had to come from him. . . . I was hurt. I stopped messing with him but I started back. Jenny resumed her relationship with her boyfriend after he admitted to cheating in the past, but he said it would not happen again. She then contracted gonorrhea and chlamydia. He was like he ain’t having sex with nobody else . . . and he, like, “Well, I’ll be faithful. I’ve been faithful before in the past.” [I said], “No, you have not in the past. You done gave me a disease in the past. Do you remember that? And he said, “Yeah, but that was then, this is now. I love you and ain’t nothing like this gonna happen again.” But look at me. Then . . . now. It’s the same thing. Same person. Rose told about the time she had chlamydia during a pregnancy. When I told him about it, he swore me up and down he didn’t have sex with no one when I was in my program [level 6 program]. . . . He even cried when I told him I had it and, and the things it could do to my daughter. He even sat and cried and

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131 swore me up and down he didn’t have sex with nobody [else]. So, I kinda believed him. But then again. . . . Men Cheat and Lie and Blame the Girl for It Another twist to this story was that the girl was not cheating in the relationship, but her partner was. Her partner not only denied he was cheating, but accused the girl of cheating and blamed her for the STI. Ashley contracted chlamydia from her boyfriend when she was pregnant. I found out my baby daddy was having sex with another girl. It made me mad. . . . He lied and lied and lied, kept lying to me saying he wasn’t. . . . Now he telling me I’m lying, I’m lying, I’m lying. . . . I mean every time he gives me something, he always be like, “I ain’t had sex with nobody, it must be you,” and I know I don’t have sex with nobody. . . . I ain’t listen to his lies no more! Nicole contracted chlamydia from her boyfriend while she was pregnant. That was the only person I was having sex with, like since the first time I had sex, so it had to come from him. . . .He was like, “Well, how you got it?” I was like, “How you mean, what you mean, how I got it?” So he went to thinking . . . say, “You had to be with somebody cause you was the only. . . . ”There he go, now he thought I was lying. Nicole then acquired another chlamydia infection from a different partner, but the story line was the same. I was like, well, who you having sex with? He claim nobody. . . . He swear he not having sex with nobody else. . . . If I go home and say [I have chlamydia] now, he’ll just be like, “Who you was round here having sex with?” . . . Cause he’ll think that I’m lying and I was out having sex with this person, that person. And I had already told him that he was the only person I was having sex with. He Admitted He Cheated A different tale was that the male partner cheated, and when confronted by the girl when she had an STI, he simply confessed he had cheated. Sometimes he admitted it when he found he had an STI. Princess described her partner’s response when she was diagnosed with chlamydia during her pregnancy.

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132 I cursed him out. I told him he could have infected my baby and I asked him had he been having sex with any other people. He told me, yeah. And I asked, was it without protection, and he told me, no. I told him he was lying because he infected me. Maurteeona experienced a lot of men who cheated on her and gave her STIs. You can put “cheated” next to all of them. . . . Lindsey brought me back the first time I had chlamydia. . . . Maurice brought me back gonorrhea last year. . . . John brought me back trichomonas, and that was this year, this July. . . . And John wait until after we had sex, and told me he had trichomonas when he was in New York and then he don’t know if he could still have it or not . . . . John cheated. I just not too long ago broke up with John. . . . I just don’t believe in getting cheated on because I don’t cheat. So I had to leave them. I left all of them. Tarianna acquired two STIs from Robert. After they had sex, he admitted he had cheated on her. I have been diagnosed with, besides gonorrhea, with chlamydia and trich. And I got those from my ex-boyfriend. . . . He was the one who gave me everything. . . . Robert slept with, well, this is what happened . . . and I didn’t find this out until after we had sex. . . . There was this lady and her daughter, this lady was what, 33 years old, her daughter was 16. And he was doing the daughter and the momma, both, and the momma and the daughter was there and pulling tricks. So after I found out all that, that’s when I decided to come get tested. And that’s when I found out I had stuff. Shan said that at first her boyfriend admitted to cheating, but after the first time he denied it. He kept on giving me stuff. . . . He had to be with somebody else cause he keep giving me this. . . . The first time he admitted it, the second time he’s talking about he ain’t been messing with nobody [else]. But I know he did. He Cheated but He Doesn’t Know Why Several times this version was expanded. The male partner cheated and admitted it, but he didn’t know why he did it. Keisha told about the second time she had chlamydia. Last year we came here together cause he told me that he had cheated on me. . . . And, I was like, “Why?" And he was like, “Cause. . . .” He could never tell my why he cheat on me, why. He just don’t know, it’s just something he gotta do.

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133 Tosha told about the time she had contracted gonorrhea. I wasn’t doing nothing on, like on the side wise, as in sleeping around. So I knew it came from him. . . . When I go to ask, start asking questions to him, it was like [he said], “Naw, I didn’t.” So he probably was in denial the first two, three weeks, and then he finally came out and said what was what. . . . I was hurt because I asked him, why? He couldn’t tell me why. That’s Any Man In a very matter-of-fact way, Rose accepted “cheating” as an inevitable part of being in a relationship with a man. But that’s any male. I feel they think they just can’t have one partner. That’s any male. And that’s something every female has to accept. All males are gonna cheat and sleep around. I accept that. . . . I have never cheated on any one of my kid’s fathers while I was with them. Princess was able to accept Harry’s suspected cheating. They tell me I have chlamydia. . . . She [DIS staff] said I’m not the carrier, my partner is the carrier. So . . . he has it and whatever he been doing. He got it from whoever he did to. . . . I mean, it doesn’t bother me. I’m not thinking about that right now. . . . He’s very supportive although he did give me a sexually transmitted disease, and let’s say, he’s just, it’s all right, for the time being. I Know I Can Trust Him The girls found various reasons to support their belief that their partner was faithful or monogamous. When Tarianna learned that her current boyfriend had acquired chlamydia from another partner, she accepted it because he was not really cheating. Him and the girl he had a one-night stand with, I couldn’t say anything about that. . . . He didn’t cheat on me because we had an understanding. . . . We’re not having sex. . . . You do your thing, I do my thing. . . . Now it’s different. . . . There’s no way [laughs] that he can do that now. . . . I know I can trust him, and I can believe in him and everything. I know that he’s not going to do it, he’s not going to cheat on me. Some girls chose not to see evidence that their partner was cheating. When Princess was diagnosed with chlamydia during her first pregnancy, she could not say whether or not she thought her partner was cheating.

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134 Sometimes I did, sometimes I didn’t. . . . I actually thought he didn’t have time to be involved with anybody else. But he always hung around females. . . . He had a lot of female, lady friends, but I didn’t think of anything like that. Princess was recently diagnosed with chlamydia again in her second pregnancy. Although she is with a different partner, her reaction is almost the same as the first time. She is not sure how she got it, but she does not accept that her new boyfriend [Harry] was cheating. She really does not want to deal with that possibility now. No. . . . If he’s not with me, he’s on the phone with me. If he’s not on the phone with me, he’s at my house. So I mean, it doesn’t bother me. I’m not thinking about that right now. . . . I don’t know what to think right now at this moment. . . . Keisha, who admitted she cheated before, said that she is not cheating on her boyfriend now. She suspects he is cheating on her now but has continued to have unprotected sex with him. Yeah. . . . I told him, he got one more time to give me something, and it’s over. . . .If I have herpes, I don’t know what I’m going to end up doing to him when I go home because I’m tired of him cheating on me and giving me all these diseases and stuff. After Jenny acquired a dual STI (GC and CT) from her boyfriend—who had already given her chlamydia—she said: I put my trust in him, and he still . . . messing around with other girls. I ain’t gonna mess with him no more. Cause the first time, I kinda like accepted it. I forgave him and stuff, but the second time . . . . He didn’t care. . . . I guess I might had done gained, I got that trust. I trusted him again for some reason when I knew deep down inside he can’t be trusted. . . . Still, I didn’t pay attention to that. Jenny cannot understand why she continues this relationship. But the good side [says] like, “No, don’t do it, don’t do it.” Then there’s another side that saying, “Do it, do it”. I always go with the voice that says go ahead with it. Why, I don’t know. . . . There’s something inside of me that’s, you understand, making this happen. . . . There’s something that makes me do it. What is it, I don’t know. And I been realized that it’s a problem about that. But I can’t figure out the problem.

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135 Poo spoke about telling lies and being truthful. When she was with her first boyfriend and found out she had chlamydia, she said: I really don’t want to believe nothing he said. . . . I had a real close relationship with his mom and dad. . . . I had told them and they was like, well, truth’s like, he had been talking to other people so more than likely he probably did, and I just stopped talking to him. About her current boyfriend and her second infection, she added: This is just all a very shocking thing towards him cause he’s very respectable young man. I don’t know whether he didn’t know it, he might not have known. He was messing with a young lady that stays around in this neighborhood area before he was talking to me. . . . He says that he went and he got tested before but he’s probably lying. . . . He might lie, he might not lie. . . . I really don’t know. . . . It just makes me not even want to have sex no more. . . . The simple fact, you just can’t trust people at all. Tosha, who has two STIs, both acquired from her current partner, commented: He finally came out and said what was what. . . . He couldn’t tell me why. So, I was, I don’t even want to know why. Just, can I trust you not to do it again? And he said, yeah. I had to accept it because he could’ve kept lying about it. But then he told the truth finally. . . . So I was, OK, it’s over now, but I just want to know the truth. . . . When we came [to the clinic], it was more like my trust had done went down. But in order for me to still be with him, I have to trust him cause I’m figuring like without trust there’s no need to be together. . . . Ever since it been over, like, my trust, a little bit, it keep coming back, keep coming back. Staying with Him Girls gave different reasons why they stayed with men who lied and cheated on them. Ashley said: Because I don’t want to have a lot of sex partners. Well, a lot of boyfriends. I try to, like, hold on to a relationship. . . . I can’t do it no more. Because he don’t want to be truthful. . . . I don’t have a relationship no more this time. . . . He just can’t keep doing that to me. It’s nothing he can do this time. Because he lied. I really thought he was gonna change but. . . . Nicole has recently acquired chlamydia from her boyfriend, but she plans to stay with him. She commented, “I’ll probably talk to him, but I can’t have sex with him like that.”

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136 Poo recently acquired gonorrhea from her boyfriend, but she still cares about him. She will probably remain in the relationship with him under certain conditions. Yes, I would, but the only thing about this relationship involving sex, it will be no sex, even with a condom. . . . I’m using condoms, or even just not having it, having sex at all. A year and a half later Poo was still with her boyfriend, but she had recently acquired gonorrhea from him again. She still may continue to have sex with him, but now her trust is down. It’ll be a real big thought and it would definitely have condoms involved. . . . I’m just kinda stuck on him. I don’t know why. But we had a long talk, and I was, like, “Well, I think we just need to put this relationship on hold. . . . I don’t trust him as much no more. . . . I mean in the future I may want to still be with him, but right now. . . . I’d just rather be by myself. . . . Tosha is aware of her boyfriend’s infidelity and has acquired two STIs from him. Even so, she has stayed with him. Even if Tosha acquires another STI, she admitted that she will stay with him, but says she will use condoms. I’ll probably stay with him. But my trust will be so down. Like anything [else] he probably would say, I won’t believe [laughs]. But yeah, I probably stay with him. . . . I didn’t want to go through meeting someone else, and going through that same thing over again, rather than just staying with him, and making sure things be OK between both of us cause I don’t want to go through nothing else like that, gonorrhea, a pelvic infection, anything. . . . If something else was to happen or to come up for the third time, it’s like, it’s over. If the third time is something that I can cure, it’ll be to the point where I have to use a condom every day cause I will have no choice then. I won’t have none, so I will have to use one every day. Every day. . . . When the MIS was reviewed in July 2003, another case of gonorrhea for Tosha was documented on March 1, 2003. Keisha admitted that she thought her boyfriend was cheating on her. But she stays with him anyway.

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137 I love him. I mean, I’m just, I’m a settling-down type, and I know I ain’t the beautifulest thing in the world. But I also know I ain’t ugly, and I’m attractive to a lot of men. And they be wanting me to be their old lady and stuff. . . . But I always stay with him cause I love him so much. Keisha came to the STD Clinic to be checked for sores in her vaginal area. She was worried that she may have herpes. She says if she has contracted another STI at this time, she will leave him. Leave him alone. . . . Yep, as much as I love him, I’m gonna do it. I mean I think he tearing down my body by giving me all these diseases. . . . I know when I leave here today, I hope it’s curable. And if it is, I’m gonna leave him alone. At the same time, I ain’t having sex with nobody else without no protection unless I get married. And that’s for real . . . or if both of us come to the clinic and get checked. That’s the only two ways, right there. I don’t plan on coming back here no time soon. Keisha did not have herpes but was positive for chlamydia on the date of her interview. Unlike the other girls, Tarianna had no deep issues about staying with an unfaithful partner. She acquired both her STIs from her third partner, Robert. Although she was angry that he had cheated, she was not deeply hurt and was easily able to end the relationship and move on. When I found out I had stuff. . . . The first thing that goes through your head is “I’m gonna kill him” . . . and I had to kick him to the curb. . . . It was hard to kick him to the curb cause I did have feelings for him. But . . . he refused to go to the clinic, he refused to believe he had anything. . . . So I told him that I couldn’t be with him. Women Cheat Too Sometimes It was not common but a few girls also admitted that they cheated. After Rose discovered her boyfriend had cheated on her, she began to have sex with other men, but she was not cheating because they had broken up. I have never cheated on any one of my kid’s fathers while I was with them. . . . What made me start sleeping with other people. . . . This was right after me and my

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138 daughter’s father had broken up . . . and I knew, for a fact, he was sleeping with someone else then. So, I guess to get that off my mind, I’ll go out and sleep with someone else. . . . However, Rose now has a new boyfriend. She admits that she is cheating on him. She still is seeing the father of her daughter. I have feelings for him [current boyfriend], but I’m not in love with him. . . . Me and my daughter’s father have . . . it’s like, twice, twice when I was with him. . . . We only slept together twice. Her boyfriend does not know that she has had sex with the father of her daughter, “No. He know I still care about him though, he do know that.” When Rose was diagnosed with chlamydia, she was not angry at her current partner because she admitted and accepted that she has also cheated. She said, “Whoever he slept with I don’t know, but I know for a fact, I got it from him . . . but I can’t hold it against him cause I did it.” Keisha acquired two STIs, chlamydia and gonorrhea, from her boyfriend. She said, “I don’t do nothing with nobody but him.” Then she admitted that while her boyfriend had gone to jail for four to five months, she did cheat. Yeah, I mean, I was having sex with other people cause he was cheating on me, and I would have sex for money at times. . . . He went to jail and I had to make me some. I had to pay bills, and I didn’t have no car to get back and forth to work. So I would like have sex for money, and that’s how I ended up having sex with 15 boys. When he got out of jail, Keisha told him what she had done. I mean, I kept it real with him. I told him, I said, what was I supposed to do? And he was mad at me, real mad. Said he was gonna leave me but he didn’t go nowhere. . . . Maurteeona did not actually cheat on her boyfriend, Bootnick, but she admitted she did not tell him the truth about her STI history. When she was diagnosed with chlamydia, she was not sure how she acquired it, but she was certain it was not from him. In fact, she was afraid that she may have given chlamydia to Bootnick.

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139 I’m trying to figure out how all this chlamydia from 2001 can reflect back here. . . . So I’m really not understanding, to tell you the truth. . . . He’s [Bootnik] straight. Now if I have chlamydia today, he has it. That’s from me. . . . He still has trust in me even though when I came and told him yesterday. . . . I said, I haven’t been completely honest with you, but I have had a couple of infections. Trusting and Using Condoms Using a condom meant a lot more to these girls than just using a condom. The girls described several patterns of using condoms. They used condoms at first and then stopped, or they used condoms with everyone else but their current boyfriend who usually was the one who transmitted the STI. Rose said about her current partner, Harry: When we first start, when we first met, he used condoms. And as we went on into the relationship, we was together, like, I guess it’s like three months, that’s when we stopped using condoms. . . . Rose said that she usually used condoms when she had casual sex, but once in a while she did not use them. I’ll go out and sleep with someone else. . . . It wasn’t no relationship-type thing. What we did, we did, and it was it. . . . I used condoms. . . . The time I got the gonorrhea in February, we didn’t use a condom. . . . It’s just something that happened. . . . It wasn’t planned, and we didn’t use a condom. When Nicole was asked if she and her partner used condoms, she said, “Yeah . . . until I got pregnant.” She explained why she stopped using them. Experience. I wanted to experience something new. Try something new. . . . He pulled the line that everybody else say, “I’ll pull out.” [The] next thing, you know. . . . Nicole was diagnosed with chlamydia during her pregnancy. Now she has a new boyfriend. They do not use condoms even though she has suspected that he has been cheating for a few months. She has recently been diagnosed with chlamydia again. She says that she does not mind using condoms, and does not know how her boyfriend feels

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140 about them because they have never discussed it. She added that their relationship would be different. She is not going to have sex with him. It’s gonna change a whole lot. . . . Cause the lady [DIS staff] was, like, that you probably can’t have no more babies if you keep getting chlamydia. And she was like, “It’ll mess up your whole insides. . . . You have a hysterectomy something like that. . . .” I don’t need all that . . . . Princess spoke about condom use with the father of her child. They used condoms at first. He wore a condom the first time. Actually he wore a condom a lot of times, but I think that one time we didn’t use a condom, I think I got pregnant [laughs]. . . . After I found out I had the sexually transmitted disease, we started having sex with protection. Then after a while he didn’t want to have sex anymore because he didn’t want to use condoms. I was, like, oh well. . . . Princess then spoke about her current partner. They also used condoms at first and then stopped. After we stopped using condoms, I went on the birth control pills. . . . I forget to take one this day, I forget to take one that day, skip a day [laughs] . . . and between that, and doing all that, I got pregnant. Jenny and her first boyfriend used condoms “the first time and every time” until they broke up. With her next boyfriend, they used condoms at first, but then they stopped. Her boyfriend was agreeable to using condoms, and he put no pressure on her not to use them. Jenny “trusted” him, but she had some nagging doubts. There’s something in my heart still telling me, “You shouldn’t do this, you need a rubber.” You know what I’m saying? But I was not listening to what my inner self was telling me. . . . It was condoms available and they was just not used. Shortly thereafter, Jenny found that she was pregnant and was diagnosed with chlamydia. Tarianna used condoms “every single time” with her first two boyfriends, but not with her third boyfriend who gave her the STIs.

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141 Well, Robert, I don’t know, it just [thinking], we used condoms, but not every time. And then the first time the condom popped . . . it was like, OK, you know. . . . It’s popped. . . . I know I should have used them anyway to prevent pregnancy, but at this time, I was on birth control so I wasn’t worried about getting pregnant. Her condom use with her current boyfriend followed a similar pattern. At first we did, but then, let’s just say one night he got drunk, he pulled the condom off, he stuck it in. . . . We just went on ahead and did what we did. You know, it’s already too late. He already stuck it in and wasn’t nothing I could do about it. So ever since that day, we just went at it without a condom. . . . Maybe because, you know, how people say you can’t feel anything. . . . That’s probably what it was. . . . Poo and her first boyfriend used condoms at first, but then they stopped. Shortly after that, she was diagnosed with chlamydia. Poo and her current boyfriend followed the same pattern. They used condoms for a while when they began to have sex, but then, just as in her first relationship, they stopped using them. Poo said the main reason they stopped is because the condoms hurt her. Well, it wasn’t something planned. It started off we were using condoms, and then, the last two times, we didn’t. . . . Personally, I don’t really like to have sex at all sometimes cause condoms hurt, it really do hurt. . . . They, like, it rubs up against you. That is very irritating, it hurts. So that was basically it, main reason. Poo was later hospitalized with PID and diagnosed with gonorrhea. When we spoke again a year and a half later, Poo said she and her boyfriend had broken up, then reunited, and the same pattern happened again. We were using condoms, we’re using condoms . . . all the time . . . every time . . . it had became a natural thing to where we would always just pull out one . . . until recently. After he went to merchant seaman school . . . well, when he came back, we started having sex again which that led to us having unprotected sex . . . . We were in that situation to where we just both wanted each other at the moment and we just went for it. . . . We didn’t even really think about it. Now she has acquired gonorrhea from him again. If she decides to have sex with him again, she said, “It’ll be a real big thought and it would definitely have condoms involved.”

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142 Maurteeona spoke at length about her condom use with her previous boyfriends. To be honest with you, all of them I used condoms with them, but after a while, it was like trust. It was supposed to be trust. And you know what I’m saying? It was a trust thing. It’s supposed to be a trust. If you trust me, we can have sex without a condom. . . . But in the end, I always be the dummy and end up doing it. . . . To be honest, where you might be getting is that it don’t make any sense because after each boy, I always had a disease [quiet for a while]. Nothing I can say to that one. . . . At that time Maurteeona was not using condoms with her current boyfriend, Bootnick. She had been diagnosed with chlamydia again but she thought it was an old infection that was not cleared up. She completely trusted Bootnick and was certain the infection was not from him. A year and a half later, Maurteeona had broken up with Bootnick and had resumed her relationship with John. When she and John first got back together, they used protection. But now she is comfortable having unprotected sex with him. Oh, when we first got together, yes, we did use protection, but as the months went by, we both went and got tested. . . . He went and got tested already before we started having sex, and prove to me he haven’t had anything. And then later on down the month, I went and got myself tested. Just to get tested again. And so when both of us seen that we was OK, you know, we just [shrugs]. . . . We talked about her opinion of John during her first interview. Cheryl: I think that you said that when you got the Trich from him that he’d been up in New York . . .? Maurteeonna: When he came down, he came down with that. That was something he didn’t know. So I didn’t fault him for that because he didn’t know. Cheryl: You made a comment, you said, “You can put ‘cheated’ next to all of them” . . . John cheated. . . . Maurteeonna: They all cheated. Cheryl: They all did. What about now? Maurteeonna: Well, he’s not cheating. Man, only way I can mark that up, because all his time and his focus and everything is on me. We see each other nonstop. We

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143 go out nonstop, so if, I mean, from my point of view he’s not cheating, but if he is cheating, he has a nice way of showing it, you know. . . . I don’t know. Cheryl: If anything happened that you did get another STD, you would feel absolutely certain that it came from John? Maurteeonna: Yeah. It would hurt me deeply because it’s supposed to be about trust in our relationship. That would hurt me. . . . I been with him, I would be with him through thick and thin, but I just think that it would be my time to leave him cause that mean he cheated. Shan does not usually use condoms with her sex partners, even the five casual partners she had in the last year. However, she added she was using condoms with one particular partner from whom she has recently acquired several STIs. The problem was that the condoms kept “popping.” He the one that gave it to me the first time I came here in May, and it had, it popped. . . . I’m back in here now because when we had sex, it popped [again]. That’s the only reason, other than that he was using protection. But me and him not talking no more cause I don’t want to talk to him cause I ain’t got time to be back in here no more. But when Shan was asked again about “all the infections she was getting,” she reversed herself about using condoms. Shan: Yeah, I know, I’m gonna stop, I do, I’m use protection. Cheryl: And the reason you haven’t, really, in the past was. . . . Shan: Being crazy till I got tired of coming here, and I realize and woke up and I smelled the coffee, realized that you can catch AIDS and stuff, but I’m glad my thing say negative, cause I could of had something. Tosha had five sex partners. This is the first time she has not used condoms. Till I got about 17, going on 18. I stopped cause I probably felt like I was getting wiser so I didn’t use one. And ever since I didn’t use one it’s, like, [sighs] things been going wrong. . . . From my first to my fourth, I used the condom every time. Every time. It was more like I was still young and I didn’t want no kids so I used condoms all the time. Even though Tosha has contracted two STIs from her current partner, she still uses condoms with him only on rare occasions.

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144 I have my moods. . . . Sometimes I feel like he need to put on one, I would, like, well, put on a condom, [and] he’ll be like, OK. He’ll put it on . . . that be me testing him to see will he put on one. And he will. He won’t ask why or why, he’ll put on one. I guess cause he probably feel like what happened the first time, and then by me asking it should be OK, but he’ll put on one. Keisha talked about using condoms with her boyfriend after she contracted gonorrhea from him. Last year when he burnt me in April . . . last year when I got gonorrhea, and I had sex with him for three months with a condom on cause I didn’t trust him. And I’m like, that’s a shame, you supposed to be my boyfriend, and I got to lay down and have, I got to use a condom with you. . . . When asked why she then stopped using condoms, she said, “Ain’t no reason. Just cause I love him so much, and he was like, ‘I ain’t cheating no more, I swear to God,’ and all this stuff. And I’m so tired of him. . . .” Priscilla was somewhat different than the other girls. When she had consensual sex, it did not appear that condoms were considered. When I asked if she and her fianc were using condoms, she somewhat avoided the question. Well, right now, we’re not really having sex because we don’t want to get a chart back and lose the baby because we were told that chlamydia can kill your child. So I ordered him not do it [laughs]—for us not to. And he understands that. So I’m happy [laughs]. Priscilla talked about condoms only within the context of being raped. At first they was gonna put the blame on me because of the fact I didn’t use protection. I said, well, being raped, you don’t know what you’re doing because the guy can use protection and the guy couldn’t. And like this guy, he didn’t use protection. Betrayal of Trust as Abandonment Several girls saw betrayal of loyalty and dependability in relationships in an emotional context rather than just sexual context.

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145 Ashley was “mad” when she found out she was pregnant because her boyfriend said she was “lying.” He did not believe her until she showed him the papers. She was “mad” when he denied he was the father of the baby. She was “mad” because her boyfriend wasn’t there for her during the pregnancy. “I was mad . . . real mad. It hurt when somebody do you like that.” Priscilla did not talk about trust in terms of sexual cheating. Her story concerned trusting her partners and then being abandoned after she had sex with them. I never really felt comfortable around men until I met my ex-boyfriend, which was Frank, and we was together for [a] good six months. And we finally had sex, which was the night of my birthday because I figured, you know, everything’s gonna be OK. Well, it really wasn’t because when I thought he was the father of my daughter, he wind up moving all the way to California. . . . [He] didn’t want nothing to do with me, didn’t want nothing to do with her. Well, I had a lot of boyfriends . . . but just none of them I would sleep with . . . except when it came to my boyfriend, ex-boyfriend, Dustin. . . . When I finally slept with somebody, which I thought it, you know, there was something there, that he cared about me. . . . I thought I trusted him. When I gave myself up to him for the first time again, afterwards it was like he didn’t want nothing else to do with me. The construction of Priscilla’s third romantic relationship may have a different ending. She spoke about her fianc as someone who may stay with her: “. . . somebody who [is] not abusive and who is willing to be there for me and the baby.” He [her fianc] shocked me because, I figured, well, nobody’s gonna be her [Elizabeth’s] father and he’s gonna wind up leaving me sooner or later. . . . And we’re going to be getting married July the 4 th ! [smiles broadly] Betrayal of Trust Seen as Having a Child with Another Rose seemed to feel that having a child together created a type of sacred bond together. For her, the ultimate betrayal was not having sex with someone else, but having a child with another person.

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146 We split up. He mess around, he had another baby from someone else and I won’t accept that. . . . I probably could accept him sleeping with someone else better than I could accept him having another child from someone else and that’s the reason we’re not together today. Power Imbalances and Violence in Dating and Relationships Many of these girls experienced forms of gender power imbalances. These imbalances ranged from subtle forms of pressure and manipulation from their male partners to violent acts of sexual abuse and rape that sometimes occurred within a relationship. Several girls described power imbalances in their relationships. They described their hesitancy to tell their boyfriends they had an STI because their partners would accuse them of cheating. Experiences girls had with this type manipulation or control were described in the section on cheating. Other girls experienced violence associated with dating behaviors. Ashley’s first sexual experience—at age 12—with her boyfriend occurred after her boyfriend’s friend spiked her drink. I was drunk. I don’t remember. . . . His friend had put something in my drink. . . . But he didn’t know though . . . that his friend had did that. . . . I didn’t like it. It hurt . . . the first time we had sex, he gave me something. Keisha described her first experience with sex—at age 14—as a date rape by a 23-year-old man. I really got raped, I mean. . . . I seen him before, but I ain’t never meet him. . . . I had just met him that day. And I told him I didn’t want to do it. . . . He was like, come on, let’s do it. He wanted to do it with me and I didn’t want to do it. So I felt like he raped me cause I told him “no.” . . . Then I didn’t have sex for a whole year cause of that incident. It hurt so bad. . . . Keisha went on to relate how the pattern of dating violence and abuse continued in her life. She spoke in great detail about her relationship with her boyfriend, Tray, whom she met when she was 15. He was 21 at that time.

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147 I had met somebody, and I thought [he] was going to be the love of my life. . . . Everything was so good up till I turned 17. That’s when all hell broke loose. . . . But as their relationship continued, Tray became increasingly abusive—both verbally and physically. Tray once fired a gun into the car where Keisha was sitting with another boy. After these abusive episodes, they would make up, but then the cycle of violence would start again. I called him. . . .I told him I was sorry for all that stuff that happened. He was all crying and stuff. And he came over, then we made up and I started talking to him. Another time he slapped her because she gave her phone number to her [male] cousin. So then he bought me like three dozen of roses, and sent them to my house. . . . That’s how he had got me back. I started back talking to him cause I was always a sucker for him. . . . And so I went to bed with him. . . . And he say, “If you do that again, I’m gonna to kill you. I’m gonna hurt you.” Tray’s abuse escalated until a time when he held her against her will at his house, bound her up, and threatened to kill her. She left him after this last incident. She also had an abortion around this time. This was my last time dealing with him, when I was 17 years old cause he tried to take my life. . . . We was at his house and he was just bringing up all kind of stuff. . . . He was like, “I can’t live like this. . . . Why you lied to me? You said you ain’t gonna leave me. . . . I know you’re gonna leave me, and if I can’t have you, nobody can. . . .” And he was like, he said he was gonna shoot me, but that might be too loud, so he was going to strangle me. . . . I told him I was pregnant. And [I asked], “You going to kill me, and your baby?” He was, like, stop, he was like, “You’re pregnant?” I was like, “Yep.” [But] come to find out I was pregnant. . . . It was his baby. . . . And I had [an] abortion. . . . and he went crazy, I pressed charges on him, I was like, I don’t want you around me no more. I want you out . And I ain’t messed with him ever since. Priscilla spoke of her experience in a date rape situation:

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148 In September, I wind up getting raped again, and I was just torn up because I didn’t want to be pregnant again by another rape, and I didn’t want to go through the horror that I went through with my daughter’s father because it was all horrible. . . . I wind up getting chlamydia. . . . Well, it was September the 16 th , and I had a bad feeling about that day, I just couldn’t do nothing about it. . . . The guy across the street wind up calling me and my sister over, and, unfortunately, I went. . . . I used to drink. And that night I was really pretty much messed up. My sister left, and I tried to leave and he grab me by my sweater, and wind up forcing my pants off me, and I didn’t want to take them off, so he unfortunately slapped me, and he just started raping me. I was literally shooken up, I can’t do nothing. . . . I knew what was going on, but I can’t do nothing. I mean, he was a big guy and you know there was nothing I could do. I mean with me being in shock, and trying to figure out what to do, it was like, I couldn’t do nothing. . . . Rose talked about being sexually abused as a young child. I was in foster care my whole life. . . . I was, at the age of 4, in a very good foster care placement, and then, when I turned 6, my aunt got custody of me, and her husband went to molesting me, so I told her. She didn’t believe me, and she gave me back to the foster care system. . . . Priscilla spoke at length about her childhood experiences of being sexually abused, raped, and physically abused. As I was growing up, my mom’s ex-boyfriends, they would molest me and my sister. . . .Well, my daughter [Elizabeth], she was a child that came from a rape. . . .He’d [my aunt’s ex-boyfriend] started raping me ever since I was 11. . . . I went for about a good year and four months with him raping me . . . and when I was pregnant with her [Elizabeth]. . . . It just got a whole lot worser because Elizabeth’s father, he would beat me up just trying to make me have a miscarriage. . . . Other girls emphatically denied any pressure, such as Maurteeona, or expressed they exerted some pressure on their male partner for sex. Becoming Pregnant and Being a Mother The girls who were mothers talked about their actual pregnancies and feeling about being a mother. The girls who were not yet mothers discussed their feelings about becoming pregnant, or having had a miscarriage or an elective abortion.

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149 Girls who are Mothers Ashley was 14 when she became pregnant. She was mad when she was told she was pregnant. “I was too young to have a baby. I had to deal with it because my momma don’t believe in abortions and I don’t either.” She is on Depo Provera now. Priscilla was 12 when she became pregnant the first time. Her first pregnancy was the result of being raped by an adult “friend of the family.” The Department of Children and Families placed her daughter, Elizabeth, in protective services, and she [Elizabeth] is currently in the custody of Priscilla’s uncle. Priscilla was 16 when she became pregnant the second time. She contrasts the experience this time with the first time. She was very happy to discover she was pregnant this time. She spoke at length about her process of becoming a mother with her first child and also about the child she is carrying. She forms her identity as being a mother. I’m a teen-age mother. . . . I have a daughter, Elizabeth. She is 3 now and I have another baby on the way, and that’s all I am, about myself [laughs]. Jenny was 16 when she became pregnant. She said, “It was condoms available and they was just not used.” However, she denied that there was any part of her that wanted to become pregnant. No. . . . I didn’t want no accident . . . I was just thinking, “I can’t get pregnant. I want to go to school. If I get pregnant, I can’t go to school.” I got to finish school. I got to be something. You know what I’m saying? So . . . pregnancy and STD wasn’t even on my mind. When I found out I was pregnant, I couldn’t believe it. Princess was 16 when she became pregnant by her boyfriend. He was in prison most of her pregnancy and was killed in a drug deal when her baby was about 7 months old. Now Princess is 18 years old and is four months pregnant. She has been with the father of this baby for only four months, and she is uncertain about her future with him. She does not feel good about being pregnant again.

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150 It’s my second child, and I wasn’t planning on it. But . . . I don’t believe in killing babies so I’m gonna have to carry it, I guess. But then again when you think about the baby, it’s all right. Nicole became pregnant when she was 16 soon after she decided to stop using condoms to “experience something new.” She is trying to complete school, but said it is hard [with a] -year-old, full-time school, paying bills, then got no job. It’s not easy.” Rose was 13 when she became pregnant the first time. The Department of Children and Families placed her son in protective services at birth and he currently lives with her grandmother. Rose is trying to regain custody of him. Nearly the whole time of my pregnancy, I was on the run. And I was constantly getting in trouble with the law. . . . When it was time for me to give birth to my son, that’s when HRS stepped in again. . . . Once you’re in the foster care system, they automatically take custody of your child. When Rose was 16, she became pregnant the second time. The Department of Children and Families almost got her daughter, too, but Rose fought for her. She went to court and won because she had matured. She had a job and was in school. Now Rose is in a relationship with a third boyfriend whom she does not love, but she said, “I’m not on no birth control. I don’t take birth control.” When asked if she wanted another baby, she responded: I want one. I do want one. I don’t want one from him. . . He want one from me, but I don’t want one from him. . . . If I got pregnant from him . . . that would, it would be nothing I could do. I wouldn’t get an abortion. . . . If it was to happen, there would be nothing I could do. . . . If it happens, it happens. I’m gonna love it, just the same, and I’m gonna love him because he gave me my child. I really don’t want one with him, but if I have one there’s nothing I can do. . . . I was gonna make an appointment to see if I’m sterile because I do believe I’m sterile. I want another child bad and I have been trying for the longest. . . .

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151 Girls who are not Mothers Poo was 16 when she was first interviewed. She and her boyfriend were not using condoms at that time. Poo had considered the possibility of becoming pregnant when she and her partner decided to stop using condoms. Yes. I don’t know . . . having a child is a big responsibility, but I like kids. I guess I like kids cause since I’m an only child, I don’t have no sisters or brothers like everybody else. So I don’t know. I guess if it happened, it just happened and if it didn’t, it didn’t. . . . He’s the same way. He, he’s not really trying to be a father, but he said if it happened, you know, it was something he had to deal with. Poo was just about to turn 18 when we spoke the second time. Her thought processes had matured, and she was in a very different situation—more focused on school and pursuing an occupation. When asked about her plans for pregnancy, this time she said: Oh, not for a long time, not for long time, not for long time. . . . Right now I’m on the Ortho Tricyclen pill. . . . I plan to work for the summer and then go to school, probably in August. . . . I want to be an accountant. Tarianna and her boyfriend had stopped using condoms, but she was not on any method of birth control. Considering her plans for further academic success, she was risking a lot to having sex without protection. Regarding a recent occurrence when her boyfriend pulled the condom off, I asked, “What if you had become pregnant from that?” Her answer was surprising and somewhat perplexing. Well, there would have been nothing I can do, but just deal with it, you know. And I have a very good family that supports me, you know, my mom, and I’m pretty sure my dad would have been involved in the baby’s life most likely, since he wasn’t really involved in mine, he would’ve. You know, everything that he didn’t do with me, he would have did with that child. Maurteeona is 17 years old and very eager to have a baby. I want a child. I’m 17 now. I want a child. . . . I always wanted a child. . . . Hopefully, not, well not hopefully, but today hopefully I’ll find out I’m pregnant.

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152 Hopefully I am. . . . I want one of my own, something I can say that’s mine . . . that’s just something I want as proud and joy, that’s just a piece of life that I want. Maurteeona’s boyfriend would also like to have a child and hopes that she is pregnant. “He would be so happy! Very happy! He already had one, but she died.” When we spoke again, Maurteeona had returned to her previous boyfriend, John. Maurteeona is not as eager to become pregnant now as she was a year and a half ago, but at the same time, she is not concerned about taking measures to prevent a pregnancy. Well, when we first got back together, we was using protection, and I had started back taking birth control, but birth control kinda gave me a problem. . . . So I just stopped it all together. . . . We want kids, but . . . I’d rather get my diploma and stuff first. So that’s not really on my mind right now, like it was. . . . Now I feel that I sit back and let stuff happen, like if I was to become a mom now, I’d be happy because I have the full support from my boyfriend, from my family. . . . I’m not taking birth control to try to prevent pregnancy, but we’re not also not real sexually active. . . . We have sex, but we don’t have it constantly like every day, all the time, around the hour and everything. John would not mind if she became pregnant. Maurteeonna said, “Oh, he’ll be thrilled. Cause, see, he’s 25 and he has no kids.” In the first interview, Maurteeona said she had never been pregnant, but during the second interview she stated otherwise. I had a miscarriage . . . when I was about 15. I thought I mentioned it in here. . . . There’s not really nothing to tell because it’s not on record saying that I was pregnant. . . . I took a home pregnancy test. . . . Then one day I guess I was under just so much stress and everything. . . . I never have seen a period in months, and when I just went to the restroom, a big blood clot came out in the toilet and I started bleeding, and I started coming back on my menstruation. . . . It was devastating. . . . I don’t sit around like most people do and cry about it because crying is not going to bring him or her back. You see what I’m saying? So I don’t really mention it. I don’t like talking about it at all. Tosha was 18 years old at the time of her interview. She was not on birth control, and she and her boyfriend used condoms only “every now and then.” When she was

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153 asked if she was concerned about becoming pregnant, she surprisingly responded that she was more concerned about her fertility rather than preventing pregnancy. I’m concerned now that I’m getting older, it’s more like, once you start getting older, that’s when you start thinking about kids cause everyone . . . but then again, that, you might be how I’m living . . . cause every person I know is either pregnant or done had a child. So maybe it’s me, seeing that my friends and people that I know have kids, but . . . yeah, I’m being a lotta concerned about it. Keisha and her partner are not using condoms. She is not on birth control. Keisha had an abortion when she was 17 while she was in a very abusive relationship. She said, I don’t want to talk about it. It’s gonna make me cry. But I wish I would have never did that, but it’s all right cause I mean, if I want to me to have a baby one day, I’ll get one. . . . When asked about her desire for pregnancy, she added: I want a baby bad. Been trying so hard [laughs]. I’m like, I don’t know, can I have kids? But I went to the doctor, say nothing wrong with my eggs . . . like one time I was taking birth control pills, and I stopped taking them so I can get pregnant. . . . It didn’t work. Her boyfriend also wants to have a baby “bad.” Shan was 19 when she was interviewed. She had never been pregnant. She did not consider the possibility of pregnancy when having unprotected sex. This subject was not pursued any further. Hope for the Future Most of the girls were very hopeful about their future. They expressed these beliefs in terms of confidence for their relationships, completing their education, and pursuing their careers. Despite everything that Priscilla had been through, she feels positive about her life and has hope for her future. She has renewed her relationship with her father and has a new mother-in-law who is providing support that her mother did not. She expressed her

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154 intent to return to school and complete her GED, and has aspirations of becoming a secretary. She has a new romantic relationship that appears to be working for her. She is planning to be married and is happy to be pregnant again. She hopes that she will soon regain custody of her daughter. Well, from now everything’s been great. I mean, my daughter she’s still growing up, I have my fianc, and then I’m gonna have this baby. So I think everything’s great. You know, it’s not exactly the way I planned to start out, but like my mother-in-law says, “Everything get better the further you go.” So everything’s going great now. Rose has hope for her future. She described herself as “a stay-at-home mom,” and said she loves taking care of her kids. She remains optimistic about regaining custody of her son. She wants to return to school for her GED and then become a nursing assistant. She expressed frustration about not having freedom to act on the things she wants to do because she does not have help to care for daughter. She feels this will change next year when her daughter begins school. Princess holds much optimism for her future. She has a good support system in her grandmother and boyfriend. Her relationship with her boyfriend is “all right for the time being” although she is not sure she has a long-term future with him. She has accepted being pregnant with her second child. Princess is now having “the best time in her life.” She has arranged her life so that it is working for her. Her son is in a day care program that gives her freedom to go to school and do what she wants to do. She is a senior in high school and will graduate in May. She plans to go to college and is waiting to hear about her acceptance at a local university. She said, “I’m getting public assistance, my Social Security for my other child is pending. So, basically, I’m doing fine right now. . .” Tarianna has a bright future and she is looking forward to going to UCLA Technical Engineering. She expressed confidence in her ability to handle any situation

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155 that life may hold for her. She said, “I like to go the right way, do the right thing, so if a accident happen along the way, I’ll just have to find some way to fix it . . . that’s how I am.” Even so, she was still immature and unaware of how risking pregnancy by her current attitude and behavior could compromise her hopes and desires for her life. Yeah, actually, just the other day me and Alex talked about that, and so we decided that I was gonna get back on the Depo, you know, and then also use condoms. . . . If me and him end up breaking up, I’m going to stay out of relationships . . . probably till after I finish school . . . get my job and stuff . . . and I guess move on with my life. But right now, while we’re together, we gonna make things work. . . . Poo expressed much hope for her future when we spoke the second time. She showed a more mature attitude toward her relationship than when she was first interviewed and is taking more personal responsibility for her actions. I’m just kinda stuck on him. I don’t know why. But we had a long talk . . . and so we just decided to be friends for a while. . . . In the future, I may want to still be with him, but right now . . . I’m just being more involved with myself right now. Poo is now taking birth control pills and added that condoms do not bother her as much anymore. She has solidified her plans for college and looking forward to her future vocation. She has no plans to become pregnant now. Not for a long time, not for long time, not for long time. . . . Right now I’m on the Ortho Tricyclen pill. . . . Next month I turn 18, and I plan on trying to get me a more stable job, and then I just plan to work for the summer, and then go to school, probably in August. . . . I want to be an accountant. . . . I think my first year I might just go to FCCJ. At our first interview, Maurteeona was very excited about her future because since she had started Job Corps, it was “slowly coming to me to succeed.” She was interested in business technology. Even though she did not complete her training program at Job Corps because she was “kicked out for fighting,” she remained very hopeful about completing her education and now wanted to become a nurse.

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156 I am gonna go back to school, but it was just that, after that I took a long vacation from school, which is, I know it’s wrong, but I am currently gonna go back. I’m gonna do night classes at FCCJ . . . and get me a GED . . . and then I’m gonna go back to FCCJ and I’m just gonna take all classes for RN, a registered nurse. . . . Maurteeona is happy about her life at this time. She has been working at Church’s Fried Chicken for four months, and has learned cashiering skills. She would like a better job—better paying and not fast food. She is content in her relationship with John and laughingly said she still likes the finer things in life. Shan is also hopeful about her future. She feels the six months she spent at Jacksonville Marine Institute helped her “straighten up” and “want to do better.” Her mother and aunt are supportive of her and are helping her financially now because she is unemployed. She is looking for a job at this time. Shan is also planning to enroll at FCCJ next month to complete her GED and then hopes to complete courses she will need for the RN program. Tosha is content with her life and optimistic about her future. She now has a good support system in her mother, her grandmother, and her aunt. She said, “I recently stay by myself, got a job, doing fine, and that’s it.” Tosha has been working full time at a nursing home for six months and said, “I can’t wait till I get my raise.” She also is working on completing her education. I still haven’t graduated, but I’m, like, by me working, I go to school at night and I work during the day, so it’s like I try to do things to . . . for myself. Even though she has acquired two STIs from her partner, she still believes in him and remains hopeful about the future of their relationship. Although Keisha had a very difficult adolescence, today she is very positive and confident about her life. She speaks with passion and says that she is a “changed person” and is totally drug free. Her own words best describe her hopefulness about her life now.

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157 I’m changed! I’m a changed person. . . . I’m making it. I’m maintaining. I’m doing good, man. . . . In May, I start back to school. . . . I have a talent to do hair. I can do that real good and that’s what I’m taking up at FCCJ, and at the same time I’m working on getting my GED. And I just feel like I’m changed from a lot of things I used to do back when I was young, and stuff like smoke weed, and drink, pop pills, snort powder, all that stuff. I don’t do it no more. A few girls were not as optimistic as the others. Ashley has some good resources, such as help and support from her mother, and both grandmothers help care for her baby. She attends a school that supports teen-age parents. But Ashley is still very much a child herself. She is continuing to process a negative view of her recent delivery, is experiencing difficulty being a mother, and sees no hope for her current relationship. She feels alone at this time. I don’t have a relationship no more this time. . . . It’s nothing he can do this time. Because he lied . . . that’s why I’m leaving him alone. I’ll have AIDS next. . . . I just want to be alone. I don’t want nothing. I’ll just be alone. Nicole was also upset due to the responsibilities of being a mother. She was looking for a job to pay her bills, and she has not yet discovered a way to obtain the education and job training she desires. She described her relationship with her boyfriend as “all right” and said he was good to her, but Nicole knows he is unfaithful to her. Jenny did not feel she had any control over her circumstances. Although she likes herself as a “person,” she is discouraged because she wants to be “better than she is.” She feels that completing her education is important for her to meet this goal. She cried as she discussed this, and seemed to feel that nothing was possible for her now. I felt Jenny was bright and had determination and that she could find her way back to school in time.

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CHAPTER 6 DISCUSSION AND CONCLUSIONS The girls in this study were all in mid-to late adolescence when they were interviewed; however critical events in their lives, relative to identity formation, had occurred in childhood or early adolescence. For some girls, these events were life-altering including parental abandonment, neglect, or abuse; violation by sexual abuse and/or rape resulting from criminal acts of others; or becoming pregnant during childhood or early adolescence before they were developmentally ready to be mothers. The themes identified in these interviews provide a larger context in which the acquisition of repeat STIs in adolescent girls may be addressed. Three themes that contributed to high risk sexual behavior are inadequate parenting prior to and during adolescence; a developmental need to form meaningful relationships with a member of the opposite sex; and the desire for pregnancy and motherhood. A fourth theme, hope for the future, provides a motivational factor that can be utilized to decrease risky behaviors and prevent future STIs. Factors Contributing to the Acquisition of Repeat STIs Absent or Inadequate Parenting The theme in these stories having the most impact on the lives of the girls was inadequate parenting. Researchers emphasize the importance of the involvement of both mothers and fathers in the development of psychologically and socially healthy children. Young children need the presence of a nurturing parent long before they become 158

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159 adolescents. Yet in these stories told by these girls, it could be seen that fathers were absent; and often mothers were also absent, disengaged, neglectful, or even abusive. The relationship between mother and daughter has been called the basis for love relationships throughout life and the daughter’s identification with the mother is the most important transmitter of love (Klockars & Sirola, 2001). Mother-daughter connectedness has been associated with future resiliency to risk behaviors in impoverished African American girls (Aronowitz & Morrison-Beady, 2004). Positive mother-daughter communications about sexual risk behavior is associated with decreased high risk behaviors in adolescent girls (Hutchinson, Jemmott, Jemmott, Braverman & Fong, 2003). Negative mother-daughter relationships have been correlated with sexual acting out and earlier teenage pregnancy (Scott, 1993). The mothers of some girls, although present, were minimally involved either because of working outside the home or because they were focused on their own problems involving men, drugs, or gambling. The lack of parental supervision is correlated with sexually transmitted diseases in adolescent girls (Crosby, DiClemente, Wingood, Lang, and Harrington, 2003). Recent attention has focused on the critical role that fathers play in the lives of their children, including the formation of sexual identity of both boys and girls (Nelms, 2004). The absence of a father has been correlated with early sexual activity and teenage pregnancy in girls (Ellis et al., 2003), and found to have significant effects on a girl’s relationships with males and achievement behaviors (Bowerman, 2003; Krohn & Bogan, 2001; Nelms, 2004). The impact of an absent father can persist into adulthood resulting in emotional distress, academic failure, and job difficulties (Stokes, 2003).

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160 Research suggests that nurturance at the appropriate times is required to fully develop the ability to think in formal operations (Brown, 2000). The stories told by these girls illustrated that formal operations that would enable them to consider possible consequences of sexual behavior was lacking. The absence of fathers in their lives, and the often-missing nurturance from mothers may in part explain cognitive limitations these girls faced in sexual decision-making. Need for Intimate Relationships Another theme identified in the interviews that clearly contributed to repeat acquisition of STIs was related to two developmental tasks of adolescence, developing intimacy in a relationship and developing comfort with one’s sexuality. Another developmental task, identify formation, occurs simultaneously and is complex for adolescent girls because girls define themselves within the context of relationships. A sense of connection to others is an essential aspect of the psychological development of girls (Gilligan, 1997). The centrality of developing intimate relationships was reflected in their stories. Yet, the stories showed confusion about how to incorporate development of their sexual identity into their relationships. Girls often equated emotional intimacy with sexual intimacy. The importance of relationships to adolescent girls impacted their perceptions and behaviors. Their search for romance and love often explained their choice to forego efforts to protect themselves from acquiring an STI or to prevent pregnancy. As girls attempted to develop intimacy in relationships, they often coped with partner betrayal. It was very important for girls to continue to trust their partner even when acquiring an STI indicated betrayal. They often felt that having sex with condoms undermined trust and intimacy in a relationship. Information from this study agrees with other recent studies

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161 (Crosby, DiClemente, et al., 2000) that concluded adolescent sexual behaviors must be understood within the context of relationship factors. All the girls were caught up in the adolescent urgency to establish their sexual identities and form intimate relationships regardless of their family background or socioeconomic status. For example, against a background of serial foster homes and delinquent behaviors that resulted in placement in two juvenile correction programs, Rose formed two intimate relationships that resulted in her first pregnancy when she was 13 years old and her second pregnancy when she was 16 years old. On the other hand, against a background of strict mothering and academic success, Tarianna began to “date,” as she said, when she was eleven years old and had sexually intimate relationships with four young men by the time she was 16 years old. Yet it seemed that having had more effective parenting was still a protective factor for Tarianna who was more positioned for succeeding in life than most other girls interviewed. Gender roles and power differentials within the romantic relationships of the girls in this study also increased their risk for STIs. Some girls described times they had sex because they were coerced or pressured by their partner or when they had sex to please their boyfriends when they did not desire it. Other girls told about having unprotected sex because their partners objected or reacted negatively. They expressed fear that requiring or even requesting condom use could damage or cause them to lose their relationship. Some girls related how they were emotionally coerced and accused by the partner when they were diagnosed with an STI even when they were not having sex with anyone else. The girls also showed a lack of self-efficacy and described their lack of power or ability to make decisions or to act in their own best interest. Some girls spoke about being

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162 powerless in terms of “there was nothing I can do,” and inevitability, “if it happened, it happened”. There must be an increase in girls’ self concept and an equalization of power in their intimate relationships in order for the sexual risk-taking behaviors of girls (and also their partners) to change. Many professionals feel that STI prevention efforts must begin early, before children reach adolescence, even before grade 5 or 6 (Whitaker, Miller & Clark, 2000). This would help girls to develop a stronger sense of self-esteem and self worth before negotiating these issues in the context of a sexual relationship during adolescence. Desire for Pregnancy A recent study of 500 girls reported that 24% of the participants expressed a desire to be pregnant (Davies, DiClemente, Winwood, Person, Crosby, Harrington, et al., 2004), but this number may actually be much higher. A small qualitative study of 8 participants, reported that all the girls indicated a desire, either conscious or unconscious, to be pregnant (Burns, 1999). This study also found that most girls had a desire to become pregnant. Six of these twelve girls were already mothers. Two girls, Priscilla and Princess, were pregnant again. Rose, who already had two children, desired to become pregnant again and expressed concern about her fertility. Keisha and Maurteeona were very desirous of having a baby. Tosha was also concerned about her fertility. Nicole, Poo and Tarianna were complacent about preventing a pregnancy and were even accepting about becoming pregnant. Further, the two girls in this study, Priscilla and Rose, whose children were removed from their custody by the DCF, experienced long term effects from the loss of their children that caused them to not only to continue try to regain custody of those children, but also to have more children.

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163 Early childbearing is not an uncommon response to adverse or socially deprived backgrounds. Girls who have limited educational and employment opportunities may perceive that motherhood will provide a purpose in life and may not see any social or economic benefits to postpone childbearing (Hanna, 2001). Girls also may desire pregnancy because they want someone to love them and heal the emotional scars from childhood. The desire to seek emotional closeness by having babies is conceptualized as an emotional deprivation model (Davies et al., 2004). Factors that motivate girls to desire pregnancy must be understood and considered in STD prevention programs. Efforts to protect adolescent girls against STIs are confounded by their concerns to have control over pregnancy and childbearing. Recent research suggests that birth control is more relevant than STI prevention for sexually active girls. The promotion of any method to protect against STIs, either abstinence or a barrier that would preclude the possibility of pregnancy may not be acceptable to girls who desired to become pregnant. Davies et al. (2004) reported that adolescent girls who desired pregnancy would not use condoms. An adolescent girl who desires pregnancy also may not perceive unprotected sex as a risky behavior. The positive outcome of pregnancy and the negative outcome of an STI would cancel each other out (Whaley, 1999). Health care practitioners must address the level of pregnancy desire present in individual girls because adolescent girls who want to become pregnant will behave in ways that allow them to meet their goal. Hope for the Future With few exceptions, the girls had faced extraordinary circumstances in their lives. In spite of their past or current life circumstances most girls were still very hopeful about their future in life. We could argue that some of the hope was probably misplaced and a result of unrealistic optimism that is conceptually equivalent to perceived invulnerability.

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164 An older, more experienced outsider would probably see that some of these girls faced bleak futures. This was in contrast to attitudes expressed by adults interviewed in a similar study. In the original grant funded by the CDC, in addition to the adolescent study conducted in Jacksonville, Florida, another study was conducted in Baltimore, Maryland with an adult population who had repeat STIs that followed very similar protocols. In the adult study, the researchers found that the adults felt very hopeless about their lives in contrast to what we found in the adolescent population (Erbelding et al., 2004). These girls appear to still be in a stage where effective intervention would not only decrease the incidence of STIs, but also act upon their optimism to improve their opportunities in life. STI Risk Reduction Intervention Needed Now It has been said that STI reinfection in adolescent girls represents a failure of primary and secondary prevention efforts of STD clinics (Fortenberry et al., 1999; Hughes et al., 2001). Even more, STI reinfection is an indicator of many other significant problems faced by these adolescents. STI reinfection reflects a societal failure to collectively insure that our children are nurtured and effectively parented so that they mature into psychologically and socially healthy adults. The community at large, schools, and public health programs must share in the responsibility for the wellbeing of children, especially those who lack effective resources in their natural parents and who live in a culture of poverty. The earliest foundation for STI prevention actually begins at home and is shaped by the parenting received by children. The effects of poor parenting are well known and there are efforts to promote better parenting skills through multiple agencies. There still is a need to further promote the critical role of the father and to provide parenting skills to fathers as well as mothers. However, changing adult behaviors that will foster more

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165 effective parenting is a slow process that may require several generations to effect meaningful changes. Adolescent girls, such as those in this study, who did not have an early foundation of adequate parenting, need intervention now. Many girls are on the threshold of adulthood and need to reframe self-defeating thinking and behaviors so they may become physically and emotionally healthy women. Some of these girls are already parenting the next generation of adolescents. Practical Interventions and Theories The need for interventions to be theory driven is well established. Paula Treichler, a noted social theorist on HIV/AIDS, said that “to take action without theory is to run the risk of finding yourself in the middle of a nightmare” (Aggleton, 2001, p. 408). Bok and Morales (1997) provided an excellent review of the behavioral change theories that have been used in HIV prevention interventions including Bandura’s social cognitive theory, Fisher’s Information, Motivation, and Behavioral Skills Model, the Health Belief Model, Prochaska’s Stages of Change, Fishbein’s Theory of Reasoned Action, Kelly’s Diffusion of Innovation, and Harm Reduction Theory. However, Aggleton (2001) stated that theoretical understanding must be used as a means to an end, and expressed how theory might appropriately be used to guide a successful intervention program: In contrast to the USA where social psychological frameworks such as the Health Belief Model, the Theory of Reasoned Action, Protection-Motivation Theory, and Social Learning Theory have held sway, European health promotion research. . . has been more eclectic. Theories have tended to be judged for their appropriateness not on the basis of degree of fit with prevailing schools of thought in academic literature, but in accordance with whether they offer useful insights for prevention and care. In European countries it is not unusual for sociological, anthropological and psychological insights to be blended together within prevention programs. While the prevention models developed this way might not stand peer review in the

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166 most prestigious academic journals, at least they prevent new infections and improve the quality of people’s lives (p. 406). Angen (2000) expressed a similar view when she stated that although an interpretive explanation is important in qualitative research, the capacity for action and the effectiveness of change that the research can generate is more important. She proposed that interpretative inquiry should be evaluated from the perspective that pragmatic and moral concerns are the most important consideration. A recent metanalysis of interventions (1985) to reduce sexual risk for HIV in adolescents, concluded that even when an intervention did show a risk reduction, it was modest and often not significant (Johnson et al., 2003). These authors proposed one simple criterion for intervention evaluation; did the intervention work? This study attempted to blend various insights from developmental theory, cognitive theory, and feminist theory to generate a framework in which STI reinfection in adolescent girls could be understood. The goal of the study was to use the information gained to develop practical interventions in a population of adolescents in Jacksonville, Florida, where the case rate of reinfection with gonorrhea and chlamydia was unusually high. However, as often said, there is no magic bullet or simple solution to changing complex personal beliefs and behaviors that are impacted by many negative societal forces. Based on the information provided by the girls in this study, I have concluded that serious efforts make an impact in STI reduction, will require the implementation of quality prevention programs. The development and implementation of effective programs will require an investment of human and financial resources. Angen (2000) stated that “interpretative inquiry should provide a thoughtful, caring and responsible answer to the question, ‘how do we become more fully who we are?’”

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167 Sexual risk reduction efforts for these girls should contribute more to improving their lives than just decreasing their incidence of STIs. In fact, in order to decrease the number of STIs it is probably necessary to improve the overall quality in their lives. Sexual Risk Reduction Interventions for Adolescents in a Public Clinic Setting Many health professionals have suggested that brief or single session interventions have little effect on sexual risk behavior and propose that ongoing intense intervention is needed to effectively change sexual behaviors in adolescents (Bok & Morales, 1997; Clark et al., 1998; Hughes et al., 2001; Robin et al., 2004; Smith Weinman & Parrilli, 1997). Bok and Morales defined an intensive interaction as continuous contact with the same individual or group using an established curriculum where relationships can develop and progressively more complex interventions can occur. A recent randomized control trial reported that adolescent girls who had received an intervention that consisted of four 4-hour interactive group sessions had fewer episodes of unprotected intercourse over the 12-month period after the study. Statistical analysis also suggested reduced chlamydia infections (DiClemente et al., 2004). Even if longer, multisession interventions were demonstrated to be more effective than brief interventions, they are considered impractical for busy public health clinic settings. DiClemente et al. (2002) reported the need for intensified clinic-based prevention efforts for adolescents with a history of STI’s. An important study conducted by Kamb et al. (1998) demonstrated that effective counseling can be conducted in busy public clinics. This randomized controlled trial compared the number of new STIs in participants who received individualized counseling in 2 brief sessions or 4 enhanced (or longer) sessions to the number of new STIs participants who received a typical educational prevention message. The study found that

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168 30% fewer participants who had received individualized counseling had new STIs at 6 months compared with participants who received the educational message. At 12 months 20% fewer participants in the counseling groups had new STIs compared with those in the didactic group. However there was no difference in STI reinfection rates in participants who received brief counseling sessions and participants who received enhanced counseling. The reduction in new STIs was found to be greater in adolescents than adults. Bolu et al. (2004) in a subset analysis of the same data confirmed new STI reduction in high-risk groups including adolescents. These authors commented that clinics with limited resources should focus on the 2 groups that benefited most from counseling; adolescents and persons with a current STI. Kamb et al. stated: This large randomized controlled trial evaluating interactive risk reduction counseling among STD clinic patients is the first to report that counseling leads to reductions in sexually transmitted infections. In addition to concerns about efficacy, concerns that interactive counseling is not feasible for busy, publicly funded clinics, or cannot be conducted by the personnel currently employed by health departments should now be put to rest (p.1166). Proposed Clinic Interventions to Reduce Repeat STIs in Duval County Adolescents Three interventions that may reduce STI infection and improve future outcomes for girls in Duval County should be considered. These suggestions attempt to consider the time constraints and limited resources of health department clinics. The first suggestion is to develop an intensive inservice for all staff who provide STI related services to adolescents. The second suggestion is to develop a specific clinic protocol for working with adolescents. The third suggestion is to provide standardized referral for adolescent needs.

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169 Inservice for STD clinic staff Robin et al. (2004) discussed the importance that having thoroughly trained facilitators is in producing effective interventions. Some clinic staff may lack theoretical knowledge or lack counseling skills needed to effectively work with adolescents. Clinic staff would benefit from an intensive inservice that would provide background knowledge and skills as discussed below. Knowledge about adolescent development. This study has shown that developmental issues have important implications in STI prevention. The success of an intervention may depend on matching the intervention to the developmental level at which the adolescent is functioning. Knowledge of developmental theory increases understanding of special concerns of adolescents and can assist staff in framing interventions so they are relevant to teens. Knowledge of cognitive development will assist staff to recognize the cognitive level (concrete or formal operations) at which an adolescent is functioning so messages are communicated appropriately. Usually prevention messages must be concrete and focused on real life situations relative to the adolescent. Knowledge about gender issues. Gender issues must also be taken seriously when adolescent girls are counseled. Theoretical knowledge of gender and power issues in male/female relationships is important to adequately assess the risks and needs of girls who may be in relationships in which power imbalances or coercion limit their ability to practice STI prevention behaviors. Skills for counseling adolescents. Although recent research (Crosby et al., 2001b; Kamb et al., 1998) indicates that providing education is not as important as providing counseling, the typical approach still used in clinic prevention services is to provide

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170 information and skills education. Sexually experienced girls already have knowledge about STIs and have knowledge about condoms and access to them. Rather than learning more condom application skills, girls would be better served by learning how to improve relational skills so they can develop healthy, positive sexual relationships in which there is mutual respect rather than remaining in relationships where they are exploited (Crosby et al.). By teaching girls how to reach decisions on sexual matters and to consider the consequences of their decisions, they can learn from past decisions and avoid developing a negative self-concept that could lead to poor decision making in the future. Basic counseling skills can be taught in an inservice so that clinic staff are comfortable in a counseling role in addition to providing health education. Interacting with adolescents. Staff attitudes and behaviors can hamper prevention efforts. The intervention that is provided may not be as important as the person who is providing the intervention. It is essential that clinic staff have a non-paternalistic and non-judgmental attitude toward adolescents. Staff must demonstrate cultural competency that includes not only race, age, and gender, but also sensitivity to the status of adolescents who may be classified as high school drop outs, teen parents, or juvenile criminal offenders. A recent study found that adolescent girls who perceived that at least one adult cared about them were one third less likely self-report STIs (Crosby, Leichliter et al., 2000). These authors suggested that clinicians and clinical staff can capitalize on this finding. By conveying an active sense of caring to their adolescent female clients, clinical staff may promote subsequent preventive STI preventive behaviors. A sense of caring

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171 occurs when individual staff become responsively engaged with a girl, hear her voice, and support her potential to succeed in life. Although the importance of caring can and should be emphasized during an inservice, having a sense of caring is an intrinsic characteristic. It is important to select staff for counseling who desire to work with adolescents and who have an ability to develop a rapport with them. Individual staff members who admit they do not want to work with adolescents should not be assigned to do so. STD clinic protocol for adolescent STI repeaters Development of a specific clinic protocol for adolescents who utilize STD Clinic services may prove helpful to reduce STI rates. Some suggestions about what should be included in the protocol are provided. Teen friendly clinic environment. Services should be provided in at atmosphere that is friendly and welcoming to adolescents. This attitude should be conveyed by all staff, including the front office staff that greets the teen and processes her paperwork, the DIS staff that provides counseling and education, and the clinical staff who provide STI diagnosis and treatment. All staff should actively encourage the involvement of her partners. Recognition that the relationship with the partner is most important to an adolescent girl and gaining the agreement and cooperation of her partner for STI prevention may be critical to the success of prevention efforts. The physical environment should reflect the positive involvement of the clinic with adolescents as well. Posters and pictures should be displayed that feature adolescents and convey messages from their perspective. The clinic is also an ideal place to display pictures of fathers with infants and children to promote the importance of the fathering

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172 role to adolescent boys and posters to promote the responsibility of boys and men in STI prevention and contraception. Literature targeted to adolescents. There is an abundance of STI prevention literature available that is written specifically for adolescents. This literature provides information that is of concern to teens and written in language that appeals to them. As an adjunct to interactive counseling this kind of literature can reinforce information provided during the clinic visit. Extended time for clinic visit. An extended time for an adolescent visit would be scheduled in order to provide the additional counseling needed. Developmentally appropriate counseling. Prevention counseling would be provided with consideration of the developmental level and cognitive functioning of the adolescent. Gender specific counseling. Gender specific counseling would be provided. Individually tailored counseling. Since the same message will not be effective for all adolescents, interventions would be tailored to each individual reflecting their particular circumstances and reality. The program would provide STI prevention messages in the context of other problem areas or deficiencies in life skills identified by the adolescent. For example, a girl who was in school but was using drugs and having multiple casual sex partners would require counseling about consequences of substance abuse as well as emphasis on dangers associated with multiple sexual contacts. A young teen mother, on the other hand, who had dropped out of school, admitted she was in an unhappy relationship with an older partner, and appeared depressed, represents a different problem. She would need counseling directed to her mental health status, inquiry made

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173 regarding potential domestic abuse or power imbalances in the relationship, and the safety of her child. The importance of continuing her education should also be discussed. Continuity of provider. Whenever possible an effort would be made to match the adolescent with the same provider to foster a relationship and consistency of counseling provided. Consistent counseling. Staff would provide information and counseling guided by a curriculum such as that explained in Everybody: Preventing HIV and other Sexually Transmitted Diseases (Schoeberlein, 2001). This is a developmentally appropriate, research-based curriculum used by a 5-year CDC national dissemination project whose goal was to prevent HIV and other STIs in middle school students. Even if clinic counselors must vary, use of the same approach and information would help maintain consistency of the interventions. Standardized utilization of professional services Referral for individual psychosocial needs. Although staff at the STD clinic cannot assume ongoing management of psychosocial problems, they are in a strategic position to identify problems and make referrals to appropriate resources. There are many existing resources in the community such as Jacksonville Children’s Commission, Florida Community College at Jacksonville, Job Corp, Buella Beal Young Parents Center, YMCA and YWCA programs, and other resources that are underutilized because adolescents lack knowledge about the existence of programs or do not know how to access them. To identify psychosocial needs, the clinic would create a brief survey to target important psychosocial problems. Adolescent girls would complete this survey in addition to the STD clinic sexual risk survey completed by all clients. The clinic would

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174 compile and maintain a current file of all resources available for adolescents in Duval County Clinic and staff should have a working knowledge of these resources. Referrals should be made in a consistent manner according to a protocol adapted by the clinic for this purpose. It is also important that these girls have adequate childcare and transportation so they can access the programs or assistance to which they are referred. Protecting adolescent girls. An important responsibility of all healthcare professionals is to report child abuse when they have been made aware of it. The legal duty to report abuse to the proper authorities exceeds that of maintaining confidentiality of the adolescent. Clinic staff must be aware of their duty to report abuse and to follow through with this responsibility. Adolescent girls who have been raped or sexually abused often have unresolved mental health issues that require counseling by mental health experts. Even moderate psychological distress is associated with increased risks for STIs and further unhealthy outcomes (DiClemente, Wingood, Crosby, Sionean, Brown, et al., 2001). Girls who had poor parenting may require counseling to learn that they were not responsible for the abandonment of a father (Wineburgh, 2000) or mistreatment by a mother in order to disengage from a negative self-concept and self destructive behaviors. Clinic staff should also use this window of opportunity to advise adolescent girls about the importance of education and refer girls who have dropped out of school to agencies that can assist in the completion of a GED or provide vocational education. Protecting children of adolescent mothers. Research has shown that mothers who have been abused themselves are at risk for abusing their children (Lesser & Escoto-Lloyd, 1999). Adolescent mothers would be asked about factors in their lives that may

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175 affect the safety and well-being of their young children. Mental health concerns (such as depression, suicidality, alcohol or drug addition) as well as physical needs such as safety and adequate housing and nutrition for the infant and the teen mother must be identified (Beeber & Miles, 2003) and referred to appropriate resources. Intervention at this level is needed to break the cycle of dysfunctional parenting to reduce the number of STI repeaters in the next generation of adolescents. SmithBattle (1995) wrote: Teenagers do not autonomously invent their futures, but rather adopt the futures that are available to them as members of a family, ethnic group, social class, and community. Therefore, we must not locate the source of disadvantage in the teenage mother alone without also acknowledging how societal support or lack thereof shapes her experience of the past and anticipation of the future (p.134). Dual Method Approach for STI and Pregnancy Prevention A longer term recommendation is that the Duval County STD Clinic and STD field operations refocus attention on implementation of a dual method prevention approach for adolescents using condoms for prevention of STIs and hormonal contraception for prevention of pregnancy that has been promoted by many researchers and clinicians (Crosby et al., 2001a; Meade, 2005; Smith et al., 1997; Whaley, 1999). Despite promotion efforts, a national survey conducted in 1997 reported that only 6.6% of adolescent girls used dual methods. Mead reported that adolescent pregnancy was a marker for future sexual risk behavior and adverse outcomes. Smith et al. (1997) reported that clinics that combined family planning and STI treatment services maintained high (70%) enrollment, with most returning primarily for family planning services. However, combined clinics offered an ideal opportunity for initiating new and ongoing interventions for condom use. This program should include adolescent boys as well as girls. This would be an excellent way to promote healthy relationships and a shared responsibility for STI

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176 prevention and contraception. It also provides an opportunity to talk to adolescent boys about the important role of being a father, and might have an impact the next generation. Implications for Nursing Although this study targeted suggestions more to STI clinicians and staff in public clinics who often are not nurses, the information is also relevant for nurses who work in a variety of settings. Nurses are in unique and key positions to make physical, psychological and social assessments and to make appropriate interventions and referrals for adolescents. Information in this study may provide knowledge to nurses who do not work with adolescents or in an STI setting. All nurses should have theoretical knowledge of adolescence, know how to appropriately interact with adolescents and recognize that adolescents who have repeat STIs usually have many other psychosocial problems. Future Research The study was not able to explain why the rate of gonorrhea and chlamydia are higher in Duval County than the rest of the state, especially such counties as Broward or Miami-Dade where a high adolescent rate would be expected. It appears unlikely that the adolescent girls themselves would differ in terms of individual or relational factors. Community factors may be more important than individual factors in explaining statistical differences in counties or various localities. Future research is needed that may discover yet unidentified variables that could explain this disparity. Also, little information is available about characteristics of STI re-infection among adolescents reported from private versus public settings. Future research may identify important differences in these populations that would help STI prevention efforts. Another priority for future research is to identify effective interventions for adolescent girls that would counter the effects an absent father on an adolescent girl. The

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177 absence of a father negatively impacts both boys and girls. Research with adolescent boys has shown that programs that matched male adolescents to Big Brothers as substitute father figures, resulted in the boys were less affected by parental rejection (Saintonge, Archille, & Lachance, 1998). However, substituting an adult male as a father figure for an adolescent girl would not be appropriate. Adolescent girls may have confusion about the need for fatherly love and establishing an intimate relationship with an older male. Programs must insure that girls are physically safe and free from sexual harassment. Adult males may also open themselves up to accusations from girls who misunderstand or misperceive the nature of a therapeutic relationship. The compelling case for many of the girls in this study was not only the absence of their fathers but also either the physical or emotional absence of their mothers or direct mistreatment or abuse by their mothers as their sole caregiver. Slater, Guthrie and Boyd (2001) discussed Carol Gilligan’s (1993) finding that a resonant relationship between girls and women was critical for the development and psychological growth of girls and described an approach of connected teaching in which girls were matched with older women. Through this process, girls were able to take control of their lives in various ways; Some girls enrolled in school; some left violent relationships, and some became parents. Future research may also focus on the effects of a positive mother figure for adolescent girls to lessen the effects of inadequate mothering.

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APPENDIX C TEEN REFERENCE LIST

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APPENDIX D INTERVIEW GUIDE

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APPENDIX E ORIGINAL TRANSCRIPTS OF TWO INTERVIEWS Interview with Priscilla 3/6/03 16yo WF One child-3 yrs old, now 3 months pregnant CT/14/03, CT/26/03 Note: Priscilla has a speech impediment, a sort of lisp that shows up more when she is talking about emotional issues. Cheryl: All right, this is Cheryl McGhan and I’m interviewing Priscilla today. Today’s date is June the third of 2003. And Priscilla, what I’d like for you to do is sorta describe yourself to me, uh, a little bit about who you are as a person. Tell me a little bit about who you are. Priscilla: Well, umm, I’m a teenage mother. Um, I have a daughter, Elizabeth. She is three now and I have another baby on the way, and that’s all I am, about myself (laughs). Cheryl: OK. How old are you? Priscilla: I’m 16. Cheryl: OK, and uh, you have a three year old named Elizabeth, and how far along are you in your pregnancy now? Priscilla: I’m 3 mos. I’ll be four months the fourteenth. Cheryl: OK, have you grown up here in Jacksonville? Priscilla: Yes ma’am. Cheryl: OK, tell me a little bit about your family, your mom and dad and Priscilla: Well, my mom (looks downcast), uh (laughs), there’s nothing to really tell about her. Um, my dad, he lives in Oklahoma Um, I got another baby brother, and he’s living with my stepmom and I just got back from there. And, so far we finally got together about two, two years ago because my mom had kept us apart for about 194

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195 five years. So we just finally started talking, and I went up there to visit him, and everything turned out great. Cheryl: So you’re 16 now, I guess you were about 11 or so when they divorced? Priscilla: Uh, I was three years old when my mom and my dad got divorced. Cheryl: OK, OK. And you didn’t have any contact at all with him? Priscilla: I had, um, some contact, um, but there’s sometimes where my family or my mom wouldn’t let my dad see me. My dadsorry (speech impediment seemed to interfere)my dad would come over to visit me and either my mom or my uncle or my aunt, they wouldn’t let him in the house to see me, so it was kinda hard for me and my dad to actually see each other when I was little. And when I started growing up, I went up to Oklahoma when I was about nine and visit, stayed with my dad for about two years, and then when I came back, come to find out he had been trying to contact me, but my mom never let me know. So, I went five years without seeing my dad, and he found out about two years ago that he had a granddaughter, and now he’s trying to be in me and my daughter’s life, and he’s wanting to be in this baby’s life too now, so Cheryl: Does your mom live here in Jacksonville? Priscilla: Yes ma’am. Cheryl: So, um, you sorta grew up here, and then went out to Oklahoma just when you’ve been with your Dad? Priscilla: Well, actually, I’ve been to a lot of places, um, Virginia, Georgia, Oklahoma. I mean, my mom, she always moved everywhere, and never actually kept us in one place. Cheryl: And you have one younger brother? Priscilla: I have one younger brother, he’s about 4 months, that I just found out about, and I have a 20-year-old brother and a 17-year-old sister. Cheryl: Oh, OK. Are they here locally? Priscilla: Uh, my oldest brother and my oldest sister are here in Jacksonville. My little brother, he’s in Jackson—, Oklahoma with my dad and my stepmom. Cheryl: OK, OK. Do you stay in touch with your older brother and sister pretty much? Priscilla: Yes ma-am. Cheryl: Good relationship?

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196 Priscilla: Uh, with me and my older sister, not too good. Me and my brother, we have a good relationship. Cheryl: How old is the older sister now? Priscilla: Seventeen. Cheryl: Seventeen. Just a year older than you. OK. And who does she live with? Priscilla: She lives with my uncle. Um, we were taken out of my mom’s custody when I was thirteen. And we moved in with my uncle when I was about fourteen. And we’ve been staying with him ever since, but me and my uncle, we never got along, so I moved back in with my mom, and it it wasn’t too good, because my mom, she kept filling, like, my head with nonsense, and I finally realized it afterwards, so that’s when I went back to Oklahoma with my dad, and I came back down here to be with my daughter and my fiance. Cheryl: When you say, um, “filling your head with nonsense”, was that a lot of talk about your dad and? Priscilla: My dad, um, trying to tell me that she was dying which she had, um, about five heart attacks and a by—, by pass. But the doctor told her she was fine, but she was trying to tell me that she wasn’t, just for me to clean up her house, soI kinda finally realized it, what she was trying to do, afterwards, and I just couldn’t put up with it no more. Cheryl: And how old were you again when you, um, your mother gave up, uh, lost custody or Priscilla: I was thirteen years old. Cheryl: What happened? Priscilla: Well, um, my mom, she had a lot of bad background with us. Um, and the, my family which is my aunt, two of my aunts, and my daughter’s father wind up calling HRS on us. But, they wind up putting me into it, and wind up making me lose my daughter, and it was, part of it was true, but when I, um as I was growing up and living with my uncle, I started thinking that he was the one who’s causing all this, and I hated him for it, but then when I moved out of his house, I realized it was more of everybody else doing it and not my uncle. He was just trying to care for us, like he’d been doing for the past—, since we’ve been little. I mean, my mom, she would drop us off at his house, just to leave with her boyfriends, from the time we was about five years old, and never really took care of us. And he wanted us to be the best way we could, and he tried to get me like that, but I wouldn’t listen to him. So I wind up growing up having a child, which he knows of that part, it wasn’t my fault. And then I got pregnant again, and now he’s happy for me because I’m being with somebody who not abusive and who is willing to be there for me and the baby. So, he’s happy about that now.

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197 Cheryl: And your uncle’s here in Jacksonville? Priscilla: Yes ma’am. Cheryl: OK. Um, tell me a little bit about your daughter, Elizabeth. Priscilla: Well, um, my daughter, she, um, she was a child that came from a rapepartand when I was pregnant with her, I didn’t really know it was the guy who raped me, which was my aunt’s ex-boyfriend. I just, I had sex when I was twelve years old, and I figured, well he’s the father. Well, it didn’t really turn out that way because, um, I knew I was getting raped and when I found out I was pregnant, it just got a whole lot worser because Elizabeth’s father, he would beat me up just trying to make me have a miscarriage. I never figured out why, and luckily I never did, but when I got close to nine months I wanted to give her up for adoption because I didn’t want her. But I couldn’t do it when she was born because she had attached (laughs) me somehow, you know? So, I kept her, I took care of her by myself from the time I was twelve years old, and she got tooken away from me because I was accused of doing drugs by the, her father. And we found out about three months later that he was the father, and figured out that’s why he was beating me up when I was pregnant with her. And it was just a lot of things from there, but my daughter, she really grew up to be a good girl. I mean, she’s smart, she’s honest, she knows everything. Cheryl: Do you know where she is now? Priscilla: Yes ma’am. I see her every now and then. Cheryl: OK. But has she been adopted by another family? Priscilla: No ma’am. No, she, um, my uncle, he’s got temporary custody, so I get her back pretty soon, I hope. Cheryl: Well, good. Good for you. Um, tell me a little bit now, when you were twelve and this man raped you, had you ever had sex before that, or was that your first time? Priscilla: Well, um, I had, um sex, one night, one time, and that was on my birthday. Because I never really actually felt comfortable because when, as I was growing up, my mom’s ex-boyfriends, they would molest me and my sister, so I never really felt comfortable around men until I met my ex-boyfriend, which was Frank, and we was together for good six months, and we had (Tape recorder cut off because electricity went out momentarily due to lightening. Electricity returned very soon) Cheryl: I don’t know if it’s raining out there.

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198 Priscilla: I hope not. (Both laugh). Well, we finally had sex, which was the night of my birthday, because I figured, you know, everything’s gonna be OK. Well, it really wasn’t because when I thought he was the father of my daughter, he wind up moving all the way to California. Didn’t want nothing to do with me, didn’t want nothing to do with her. Like OK, like this the kind of man he wants to be and ever since then it, it just took me awhile, even after I was raped by Elizabeth’s father, it took me a while to actually get close to a guy, and my uncle, he thought, you know, well you’re dating this person, so you’re having sex with him. I mean, that wasn’t the thing with me. You know, I wanted to see how everything would go, and Cheryl: With Frank, do you mean? Priscilla: No Cheryl: Or the other man? Priscilla: The other, um, after I was raped by my daughter’s father, I, um, started dating again. Cheryl: OK. Priscilla: And it took me a while to date, but when I started dating, my uncle, he thought, you know I was having sex with him, and I couldn’t prove to him that I wasn’t cause there was no way. And, even if I know, even if I knew that I wasn’t having sex with him, my uncle never knew, because, you know, with me being raped, he thought, well, you’re gonna be a whore now, so you’re gonna go off and sell your body, it wasn’t like that with me. I couldn’t trust no guy. And finally, when I thought I trusted somebody, it was about last (thinking) October, it was about in October, when I thought I trusted him. When I gave myself up to him for the first time again, afterwards, it was like he didn’t want nothing else to do with me. I was think, OK. Well, recently after that, when he, uh, had broken up with me, in September, I wind up getting raped again, and it was, I was just torn up because I didn’t want to be pregnant again by another rape, and I didn’t want to go through the horror that I went through with my daughter’s father because it was all horrible. Unfortunately, I did because I had to go to court, and when I went to court and I seen him, and I just started having nightmares. Luckily, I had my fiance because he was there to help me, he comfort me, and he actually let me squeeze his hands (laughs) when I had the nightmares, even though I wanted to break em (laughs). You know it was kinda hard for me. Cheryl: Did you press charges against the first man? Priscilla: Well, I didn’t press charges against him, um, the first time, because of the fact that when I tried to, the people wouldn’t believe me, the cops because of the fact they couldn’t find no DNA or anything like that in me. So, I had to, like, wait, for a couple months to, for them to do something about it. And my mom, come to find out, was my mom, well, she knew about the whole rape thing. She was having her father to pay him, pay her, just for me to get raped. Because she was low on

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199 money and she didn’t know what else to do. And at this point I really hate my mom for that because she let me go through all the tor—, um, torment and, you know, me getting beat up by her father and everything, just because I was pregnant and, it was like, so I mean, people was innocent, and my mom knew all about it. Cheryl: Are you saying that he paid your mother money Priscilla: Um hmm. Cheryl: to allow him to rape you?. Priscilla: Um hmm. And I didn’t find that out until after my daughter was born, and when I overheard him and her talking, because, um, they, he was planning on raping me again after my daughter was born, but after that I wind up living with my aunt, and I took my daughter with me, just to get away from there. Well, unfortunately she had the cops called on me and I had to go back. So, it was kinda hard to actually get out because I can’t call the cops again while they’re planning on raping me, because they wouldn’t believe me the first time. So I had to wait and wait and wait until, like, finally somebody get me out of my mom’s house, to actually prove that he had raped me. And they didn’t find that out until after they did the DNA on him and my daughter, which came back positive. Cheryl: When was that done? Priscilla: Um, my daughter was about seven months, six or seven months Cheryl: So during your pregnancy you really didn’t know that you were pregnant by him. Priscilla: Exactly. And I kinda figured, I kinda figured it out after she was born because, um, his oldest daughter was, um, showing me pictures of him when he was a baby, and him and my daughter looked exactly alike. And I started getting worried because I didn’t want to have a child that was being a part of a rape victim like me. But I can’t do nothing about it because I’ve already grown to my daughter, and I didn’t want to give her up. So, I kept it all into my mind, and I kept suffering for it because I kept crying every night, and having all these nightmares, and watching my daughter watching me, and hearing me suffer, you know. And it hurt me really bad, because my mom, she was allowing it, and she wouldn’t do nothing about it. So I went for about a good year and four months with him raping me. He’d started raping me ever since I was eleven. Cheryl: Was that during your pregnancy, he would continue to do that? Priscilla: Yes. During my pregnancy and after my pregnancy. And then finally I just gave up, when I heard my mom and him talking, I just left. I couldn’t stay there and let him keep on doing it. So I left and went with my aunt.

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200 Cheryl: What about the baby? Priscilla: I took my daughter with me. I wasn’t about to leave her with them, because, I mean, my mom, she really, until this very day my mom doesn’t like my daughter. And now I figured it out why, because of the fact that my daughter is the evidence of me being raped and my mom knowing about it. And my mom, she had tried so hard to get rid of my daughter. I mean she tried putting her, um, making me put her up for adoption. She tried having her get hit by a car, I mean she tried everything. (laughs). And neither one of it worked. Cheryl: Do you have any relationship with your mother now? Priscilla: No ma’am. Well, I had to call her up today, just to ask her for some rent, see if I can get some money off her, so me and my fiance wouldn’t get kicked out, but (laughs) that was it, you know, there was nothing else I can do. But ever since I left my dad’s, it, it was nothing else to do with her, and it’s still gonna be like that. Because I don’t want my, my baby growing up around her. And her not knowing what to do with a child, and doubly after the way she treated my daughter. I just don’t want that for my baby. So, she already knows that I don’t want nothing to do with her, or having her do anything with my baby. Cheryl: This baby that you’re carrying right now Priscilla: Um hmm. And my daughter. She’s not allowed nowhere near my daughter. Cheryl: OK. But you think you will be getting custody of your daughter back? Priscilla: (Nods) Cheryl: What happened again that they took her, something about drugs? Priscilla: Yes, um, her father had accused, um, had told HRS that I was doing drugs. And, um, it caused me a lot of problems because when she was taken out of my custody, they had kept promising me and promising me that I would get my daughter back. It’s been 2 years, and I still don’t have my daughter. You know, it, she’s still living with my uncle. Cheryl: Was there anything to the allegations about drugs? Priscilla: Well, they done a drug test on me and, which I knew it came back negative, and they had promised me to give me my daughter back, but since they had, um, finally found out the proof of me being raped, they was afraid of me harming my daughter, because the fact of who her father was. And I never got it because, I mean, I kept my daughter from day one, I mean, yeah, I wanted to give her up, but I kept her from day one, I tried every single way I could to feed her and make sure she have food in her stomach, and bathed, and clothes on her. You know, I had literally borrowed money from other family members just to feed her

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201 and put clothes on her. So, it was really hard on, at that time. And they never got it, you know. They’d, um, told me, you know, well we don’t really know that for sure. I was like, I’ve got every hospital work, paper work, receipts, everything, you know, proving I do take care of my child. They still wouldn’t give her back. And now they’re telling me that in order for me to get her back, her father’s got to give up his rights. And he won’t do it, so in order for him to give up his rights, I have to give up mine, and I told them I wasn’t gonna do it. But now, my fiance’s mother is helping me get my daughter back. Cheryl: So, um, tell me a little bit about your fiance. Priscilla: (Smiles). Well, he’s a great guy, well, boy, he’s eighteen. Um, he’s been with me through thick and thin, you know, through my nightmares. You know, he loves my daughter and he’s actually allowing her to call him “dad”. Um, he, it was kinda funny when I found out I was pregnant with this one (laughs) because, um, I was up in Oklahoma and I called him up. I said, “You might want to sit down for this”. He goes, “OK, I’m sitting down”. And I told him that I might be pregnant, and he falls right out of his chair (laughs). And now he’s, like, actually being a man. And he shocked me because I figured, well nobody’s gonna be her father and he’s gonna wind up leaving me sooner or later. Well, I went to call him up a week later, and his mom told me that he’s out working. I was like, well, I know that. She goes, “No he’s working three jobs”. I’m like, “What?” You know, it shocked me really bad. And, just, like, he’s working and trying to make the money to get us in a bigger place before the baby comes along. And, we’re going to be getting married July the 4 th ! (smiles broadly). Cheryl: Well, congratulations. Priscilla: (laughs) I know. Cheryl: That’s neat. Priscilla: It’s happy (laughs). Cheryl: How did you meet your fiance? Priscilla: Well, um, at the time I was staying with my mom, the guy across the street, which was the one which raped me, uh, last year, uh, him and his dad introduced me to Brandon. And me and Brandon, we started talking, and then finally, one day he gave me his number and I give him mine, but I forgot to tell him my phone was disconnected (laughs) so once it was cut back on, I decided to call him up, and I called him up—he don’t live here anymore, so I was like, oh God, so then finally I called him up about two months later, again, and that’s when we started talking again, started dating. Cheryl: Now, how old were you then?

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202 Priscilla: I was sixteen. Cheryl: Sixteen, so how long have ya’ll been together? Priscilla: We’ve been together close to five months. Cheryl: Five months, OK. And, um, has he, does, he have any children? Priscilla: No. Cheryl: This will be his first child? Priscilla: Um hmm. Cheryl: OK. And, um, you are living right now with your mother-in-law, or you’re going to be? Priscilla: Oh no. Me and him are living together. Cheryl: OK. Priscilla: Yeah. Cheryl: OK. Priscilla: Um, we just don’t have a phone in the apartment. Cheryl: OK, all righty. Um, so what brought you to the clinic today? How did you end up here with us? Priscilla: Well, um, last year when I was raped, I wind up getting chlamydia Cheryl: Let mehave you been raped by more than one person? Priscilla: Two guys. Cheryl: Two different guys. And the second onetell me a little bit about that one. How did that all happen? Priscilla: Well, um, it was September the 16 th , and I had a bad feeling about that day, I just couldn’t do nothing about it. Cheryl: Of last year? Priscilla: Um hmm. Cheryl: Two thousand and two? Priscilla: Yes ma’am.

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203 Cheryl: OK. Priscilla: Well, when I had that feeling, um, the guy across the street with which was, Robert Gill, he wind up calling me and my sister over, and, unfortunately I went, even though I didn’t want to leave the house because I was feeling scaredof leaving. And, um, I wind up going over there, unfortunately, I used to drink. And that night I was really pretty much messed up. And when my mom, she was calling me and my sister. My sister left, and, um, I tried to leave and he grab me by my sweater, and wind up forcing my pants off me, and I didn’t want to take them off, so he unfortunately slapped me, and he just started raping me. And had his, I think, ten year old son involved, and literally forced him into ra—, uh, helping him rape me. And later on that night when my mom had gotten back, I was literally shooken up, I can’t do nothing, I was sick, you know, it felt like I was having a seizure but I wasn’t. We had called the cops to report it in, and, um, I literally got pissed off at the cops because they were, um, trying to put it as it was my fault and I didn’t see it thata way. I mean, yeah, I went over there, and I had a few drinks, but they were trying to tell me well, you could at least screamed or something like that. I was like, truly, I said, “I was in shocked”. I didn’t know what was, I knew what was going on, but, but I can’t do nothing. It was like something was holding me down and not only him. I mean, he was a big guy and, I mean, I know I’m big, but (laughs), you know there was nothing I could do. I mean, doubly, with me being in shock, and trying to figure out what to do, it was like, I couldn’t do nothing. And, um, the cop had asked he and, me goes, well, um, did it started out you and him having sex? I was like, no, I said, it started out, me going over there, I had a couple drinks, I started to leave, he grabbed me and, um, forced my, helped me force my pants off of me, because I wasn’t gonna do it. And he goes, well, it seems like to me that either you’re lying or he’s lying because of the other cops were over there talking to him. I was like, um, can I say one thing? I was like, for one, I haven’t had sex since I broke up with my ex-boyfriend. I said, before him, I haven’t had sex with nobody. I said, because before that I was raped again. And, he goes, well, that don’t mean nothing. I was like, are you listening to what I’m trying to tell you? I said, I was raped before, and I was raped again. I said, like before, I didn’t know what to do. And I said unfortunately, I was eleven years old being raped. And he goes, well, you’re, um, fifteen. I was like, yeah, I’m fifteen, and I still don’t know what to do. I said, because, my mom don’t tell me what to do when it comes to people raping you. I said, she don’t hardly have any conversation with me. I said, my uncle, he definitely don’t know what to tell you when you’re being raped, because, well he’s not even a father. And, he goes, well, don’t you, um, did you ever take, like, counseling or therapy with the other rape. I was, like, no, I said, because, um, finally I got over it, after a while. And it finally got them to the point of them taking me downtown to Shands, to get me checked out. Next day they called me up, and they found, um, his, um, like, kinda like DNA in me, they found that in me and, um, they matched up the teeth mark that was on my breast where he had bit me at. Because I tried, um, to, like, struggle, and he had bit me. So, it all came, you know, that everything matched. So, that’s what took them to the point of, like, actually believing me. And then after, um, a couple, not even but a week, I, um, had to go to, to a, um, deposition, to tell my, um, side of the

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204 story, and they thought, well, since I didn’t show up, it must not be true. Well, I, um, I had explained to them about the first time, I didn’t know about, the second time the, um, my mom’s vehicle broke down, so we definitely can’t get there. So the third time we had to go to court, and they never let me know that he was going to be in the courtroom. They just told me, well, you’re just going to talk to a judge, explain to him why you didn’t show up. I was like, OK. Well, when I got in there, my mom had, um, told me, well, Robert’s in here. I was like, you’re joking. And she goes, no, he’s right over there. And I looked over and he was right over there and I just, I just started tearing down, I couldn’t even stay in there. My aunt, she had to help me out to the, um, to the lobby, because I couldn’t stay in there and see him. And, finally, my attorney, he had came up to me, and he had seen them, um look at (inaudible) he gave me when I had showed up and he had explained to me that everything’s going to be OK, he’s in handcuffs, he’s not going to hurt you, and I tried to explain to him, I said, this is something you can’t get over with. He goes, “Well, I don’t know what you’re going through, but I do know it’s something you can’t get over with”. So, I had to go in front of the judge, he was standing next to me, and that really got me to a point where I was freaking out and finally the judge explained to me, well, next time when you, um, go to your deposition, you’ve got to show up. And he goes, we’re going to have a trial set for, um, next month. I was like, OK. He goes, you’re gonna have to show up to that trial unless he confesses. And that really got me to where I wasn’t ready to show up to the trial. So, after I left I kept having, um, flashbacks went through my mind of what happened that night from seeing his face that very day and I wind up calling, um, my case manager, who controlled the case, and I had asked her, I was like, why didn’t you tell me he was here? He go—, she goes, well, who? I said, “Robert. He was there at the courtroom”. She goes, well I didn’t know he was going to be there”. I was like, “Well, he was there”. And ever since that night, that day, I’ve been having nightmares and more nightmares and finally I decide, well, since I’m tired of my mom treating like she was treating me, I figured if I go to Oklahoma to my dad, then everything would change. Nothing change. I had more nightmares and it just got worse. So when I finally missed everybody down here, I came back and I’ve been here ever since. Cheryl: How long were you out there? Priscilla: I was out there for about 2 months. Cheryl: OK. And, um, your fiance is from here? Priscilla: Yes ma’am. Cheryl: Tell me again how you met him and Priscilla: He was, um, he was friends of, well, not friends of Robert, but of his cousin, and, um, his cousin goes over there a lot to help out Robert and his dad. And, um, one day I was taking my daughter over there to see, um, Robert’s dad because she likes getting candy from him, and, um, he was there one day, (hiccup

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205 or burp) excuse me. He was there one day and, um, Bob and Robert’s cousin introduced me to him. And ever since then we’ve been talking every time he goes over there, and finally got his number, and (laughs) it, it’s been good times from there. Cheryl: Were you out in Oklahoma when you found out your were pregnant? Priscilla: Yes ma’am. Cheryl: OK. So you got together then, you had been with him sexually before you left to go out to your dad’s? Priscilla: Yes ma’am. Cheryl: How’d all that come about? Priscilla: Uh, what part? Cheryl: Well, um, deciding to start a sexual relationship from more than, I guess, just a friendship or dating. Priscilla: Well, um, when he called me up one day, um, it was about a week later after I called him. Um, he had asked me out. Uh, asked me if I would go out with him, so he came over to the house, I introduced him to my aunt and my mom and my other aunt. And ever since then we’ve been dating, being boyfriend and girlfriend. And now I’m pretty glad I did meet him, because he, he’s been everything I was waiting for. Cheryl: OK. Now, let me ask you what brought you here today. Priscilla: Uh, what brought me here today was, um, I found out from labor and delivery that I had chlamydia again. And, well, they thought it was from him, and I told them that he was a virgin until he met me. So they told me, well, since I have it, he probably more likely has it so he to go get checked. So, we’re here to get him checked. Cheryl: So, when you say labor and delivery, did you go to the emergency room? Or, or during your prenatal care Priscilla: Uh, when I had, um, got in, when I got back from Oklahoma, I had to go, because I was having lower back pain, and at first, I thought, um, the baby was trying to abort itself because that’s what ER had told me. So, um, I wind up going over to labor and delivery, and while I was up there, come to find out I had chlamydia. And, they were trying to put it on him but I, I wasn’t going to let them, because it wasn’t his fault. Cheryl: So, um, they treated you, and he’s here to just to get treated, just in case, because he’s been with you?

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206 Priscilla: Um hmm. Cheryl: OK, um, and before he was with you, he was a virgin, you’re the first woman he’s ever been with Priscilla: Yes. Cheryl: OK, and correct me if I’m wrong, but sounds like you have now had four partners. The first was a boyfriend? And then a rape? Priscilla: Um hmm. Cheryl: And then, was there another boyfriend in there? Priscilla: Well, I, I had a lot of boyfriends Cheryl: Uh huh Priscilla: But just, um, none of them I would sleep with Cheryl: Uh huh. Priscilla: Except when it came to my boyfriend, ex-boyfriend, Dustin. Cheryl: OK. Priscilla: When I finally slept with somebody, which I thought it, you know, there was something there, that he, he cared about me. Cheryl: Was he the very first one? Priscilla: Afterwards, yes. Cheryl: After the rape? Priscilla: Yes. Cheryl: So you had your very first boyfriend, and then the first rape, and then there was Dustin Priscilla: Um hmm. Cheryl: And then you were raped again? Priscilla: Um hmm. Cheryl: And now your fianceand so total of five partners? Priscilla: Um hmm.

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207 Cheryl: OK, um, and the second rape, you, he lived across the street, I guess you were living with mom then? Priscilla: Yes. Cheryl: And the first rape, he lived across the street, too, didn’t he? Priscilla: Well, um, no. Well, he lived a quite, a couple miles down. Cheryl: Oh, OK. Priscilla: Um, but he was also dating my aunt Cheryl: OK. Priscilla: So that’s how, um, we started talking to him, me and my mom and my sisterand my brother, was through my, um aunt. And Cheryl: Your aunt is your mom’s sister? Priscilla: Yes. Cheryl: Does she live close by too? Priscilla: Well, I really don’t know where she lives at, because, um, they got kicked out of their trailer, so, um, only thing I know is she’s staying in a hotel room. Cheryl: But, back then did she live close by? Priscilla: She lived with him. Cheryl: OK, and he was just down the street, sorta, from where you were living with your mom? Priscilla: (nods). Cheryl: Ok, Ok, umall right, so, now today you found out that you have chlamydia. Do you feel that that happened from the second time you were raped? Priscilla: Actually, I know it was, because the first time I got, um diagnosed with it, um, it was, it was about four months after my rape, and I haven’t been with nobody, other than being raped by him. So, um, when they had test, um, test me for it, I told them, well, I know who it is then because I haven’t been with nobody. So I had told them who it was, and at first they was gonna put the blame on me, again, because of the fact I didn’t use protection. I said, well, being raped, I had, you don’t know what you’re doing, because the guy can use protection and the guy couldn’t. And like this guy did, he didn’t use protection. And she goes, like, you were raped? I was like, Yes ma’am, I was. Well, they wind up giving, giving me some pills to take for the chlamydia and, um, I went to see my regular doctor about it, to see if it

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208 was all cleared up, and, well, the, they told me it was. So, after that, everything was OK, and about a couple months later, um, I found out that I had it again. And they wanted me to be treated for it right away because the fact that I was pregnant, and they told me this stuff that it could do to the baby Cheryl: You mean this time? Priscilla: Yes. They told me, uh, what it could do to the baby if I don’t have it treated. Cheryl: Do you remember, um, what month it was when you had it the first time? Priscilla: It was in Dec—, well, um, they said I had it for a while, but, uh, it was in December when I found out I had it. Cheryl: OK, and what had happened, then, that you got treated? Priscilla: Well Cheryl: How did you end up, was it at the hospital, that found out? That treated you? Priscilla: I found out from my OB, well GYN, I’m sorry, GYN, because I us—, I had a cyst on my left ovaries, so I had to go see them, like, every other month, to see if the cyst were bigger or if it was small. Well, when I went to go see him in December, that’s when they told me that I had chlamydia. Cheryl: And did they give you the medicine, the pills? Priscilla: Um hmm. Cheryl: For it, at that time? Priscilla: Yes ma’am. Cheryl: And you took all four pills. Priscilla: Yes ma’am. Cheryl: OK, in December. When did you find out about the second time? Priscilla: Um, it was last month. Cheryl: In May? Priscilla: Yeah, I think, yeah, it was in May. Cheryl: And you found out after you got treated the first time, they said it had been cured. You got tested.

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209 Priscilla: Um hmm. Cheryl: So, how do you think you got it again? Priscilla: Well, um, labor and delivery told me that there could’ve been the possibility that it was not all gone, because, um, sometimes, doctors can look over something like this. So, um, she thinks it was not all cleared, and that’s why I feel, either it wasn’t all cleared or it was like a virus that comes back. Cheryl: Um hmm. Priscilla: And she told me more likely, it was not all cleared. So, that’s how I wind up getting it this time. Cheryl: OK. Other than these two times of having chlamydia, have you ever had any other infections or diseases sexually? Priscilla: Well, I, I had three times, um, pelvic inflammatory disease, which was from the first rape. And, um, that was it with that one. Cheryl: Were you ever hospitalized with that? Priscilla: Uh, the first time I was, because I was also pregnant with my daughter when I found out with that one. Cheryl: OK. Priscilla: And, um, the second, two second times, I wasn’t. They just, um, gave me some medicine to take, and sent me home because I wasn’t pregnant. They didn’t want nothing happening to my daughter since I had it, so that’s, um, why they admitted me the first time. Cheryl: OK. So, now you and your fiance, um, are neither one of you, you don’t feel, are having sex with anyone else? Priscilla: No. Cheryl: And, um, you are going to get married next month. And, um, you’re moving to a new place? Priscilla: We’re hoping to find a bigger place. Cheryl: You mentioned you’re having some problems facing eviction now? Priscilla: Yes, um, we finally got the money for, to, um, to pay the rent. Cheryl: OK. Priscilla: So, that’s a good thing.

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210 Cheryl: OK, was your mom able to help you out with that at all? Priscilla: Yeah, she, um, she gave us the money. It was supposed to have been my dad who was giving me the money, but they never gave him his paycheck, so he couldn’t send me nothing. So, my, I, unfortunately, had to call up my mom because I knew she had gotten her check today, to see if I could borrow some money from her. We’ll pay her back Saturday because he don’t get paid until Friday, so Cheryl: Is he still working three jobs? Priscilla: No, right now he’s working two jobs (laughs). Cheryl: OK. Priscilla: Um, he goes to, uh, out of town to Savannah, and then he works at, um Robert’s cousin, um, on week—, weekends when he’s home to get up the money to pay for the rent. Also, try to get up more money for when the baby comes. Cheryl: So, um tell me a little bit about school. How far did you get in high school? Priscilla: Well, um, I went, I dropped out in the seventh grade, well, not actually dropped out, I, um, transferred to FCCJ to try to get my high school diploma, but that didn’t work out too good because I never had a ride to school, and I only went about two or three times while I was there, so I had to, um, quit that semester, and waited for another semester to come, so now, me and my fiance, we’re going to go together and get our high school diploma. Cheryl: Good, have you started that yet? Priscilla: Well, um, the new semester don’t come until September so we got to wait til then. Cheryl: OK, and, um, you say he’s eighteen? Priscilla: Um hmm. Cheryl: And how far did he get in school? Priscilla: I’m not sure what that (laughs). Cheryl: OK. Priscilla: I’m really, I’m really not sure, I think he dropped out when he was in tenth or ninth grade, I’m not sure. Cheryl: His, his mom, though, your soon-to-be mother-in-law, is supportive, and? Priscilla: Yes ma’am.

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211 Cheryl: You feel you’ve got some good people around you? Priscilla: She has helped me out a lot since I found out I was pregnant. Cheryl: OK. Priscilla: So, I mean, if she, if it wasn’t for her, I would, I wouldn’t be, like, trying to get on food stamps, and WIC, and stuff like that, cause she’s taken me everywhere. Cheryl: Are you getting good prenatal care? Priscilla: Um hmm. Cheryl: You started? At a clinic or Priscilla: Um, I’ve been going to my OB, because the clinic I go to, they don’t take pregnant women, so I have to go see my OB. Cheryl: OK. All right. Um, you’re having to pay for that out of pocket, or? Priscilla: Oh, no! I get Medicaid. Cheryl: OK, so he’ll take your Medicaid. Priscilla: Yeah. Cheryl: OK, that’s good. What are your hopes for the future? Priscilla: Well, um, I really, um, I first started out, I wanted to be an artist because, well, I’ve been, uh, drawing for the past three years, so, I’ve been wanting to be an artist, but now I want to be, um, like a secretary because I’m good with computers, so I might do both, or I just might do the computer. So, I’m really not sure because (laughs) it’s kinda confused on which one I want to do. So, I’m really wanting to go to the computer part (laughs) Cheryl: Um hmm, OK. Um, do you feel that you’ve really healed ? (Tape changes over to other side, several lines of dialogue lost. However she tells me “no”) Priscilla: I mean, I can’t even let my fiance leave me for the night (laughs) because, I ca—, I’m scared of the night now. I have to have a night-light because, um, I was raped at night, (erh) on both rapes, I was raped at night and I just never got used to the light, or to the darkness yet, so it’s kinda hard, still hard. Because I’ve gotta get use to being in the dark, and I gotta get used to my fiance leaving me at night, you know, because, well, he’s gonna be gone all weekends, or

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212 weekdays, to go to Savannah. So, I gotta do something, but it’s gonna be kinda hard. Cheryl: OK, have you, um, thought about getting any counseling or? Priscilla: Well, I’m supposed to be in, um, like, a group, um, a therapy class, but, um, when I left to go to Oklahoma, it cancelled. And I was supposed to get in therapy up there, and I was ordered by my attorney to get in therapy, but I didn’t have no Medicaid, so, I had to wait. So, now when I, I got to go back in therapy (laughs) down here, so Cheryl: OK, um, your fiance, does he, um, drink at all? Priscilla: No. Cheryl: Any other, like, drug use, smoking marijuana or anything like that? Priscilla: Nope, I don’t allow that (laughs). Cheryl: And what about yourself, do you drink at all now? Priscilla: No, not since September. Um-um. I have not at all. Cheryl: OK, no other, marijuana, or any other Priscilla: Oh, I never done that. Cheryl: Never did that? Priscilla: No, I never done that. Cheryl: All right, um, do you and your fiance now use condoms at all? Priscilla: Well, right now, um, we’re not really having sex, because, um, well, we don’t want to get a chart back, and lose the baby, because we were told that chlamydia can kill your child, so, I ordered him not do it (laughs) for us not to. Cheryl: OK, and how long has that been? Priscilla: Oh, God, that’s been about a month (laughs). Cheryl: A month? So, so you’ve known you have the chlamydia for a month? Priscilla: Well, it’s probably been about a month now. Well, no, it’ll be a month in, in another two weeks. Cheryl: The second time you had it, the most recent time now, that’s where they gave you the pills, at the hospital?

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213 Priscilla: At labor and delivery. Cheryl: In la—, at, was it Shands, up at Shands? Priscilla: Um hmm, yeah. Cheryl: And, um, he’s just now come to get treated himself Priscilla: Yes, because he’s been out of town so much Cheryl: OK. Priscilla: so we finally got him up here. Cheryl: OK, you haven’t had sex with him, though, since you found out you had that infection? OK, so now, he’s gonna get treated? OK. Priscilla: Yeah, because I don’t want to take that risk of losing out baby Cheryl: Right. Priscilla: And he understands that. So, I’m happy (laughs). Cheryl: Good. Golly, I think I’ve talked to you just about everything I can. Anything else you’d want to share about your life or anything that’s happened to you. Priscilla: Well, from now everything’s been great. I mean, my daughter she’s still growing up, I have my fiance, and then I’m gonna have this baby. So, I think everything’s great. You know, it’s not exactly the way I planned to start out, but like my, um, mother-in-law says, everything get better the further you go, so everything’s going great now. Cheryl: Does your mother-in-law know about all the things that have happened to you? Priscilla: She, she knows about most of it because, I really, I mean I told her before, um, me, um, me and him, like, actually, planned on getting married. Because I don’t want her, uh, thinking that I’m, like trying to control her son, or, you know, I blame her son for anything that went on in my, uh, life, so I let her know of what went on and he let her know, so thataway she won’t hate me for anything. Cheryl: OK, OK. I think, um, unless there’s anything more you want to tell me, we’re about done. Priscilla: Well, actually I just want to tell the people out there they need protection. I found that out (laughs).

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214 Cheryl: Yeah, that was a question I should ask you, if it were your younger sister or any of your daughters, what are you going to tell them? Priscilla: I would tell them, um, well, I would tell my daughter to wait because, you know, growing up and like I said, having a child, it’s not easy. And when you catch HIV, or chlamydia or gonorrhea or stuff like that, it’s not very easy. Because, you know, you have to go through all this medical treatment like taking the pills, and making sure it’s completely cleared. So I would confer, if she was to have sex, to use a condom, and far as my si—, younger sister, if I do have one, or my older sister, I would prefer her to use a condom too. Cheryl: What advice would you give for protecting your daughters or sisters or anything from a rape experience? Priscilla: The best advice I would give them is to not do what I did, and that was to, to go in shock, try not to have them to go in shock, if, you know, try to scream or something, you know, let somebody know that you’re being raped, you know not to make the same mistake that I did. And, that’s, that’s about the best advice I can give them. I mean, if not, they should, uh, like, tell somebody, like, right away or go to a next door neighbor, you know, like if none of the adults are home at, at the house, then go to somebody who will, uh, let you call the cops. But, most of all, try to, you know, either get out of it, or try to, um, get some help. Cheryl: Have, um, you and your mom ever been able to talk about what she did to you in terms of Priscilla: I’m, I really couldn’t talk to my mom, I mean, me and her, we grew up, we have a bad relationship right now, for a mother and daughter, and it’s not easy to forgive her for it because of what she did. And, it’s something that’s gonna take a while, so, I mean, there’s nothing I can do there until I feel that it’s right to forgive her, then I’ll forgive her. I mean, people tell me, you know, well, you should, uh, put the past behind you, and face on the future, but, what they don’t realize is my mom don’t know how to change. She is still the same person that she has always been, and she will always be the same person. And so, she feels it’s right for herse—, for herself to change. Cheryl: OK. Well, I’m going to really thank you for talking with me. Priscilla: You’re welcome. Cheryl: You’ve had a very rough, um, adolescence, so I hope things are going to get much better for you now. Priscilla: Yeah, I hope so too. Cheryl: Good luck with your pregnancy too. Priscilla: (laughs) I don’t knowthis pregnancy’s already giving me

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215 (Inaudible due to interviewer coughing) Cheryl: I’m going to turn the recorder off, now, OK? Priscilla: OK. Interview with Tarianna 6/2/03 16 yo BF No Children CT/8/02, GC/7/02 Cheryl: This is Cheryl McGhan. Uh, today’s date is June the 2 nd , uh, two thousand and three, and today I’m interviewing Miss Tarianna. Uh, and Tarianna, what I’d like for you to do, is just tell me a little bit about yourself as a person, just a little bit about your life and, uh, who you are. Tarianna: OK, um, honestly, I, I just graduated high school at, uh, sixteen years old. I’m sixteen now, I have a scholarship to go to UCLA, techno—, technol—, agh, Technical Engineering. And, there’s, like, I’m just planning on going ahead and going on with my life, going you know, try to stay in church and everything, get things going the right way, so But I’m a very outgoing person, open-minded, I like to have a lot of fun with friends, and you know, you know but help my mom and my grandmom, mostly with the kids, so I’m, I’d say I’m a very delightful person, you know. But other than that, that’s basically me I like to go the right way, do the right thing, so if a accident happen along the way, I’ll just have to find some way to fix it, or a problem, I’ll have somebody solve, help me solve my problems, or solve them myself, that’s how I am. Cheryl: Tell me a little bit more about your school life, it sounds exciting, your prospects for the future. Tarianna: Well, actually I was a straight A student from elementary all the way up to high school. That’s how I got the scholarship I have. And I was very popular, but I never, you know, paid attention to any of the other kids in class and stuff, I always paid attention to my studies and my lessons, so I could go ahead and stay a straight A student and get through school. Um, then, by the time graduation came, I was happy because my whole family was there. I had them giving me the inspiration and inspiring me that I needed to get through school with it, you know. I had them helping me. So, you know, with my family on my side, and you know, me, keeping my head in my books, that help me get through. That’s what, you know, teenagers need to do. Cheryl: What are your primary interests in, academically? Tarianna: Like, uh, not repairing computers, but like, you know, making games and stuff, or you know, making my own ideas on the computer.

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216 Cheryl: Um hmm. Tarianna: You know, just stuff like that. I would like to do that, it’s, I’m more interested in, you know, I go to my dad’s house, use the computer. I make all kind of stuff on the computer. Games, video’s, music, you know, but that’s what I do. Cheryl: So, are you going to be leaving this summer for college? Tarianna: No, I leave next September. Cheryl: A year from thisyear. OK Tarianna: Um hmm. Yeah, that give me a little time to study, have everything done, you know, that I need to do here, take care of my business, all the things that I need to take of, that way when I go up there I have nothing to worry about down here. So, everything’s working out pretty good right now. Cheryl: OK. What do you plan to do in this year before you go to college? Tarianna: Right now, I’m, uh, helping my mom out with my little sister a lot, you know. I don’t want her going down the wrong path, you know. I want her to be better than me and my mom, you know, I want her to get through school first, most of all. So, I help her out with things, like her education, and everything like that. And then, I’ll take her off, you know, places. Then I help my grandma out with my three little cousins, even though sometimes she end up keeping all six of them, butI help her out. I just help my family out more than anything, you know. They was there for me, so now I’m there for them. Cheryl: OK. Are you going to be in school at all during the year, too, before you leave for college? Tarianna: Um. No, I’m actually gonna go get a job for a little while. Cheryl: Do you know what? What kind of job, now? Tarianna: Probably, probably going and working with computers. Most likely, you know. That’s probablyso I’ll have experience with it before I go to college Cheryl: Um hmm Tarianna: And then get up there and be like I don’t know what I’m doing, wait a minute, I don’t wanna, you know, I’d just get lost in the system, I don’t want to be like that, so I’m going to get some experience with computers. Then once I go off, I won’t have no trouble. Cheryl: Tell me a little bit about your family.

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217 Tarianna: Well, my mom, she’s always been a strict person, you know, that’s why, that’s why I am, I am who I am today, you know, she’s always there on our butts about school, and doing the right thing, she always kept us in church. My dad, I really can’t say too much about him, you know. I barely know my father. I know of him, I know who he is, I’ve seen him a couple of times, but we do not have a father-daughter relationship, which was pretty tough. But, you know, I had him there for certain things that I needed him for, you know, he was there when I really did need him, but I just don’t talk to my dad. That’s about, that’s about it with my dad. My grandma, she’s been a big part of my life, you know, she’s been there since day one, you know, she’s been helping my mom out with us, and, you know, it just my grandmom and my mom, they, those the only two that I really know. Cheryl: Do you, uh, does grandmom live with you? Tarianna: No, grandmom lives in the same neighborhood as me (laughs) cause, uh, I could go on over there and help her out or she can, she calls me and asks me if I need anything, am I doing OK, you know, make sure her granddaughter’s doing alright. Cheryl: So, who lives at home with you now? Tarianna: Well, right now, my mom stay at home, my little sister. My brother is, no, my brother is locked up right now at this time. Cheryl: How old is he? Tarianna: He’s whateighteen, he’ll be nineteen, December. But he’s locked up at the time being. When he gets out he’s getting married to my sister-in-law, Becky, you know. She’s a big part of his life, you know, and I’m proud and happy for him, She’s, he got somebody care for him just as much as he cares for her, so. But I got my sister, my mom, my brother and me. And my old man (laughs). Cheryl: How old is your, um, sister? Tarianna: My sister, she’s eleven. Cheryl: OK, and then grandmom lives in the same neighborhood, so that you have a good support system there. Tarianna: Yes, we do. Cheryl: And your dad, now, you mentioned earlier, that sometimes you go over to his house to, like, work on computers, and all? Tarianna: Um hmm. Cheryl: But, you don’t do that very often or?

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218 Tarianna: I do it a lot, but I just, he don’t never be home. I have keys to the house, or my grandma which stays, on my dad’s side, stays with him. I’ll talk to her, you know, and my two uncles that stays there, but I just don’t get along with my father too much, you know. You know, I love him, he loves me, don’t get me wrong, that’s the unconditional love, but me and my dad, we just don’t see eye to eye, you know. So, it’s more hard for me to talk to my dad about things that I need to talk to him about, you know, cause he’s like, the kind of person that’s, like he think that you should do this one way and just this one way, instead of trying a new way or something, you know. And he’s old fashioned, basically. You know, he doesn’t know exactly how to cope with me, you know. He just, and see, he’s done had males, he’s done raised his brothers and everything, and I’m his only daughter, so, he, he really don’t know how to deal with my female problems and everything, you know, and so it’s like harder for him with a female, you know. I do sometimes try to talk to him, sometimes, and he’ll sit and listen and, and, he don’t have any idea what I’m talking about, so I just, like, “Forget it, Dad,” and I’ll go talk to my mom about it. But, me and my dad, you know, we don’t see eye to eye, but we get along sometimes, and sometimes we don’t. We have our, you know, disputes and everything, but we always settle them. Cheryl: And? Tarianna: But he hasn’t really been there for me most of my life, you know. He’s been there, but he hadn’t. And that’s why our relationship is like it is today, you know. I’m not saying it’s screwed up or not saying it’s a great relationship, it’s probably in between, and so. But me and my dad, I love him and that’s about, that’s basically it, you know. Cheryl: Did, um, dad ever reside in the same house as you and your mom or ? Tarianna: Um, yeah, until I was about five years old. Cheryl: Is he the dad of your older brother too? Tarianna: Yes, he is. Cheryl: But not your younger sister. Tarianna: Not my younger sister, no. Cheryl: OK, so he left the home when you were about five. Tarianna: Um hmm. Cheryl: But stayed locally, though, he, he’s been around pretty Tarianna: Yes, he’s been around, yes. Cheryl: Um, what do you think your biggest differences with him are?

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219 Tarianna: Hmmmph (thinking). The biggest differences will be(laughs) OK, my biggest difference is, I SAID it already! I, me, being a female, he don’t know how to cope with it! You know, he likes to do manly things, so I guess that’s part of the reason I grew up as a tomboy, cause he always treated me like a little boy and everything, so. Cheryl: OK, all righty. (Coughs) OK, now you mentioned earlier that you have an “old man”. Tarianna: Yes, I do. (Smiles) Cheryl: OK, well, tell me a little bit about him. Tarianna: Well, he’s actually a pretty nice guy, you know. He’s, uh, in church, you know, his family, whole family grew up on church, he’s very strong. He believes strongly in the Lord, and he has me going to church now which is pretty good. I been going to church, but I stopped for a while. He got me back in church. And he does not lie at all. Which is pretty good, you know. I like that about him because, you know, at least I know I can trust him. We have that trust level with each other, you know, where we can tell each other anything and everything. We might g et upset, but we know, you know, she’s being honest, he’s being honest, you know, and our relationship is going great right now, sobut, at this time, why I’m here is because, um, he actually, before we got together, he was, uh, seeing a friend of mine. It was just a one-night stand, you know, and, uh, he used a condom on him and it popped. She gave him something. He went to Shands Hospital, got it cleared up. Well, they gave him some pills, they didn’t know exactly what pills they gave him, so they called him here to get a shot. And they said, if you have a partner, bring her along with you. And then, he brought me here last Friday with him. So, they say he was tested positive for gonorrhea, that was it, and sobut that was about it. I came here, you know, and got a little shot, but, uh Cheryl: Did you get another shot today? Tarianna: (Nods) Um hmm. Cheryl: OK. Tarianna: I did. Other than that, I have been diagnosed with, besides gonorrhea, with chlamydia and trich. And, uh, I got those from my ex-boyfriend, you know. He ended up sleeping with one of my best friends, and never went and got checked, and ended up coming home and giving it to me. And I had to kick him to the curb, you know, I ain’t dealing with that disease stuff. But, uh, (laughs) it was hard to kick him to the curb cause I did have feelings for him. But he never went and got checked after I told, after I came and got checked, he never went and got checked or anything like that. I didn’t have sex with him or anything, so I told him that I couldn’t be with him, he, he refused to go to the clinic, he refused to believe he had anything. So, all he’s doing now is going around passing it to other people which is not good, you know. So, I just believe that, you know, he’s wrong for doing it, he’s

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220 wrong for going around and passing it around to other people. And that, that really is disgusting. And when I first found out that I had the stuff, and he gave it to me, you know, I went home and clicked on him, you know. I kinda went crazy, I threw (laughs) the dining room chair at him, butand I was hitting and throwing all kind of stuff, irons, shoes, coat hangers, I was going crazy on him. But, um, after that experience, it, you know, made me use my head and I’ve been with Alex a lot longer than I was with him. Me and Alex been together for a while now, so, you know, and that’s the only partner I’ve been having for the last past, what, four or five months now. But before we started having sex we was already together, so. It was, you know, it’s pretty cool thing, you know. I knew him as a friend, I knew Alex my whole life. You know, we grew up together, and, uh, we just bumped into each other again one day and started hanging out being friends, then we went from friends to cuddy buddies, not having sex, but we cuddle, sleep together, you know, be there for each other. Then we went from cuddy buddies to a little further on, then we decided to be together since we already knew everything there was to know about each other, everything was going great between us, you know, so. That’s basically between me and him. We probably, only thing we don’t have right in out relationship now is, we can never agree on things, like, where to go eat at, or, you know, just like, fun stuff or what places we’re gonna go have fun at, like to the beach or the movies. Never can agree on things. Cause he always want this one or this way and I want to go this and do this, or this thing, and we just never agree on anything. But we end up going and have fun anyways. Cheryl: How do you settle your differences? Tarianna: Rock, paper, scissors! (Both laugh) Cheryl: That’s a good way to do it, huh? Tarianna: Well, like the grocery store, we go to the grocery store, I want this kind of cereal, he want this kind of cereal, best two out of three, rock, paper scissors, I win Cheryl: (laughs) OK Tarianna: ...we get my kind of cereal I want, he win, we get the kind of cereal he want. That’s the same way with any other place, rock, paper, scissors Cheryl: Right. Tarianna: and once you do that it ain’t no way you can get around it, you know, if he won, he won, we go to his place, if I won, I won, we go to the place I want to go to. So, that’s probably the easiest way to settle it, if you really want to settle something, do rock, paper, scissors and you get the through with it, you know, so. Cheryl: How old are you now?

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221 Tarianna: I’m sixteen. Cheryl: Still sixteen. And you just graduatedjust real recently, like just a month or so ago Tarianna: Yes, I did. Cheryl: What school did you go to? Tarianna: I went to Sandalwood High. Cheryl: OK. Uh, how old were you when, you, I guess, had your first sexual experience? Tarianna: First sexual experience, I was fourteen my first love, Christian, but he was nowhere near fourteen. He was, what, nineteen years old, and I sorta lied to him about my age. You know, he took my virginity, I took his. I was his first love, he was my first love. So, I, everything came out, you know. Like I said, before I lied to him about my age. I had to tell him and everything. Once I told him, he was like, well, it’s already too late, you know, I’m in love with you, and we stuck together for awhile, soYou know, until this day, we still talk to each otherHe still says he’s in love with me, nobody else is going to be able to take my place in his heart, and I tell him the same thing. Me and Alex done talked about his first love and my first love. We all still talk about our first loves and we’re cool with that. We done met each other’s first loves and know them as friends and everything, so. It’s a pretty good situation around this time. Cheryl: What led up, um, in your relationship, with Christian...? Tarianna: Um hmm. Cheryl: to, um, have sex with him? Tarianna: Well, at first, I guess it was just, you know, everybody around me wasn’t virgins and, you know. And at this time, you know, I was in love with him. Which I got to say, mo—, most of the time fourteen years old don’t know about love. But you know when you’re in love because you can feel it, you know. You know how you feel about a person. And for me, at that time for me to be fourteen, I was very mature for my age. I, everybody always be like, well, your mentality is older than fourteen, you know. You act older than fourteen, you sound older than fourteen so, you know, I felt it, I knew it, and he knew it. And, uh, so I wanted to lose my virginity, and I say, who’s the best person to lose your virginity to than your first love if you don’t want to wait to get married, so. I guess that was what started it off, you know. Cheryl: Was it a planned thing between the two of you?

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222 Tarianna: Yes, it was. Yes it was because we waited, we was seeing how long we was gonna wait, and then we just planned it outit was kinda hard at first cause I was scared, I’m not gonna lie, I was real scared. And, uh, like, matter of fact, I remember it, I still remember the date, first day I ever had sex was February 13 th . Cheryl: What year? Can you remember thethat’d be two years ago, right? Tarianna: I’m sixteen now, so I was fourteen. Cheryl: Fourteen, yeah. 2000, 2000 or 2001? Tarianna: 2000. Cheryl: 2000, OK. So Tarianna: But that was, you know, for me to even hold out that long, that was pretty good, cause there’s, you know, little girls out here having sex, eleven, ten, eleven, twelve years old, you know, thirteen, you know. But the time that I had sex from fourteen to sixteen, I also, you know, limited who I sleep with, and, I know how many guys I’ve done had, from the age of fourteen to sixteen. I’ve done only had four guys from the age of fourteen to sixteen. And all four of them I have long, you know, term relationships with. And I always made them wait before I ever had sex with them, so that’s, that the best thing you can do is make em wait cause if you give it up too soon, they’re not going to have any respect for you, they’re gonna think, “oh, this a whore”, you know, “she’s just not the one”, or “she gives it up too easy, I can’t trust her around other men”, so that’s, you know, and me personally, I have a lot of male friends cause I can’t get along with females. I always grew up around males, you know, doing little male stuff, playing flag football, basketball, so I’m like one of the guys to my friends, they see me as one of the guys, they don’t see me as, you know, a female Cheryl: Um hmm. Tarianna: So, which is, pretty, you know, pretty cool cause I can see where they’re coming from, I can relate to em on their subjects, and then also I can relate to them on female subjects. You know when they’re having female problems, they come and ask me, you know, “I need a female’s point of view on this onecould you help me out with such and such”, or when I’m having a problem, I go to them for a male’s point of view. And we always keep it real with each other Cheryl: Um hmm. Tarianna: So, that’s like, my, my friendships and my friends and everything, my friendships with them are perfect right now. I can say perfect. I have not had a fight with any of my friends, you know, and then, we’ve know each other for a long time, and it’s been the same friends, you know. Grew up together, you know, now most of them are grown, they’re either, you know, twenty, twenty-one years old now. And they go off and leave me now since they old enough to go clubbing and

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223 everything, so like, ah boo, you know but we still get together every Saturday, go play base—, basketball, not baseball. You know we still have our friendship thing going on which is good because whenever they need me, I’m there, whenever I need them, they’re there. So they’re basically, instead of them being friends, they’re more like family, so. Cheryl: How long with Christian, would you say, ya’ll were together before you had sex? Tarianna: OK. Well, Christian was, like, nineteen, going on twenty, I believe I said, and, um, I was fourteen when I lost my virginity. We was together from when I was eleven years old. I was tall, I had everything, so he didn’t know, like I said, I lied about my age. I still had my baby face, now, but he wasn’t really too much paying attention to my face. It was everything else, you know, but he, the first thing that attracted him to me was my face though, you know, cause I always wore baggy clothes and everything so a male couldn’t see my body, that way if they wanted to talk to me, they won’t be talking to me because, “Oh, she’s got a, you know, bubble butt, or big tits,” they be like, “Well she has a nice face and she seem like she has a nice personality”, when they can talk to meso they don’t see my body. I don’t wear all that tight hoochy-mama stuff trying to catch a man, and all that right there. I stay me, I be me, I feel, you know, protected when I wear my clothes, you know, my male clothes and everything, you know, I’m not showing off my body or anything like that, you know, except when I’m in the bikini, or a bathing suit, that’s about it. So, but um, from the age of eleven, I told him I was eighteen years old, which I did look eighteen at the time. From the age of eleven to fourteen we was together, so that’s why I was, like, and I, we lasted a while before we had sex, you know. So. Cheryl: And what happened to the relationship after that? Tarianna: Well, see, Christian’s Italian. He stayed in Italy, he come down here to visit his cousin. You know I met him at the Cinco de Mayo. So. And he visit his cousin, he come down here for four months, visit his cousin, stay for four months, and go back home. So, but we was at the fact, we was at the point where he was so in love with me and I was in love with him to where he wanted to be down here with me all the time. He met my mom and my dad, both of them liked him even though I was kinda young, you know. So I had my parent’s approval. But, uh, he, uh, wanted to come down here with me. And his best friend, his best friend that stays down here, he asked her to do him a favor. All three of us sat down and talked about it. He wanted to marry her so he could come down here, you know, cause he was, you know, an alien, basically. Cheryl: Now when you say come down ‘here’, where were ya’ll then?

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224 Tarianna: We was in Mayport. I mean, he wanted to come to Florida, you know, he was down here already, but he wanted to come back down here and stay down here. He lived in Italy. Cheryl: Right. Tarianna: So, you know, and I was too young, I was too young to get married at the time. But he wanted to come down here to be with me, so, me and him and his friend talked about it, about him getting married to her, and she was supposed to be doing him a favor so he could come down and be in the US, be US citizen by getting married to one. And I told him, you know, we talked about it and then I said, “No, that don’t seem like a good idea because I wanted to be your first wife”. I said, “don’t do it”, you know, I said, because whether people know it or not, it doesn’t matter how many times you get married, the law’s gonna always recognize that first wife, regardless if you have that second or third, they gonna always recognize that very first wife. So I told him I wanted to be his first wife and I wanted him to be my first husband. So, what he did was, he went behind my back anyways and did it. No, but he was doing it for us, you know, they wasn’t together or anything. And he went behind my back and got married to her and they was just, they were still friends, they wasn’t together, she had her old man, she talked to her old man about it, you know, they understood it. They understood everything that was going on at the time. And I found out, I got mad at him. For a minute I was like, “OK, well, fine”, you know, I dealt with it, I had dealt with it, but it made me upset when I had to wake up and see that ring on his finger, you know, and knowing that he’s married to a differentyou know, I, I don’t care if it was his best friend, it made me feel bad, you know, because, you know, I was supposed to been his first wife. So, um, it’s like this, you know, I broke up with him. I told him that I couldn’t deal with it any more. So, but right before I got ready to break up with him, she started saying, Oh, cause she broke up with her old man to be with Christian. And Christian told her he did not like her like that, it was just a favor. She said, well, she started pulling that “I’m your wife, and you gonna start treating me like your wife” and all this and that and I told him not to do it the first place. So, that’s the main reason, that’s what led up to the break up between me and him was that I ain’t feel like going through all that. So he got a divorce from her, went back to Italy, then he finally met somebody he liked. He don’t love her quite as much as he loved me because two days before the wedding he told me that if I said, you know, I don’t want him to get married, if I want him to come home to me that he would have done it which he really would have done it. But I didn’t want to ruin somebody else’s life by my decision, you know, I’m not fixin to make the decision for you. I’m not fixin to give you the answer you’re looking for so you can just leave. So, he got married again which he’s happy married now, but he, we, still talk, you know, and Cheryl: Is he still in Italy? Tarianna: No, he’s in Tennessee right now. He’s married to, uh, a Army girl, she’s in the Army, so... I’m proud of him, though, you know, I’m, I’m happy for him, I’m happy that he found somebody that likes him and love him But he always tells me when we, you know, gets on the phone that he’s never gonna love her as much

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225 as he loves me, and I tell him that I’m never gonna love anybody as much as I love him, but, you know, we got our lives, we went our separate ways, we’re still friends which is good, we still talk, we still there for each other regardless of what our mates think, we’re always gonna be there for each other. So, that’s our relationship, me and Christian, you know. Cheryl: And then what happened after you broke up? Tarianna: With Christian? Cheryl: Well, yeah, your love life then, your next boyfriend, or Tarianna: My next boyfriend, well, my next boyfriend, we only had sex one time, we was together for about five months, and then after we had sex, he just up and left, so I was like, “Whoa”. You know he waited that long to get it, and then just left, so I really wasn’t too much about that one, so. But the, uh, after Christian, you know, that was the one before Alex, he was the one who gave me everything, like chlamydia, gonorrhea, and trich. So, I just, you know, I told you before I just let him go because of the situation. Cheryl: So, there was Christian, and then there was someone else that was five months, and then he left Tarianna: Yeah, his name was Tyrone. Cheryl: And then there was a third person Tarianna: Um hmm, which was Robert. Cheryl: How did you meet Robert? Tarianna: Through, it was my best friend’s cousin. And that’s how I met him, was through her. She wanted to (laughs) cause we look almost alike, if you put us together, they think we look like twins. But we’re not, we’re not even kin, so, it’s pretty crazy. I don’t know, it’s crazy. But we liked each other and we got together. But, he, I don’t honestly know why he would wait five months to have sex with me and just up and leave once he got it, you know. Some people do that, that’s why now days you have to be careful, and that it’s best to wait even longer now because, you know, you never know what’s gonna happen afterwards. Cheryl: Was Robert the second person you had been with? Tarianna: No, the third. Cheryl: The third, that’s what I thought. And he was the one that waited five months? Tarianna: Um hmm.

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226 Cheryl: Or the one before him? Tarianna: No, he, Robert was the one that waited five months. Cheryl: But what about the one in between Christian and Robert? Tarianna: Um, we only did it, um, (thinking) the one between Christian and Robert was Tyrone (thinking) and into, what, seven months of the relationship, we did it, and Denise, his first love wanted him back and he went back to her, so. I couldn’t necessarily get mad at that because if I was with somebody that, you know, I didn’t have real, real strong feelings for, and I still in love with my first love, I would want to go back to him too, if he would want me back, so. I wouldn’t, I wasn’t really mad at that situation, you know, I knew it was going to happen already, but I was just waiting for, for it to happen, you know. Cause I really couldn’t say too much about that situation. But now, I’m with Alex, we’ve done been together for awhile now, and, uh, I’m—, he’s gonna be most likely, if, um, me and him end up breaking up, I’m going to stay out of relationships for awhile. A good, little while, probably till after I finish school. You know, get my job and stuff. And, uh, I guess move on with my life, but right now while we’re together, we gonna make things work, try to make the best of things, and you know, just carry on, do what we’re doing now, you know, staying in church, being there for each other, you know, talking to each other. Cheryl: Tell me a little bit about, it was Robert, you said, that gave you the STD, the very first one you had Tarianna: Um hmm. Cheryl: Tell me about how all that came up, how you found out and everything and ... Tarianna: Well, Robert slept with, well, this is what happened. OK, when me and him was dating, what happened wasand I didn’t find this out until afterwards, after we had sex. Uh, there was this lady and her daughter, she, this lady was what, thirty-three years old, her daughter was sixteen. And he was doing the daughter and the momma, both, and the momma and the daughter was there and pulling tricks, and everything like that, so after I found out all that, you know, that’s when I decided to come get tested. And he caught it from the momma and the—, well, I don’t know, thee momma, well if they doing the same guys, both of them got it. So, caught it from both of them, and, uh, when I found that out, I came and got tested. And that’s when I found out I had stuff. So I, like I said, I clicked on him, threw the dining room chair at him, I threw irons, coat hangers, shoes, everything that I could find. I even gave him a few clops upside the head with my fist, you know. I was mad, you know. That was the first time I ever had anything, I’ve never had anything before that, and when you first get that news, you’re thinking, the first thing that go through your head, is “Oh, this person done gave me something” and I’m pissed off about it. I just don’t like the fact that he did thisand now honestly,

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227 the first thing that goes through your head is “I’m gonna kill him”. That’s the first thing that goes through your head, and then you get home and you blow up and you go crazy on him. That’s me. And, you see, when I go crazy, I have a habit of going overboard, so. I don’t think nobody want to make me (whispers) mad, but that’s what happened to him. Cheryl: At the clinic they keep a, um, computer record of the STDs Tarianna: Yeah. Cheryl: that you’ve had, and the first one, I think that you had, was in February Tarianna: Um hmm. Cheryl: when you had gonorrhea? Tarianna: Um hmm. Cheryl: Um, did you come into the clinic, because you were having problems, symptoms, yourself, or because you found out that Tarianna: I found out that he was doing this so I figured I needed to come get checked. Cheryl: OK, and they did treat you then for gonorrhea? Tarianna: Yes, they did. Cheryl: And then in October, you had chlamydia Tarianna: Um hmm. Cheryl: Was that still with Robert? Tarianna: Um hmm. No, no, with Robert, no, it wasn’t with Robert, it was actually with (thinking) NO, it was with Robert, cause when I came here they didn’t detect that I had chlamydia, so they just gave me a shot for gonorrhea. And then they called me back, and I don’t know what took them so long, they said, well, you, this has been found in your bloodstream, and you need to come in. And I came in, and they treated that too. Cheryl: So even though you were treated in October, you think it came from being with him back in February? Tarianna: Um hmm. Cheryl: Cause it wasn’t like a separate infection?

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228 Tarianna: Yes, it wasn’t a separate infection. It was both together and they didn’t, you know, contact the chlamydia, they only contact, they couldn’t see it up under I guess it was just starting or whatever at the time but they gave me the shot for the gonorrhea instead of chlamydia, then by the time October came, it was like, I, like I said, I don’t know what took it so, what took so long, you know that’s months that went by and they called and they, “well this has been found in your blood stream. You need to come back to the, um, clinic”. I like, “all right”, came in, took a shot, and got it cleared. Cheryl: Now at that time you weren’t with Robert any more? Tarianna: Nmm nmm, I was by myself at this time. I was, wasn’t seeing anybody. Cheryl: OK, OK, and they gave you another shot? Or you just took pills for the chlamydia, do you remember? Tarianna: I believe they gave me pills for the chlamydia. They didn’t give me shot, they gave me pills and some stuff to drink in my mouth, and that’s about it. Cheryl: OK, and so at that time you did not have any sexual activity Tarianna: No, at that point I did not have any. Yes, you’re right, absolutely right. Cheryl: OK. Um, and so how long have you been with, um Tarianna: Alex. Cheryl: Alex, now? Tarianna: I’ve been with Alex since last (thinks) November, yeah, last November, November third was the day we got together. Cheryl: And now he’s found out that he has an infection Tarianna: Um hmm. Cheryl: Was he having symptoms? Tarianna: Well, at, when he first found out, you know, he say that he was burning and stuff down there, and, uh, this was way before we even had sex, way before we got together we was still friends and he told me about it. So I went with the doctor to him and everything. Shands Hospital, they gave him some pills to clear it up. So, after awhile, about two weeks, all the symptoms went away, he wasn’t burning any more, his wee-wee wasn’t hurting, you know, everything seemed fine with him. But the thing is, they called him back here because they didn’t know what kind of pills Shands had gave to him, they didn’t know if they gave him the right treatment or not. So, they was like, “well, come in”, you know, he, he told them, “well, they gave me pills, I feel all right”, you know, and they said, “well, if you feel that

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229 nothing’s wrong with you, just sign these papers here, and you can go”, but he say, just to be sure, you know, he went on ahead and took the, another shot, a shot. Not no pills, but he took a shot here. Cheryl: That was back in November? Tarianna: No. Cheryl: No? Tarianna: That was now Cheryl: Oh, now. Tarianna: In between this time, from last Friday. Cheryl: Oh, OK. Tarianna: And, we was together, that’s when we, that’s when, uh, you know, we got together, but in between the time we been together, this is what happened. (whispersinaudible) Cheryl: Let me get this time frame just down a little bit better. The first time ya’ll Tarianna: Met back up and re-united was November 3 rd . Cheryl: Re-united, tell me about that. Was there a period that you didn’t see him, and then got Tarianna: Yeah. Cheryl: OK, tell me all about that. Tarianna: Like I was saying, we had, like Alex, I didn’t see him for awhile, like I said, we grew up together, and we haven’t seen each other for about ten years, and we bumped back in each, into each other on November 3 rd . So we started being real good friends, at this point Cheryl: When you grew up together, how, at what age? Tarianna: At from babies. Cheryl: Babies till Tarianna: I was about, babies till, like, he was sixteen at this point. He’s, what, twenty now. Cheryl: OK.

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230 Tarianna: So, I was, you know, he knew me when I was still a baby. He was one of the first people with my mom and them that to hold me, you know, and I’m like, “Aghhhhh”, kinda weird, when you think about it, he held me when I was small, Oh my God, now we’re together. So it was a kinda a pretty awkward situation, but everything worked out for the best, so. Cheryl: OK, so he’s twenty, you’re sixteen. When you were a little tiny baby, he was about four, four or five, right? And then did he move away? Tarianna: Yeah, he moved, his family moved away, that’s what it was. They moved, we got, lost contact, and didn’t see him for about ten years, and now we bumped back into each other on November 3 rd . And that’s when he had that one night stand with her. But, you know, he didn’t start having symptoms until, you know, couple months later. Cheryl: And so when he was burning, he went to Shands Tarianna: Yeah. Cheryl: and then he thought things were cleared up Tarianna: Yeah. No, most likely they’re, the things were cleared up, but just to be safe, he came back and went on ahead and took another, took a shot. Cheryl: Today? Tarianna: No, Friday. Last Friday Cheryl: Oh well, recently, very recently, though. Cause even this now has been, um, close to six months isn’t it, about five to six months. Tarianna: Um hmm. No, see at the end of, and the time, like I said, that we was dating, we wasn’t having sex at first, we was just friends, then we became cuddy buddies, where we would just hug and hold each other, and sleep to—, sleep in the bed together, and stuff, but we never have sex. We just, you know, getting real close. So, by the time, he found, you know, that he was having all those symptoms, we wasn’t having sex. And he went on ahead and got tested. He came out with something and took the medicine. Then it cleared up. And then he supposed to got cleared up, and then, after that, we went a little bit further with things, and that’s when we started having sex, and then, like, last, last what, yeah, last Friday, matter of fact, they called, they called him on Friday, and we came in Friday afternoon, right near closing time. They called, and they was like well, this is what it was, we don’t know what kind of pills they gave you, uh, we don’t know if it was the proper treatment, so you need to come in. Cheryl: They called him last week about an infection from Shands back in November?

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231 Tarianna: No, not November. Cheryl: What, what date? Tarianna: See, what it was, like I say, me and him was friends at first. Cheryl: Um hmm. Tarianna: OK, him and the girl he had a one night stand with, I couldn’t say anything about that cause we was just friends. Cheryl: What month did that happen in? Tarianna: It was not too long ago, it was, what, last month sometime. Cheryl: Oh. OK. Tarianna: or at the end of last month or in the middle, near that time frame. Cheryl: Uh huh, uh huh. Tarianna: I, like I say we wasn’t going together at this point though. Cheryl: A month ago? Tarianna: No, we was going together, but we wasn’t Cheryl: Having sex? Tarianna: Yeah. And, uh Cheryl: So he apparently had sex with someone else. Tarianna: But he didn’t cheat on me, because we had made, you know, we had an understanding to where, you know, we’re not having sex, we’re not fully, fully together yet, you know, you do your thing, I do my thing, even though I never slept around with anybody, he slept with her, and condom popped, boom, you know, that’s what happened. He went to Shands, got it cleared, well supposedly, But in between the time he supposed to have it cleared at Shands, he never seen the girl again or anything like that. But, you know, two weeks passed by, he didn’t have any more symptoms, we believed that everything was all right, nobody gave him a phone call saying come back in until last Friday. They told him to bring me in with him. Cheryl: Although he has been treated Tarianna: Yes.

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232 Cheryl: So there is a chance that you really don’t have anything. Tarianna: Well, today I, they went under the microscope and they said everything looked fine with me, I didn’t have anything. Cheryl: But they just went ahead and treated you just in case, as a contact? Tarianna: Yes, yes they did and, uh, they, now all I have to worry about is, you know, the tests, the other test results back from the lab. Cheryl: OK. Tarianna: So, but other than that, everything seems fine. Cheryl: Now, you mentioned that the condom broke with the other girl that he was having sex with Tarianna: Um hmm. Cheryl: What about the two of you when you’re together, did, do you use condoms, or any protection? Tarianna: At first we did, but then, let’s just say one night he got drunk, he pulled the condom off, he stuck it in, I slapped him in the face doing it, but then, we just went on ahead and did what we did, you know, it’s already too late, he already stuck it in and wasn’t nothing I could do about it. So, ever since that day, we just went at it without a condom. Cheryl: Why do you think he pulled the condom off that time? Tarianna: Because he had it clear that he say believed that I didn’t have anything, which I knew I didn’t have anything, cause I didn’t have any symptoms, I didn’t, wasn’t burning, wasn’t nothing, you know, and it’s been months that’s done gone by since the last time I had sex. So, I knew I didn’t have anything automatically cause I knew I haven’t been with anybody at this time. Last person I was with before him was Robert, so I knew I didn’t have anything, I automatically knew cause I was abs—, I was, I stayed away from sex basically from the time that I was with Robert till the time I was with him. Cheryl: What about Christian? Did you ever use condoms with him? Tarianna: Yeah. Cheryl: One time, or sometimes or all the time? Tarianna: Always, all the time, every single time. Cheryl: OK, and then, the next partner you had was who again?

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233 Tarianna: Terry. Cheryl: Terry. Tarianna: I mean Tyrone. Cheryl: Tyrone. Did you use condoms with him? Tarianna: Yeah, I did. Every single time. Cheryl: Every single time. Tarianna: The only two people I didn’t use condoms with Robert and (inhales) Cheryl: What made Robert different than the first two that you decided not to use condoms with him? Tarianna: Well, Robert, I don’t know, it just (thinking), we used condoms but not every time, and then the first time the condom popped on it, on us, it, it, was, like, OK, you know. It’s popped, you know, I know I should have used them anyway to prevent pregnancy, but at this time, I was on birth control, so I wasn’t worried about getting pregnant. But, uh Cheryl: What kind of birth control were you on? Tarianna: Depo shot. Cheryl: OK. Are you still on Depo? Tarianna: No, (laughs), but other than that, that’s what happened. Cheryl: Now with Alex, now, um, took the condom off and had sex with you, what if you had become pregnant from that? Tarianna: Well, there would have been nothing I can do, but just deal with it, you know. And I have a very good family that supports me, you know, my mom, and I’m pretty sure my dad would have been involved in the baby’s life most likely, since he wasn’t really involved in mine, he would’ve. You know, every thing that he didn’t do with me, he would have did with that child, so. Cheryl: With all the plans that you have for your future lined up, are you going to take any steps to be sure that your don’t become pregnant or how do you feel about that? Tarianna: Yeah, actually, just the other day me and Alex talked about that, and so we decided that I was gonna get back on the Depo, you know, and then also use condoms. I mean he’s got it cleared up, whatever he had, I have it cleared up. So, now, we both, but I didn’t have anything, but, you know,

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234 Cheryl: So ya’ll had an understanding before you were having sex that he, it would be all right with you if he had sex with someone else, and now how do you feel about it? Tarianna: Now, It’s different. Now we’re together, together. And there’s no way in, you know, limbo that (laughs) that he can do that now, so he’s, like I say, uh, Alex is a very Christian person, and he don’t believe in just he’s a man now, don’t get me wrong, he’s gonna want it, but now he, he’s with me, like, literally, he’s just with that one person, and he stay’s with that one person, and I’ve known him to be like that, you know, since we were small, growing up. Cheryl: So, you’ve known him a long time too. Tarianna: Yes. Cheryl: You have long-term relationships with a lot of people. Tarianna: Um hmm. See, I’m not, I don’t just move from male to male to male to male because, you know there’s too much stuff out there, you know. And, in my cases, there was accident, and then, you know, I should’ve used my head and been like, you know, you gotta put this condom on, but see, me and Alex used a condom at first, then after that, you know, we didn’t, and then I still came back here today, you know, he had got his cleared up. They say I don’t have anything, so he didn’t give me anything. This is what they’re saying here. You know, under the telescope, they looked under it, they say I didn’t have anything, there was no signs of anything. And it’s been a while since, you know, me and him did it, so it should show by now if I did have anything, and, uh, so I know that Alex didn’t give me nothing, I don’t know Cheryl: So you have a good trust Tarianna: Yeah. Cheryl: in him now that he’s not going to be with anyone Tarianna: I know he’s not going to do it because of the fact of his, the way he was brought up, and the way, you know, if you actually sat down and talked to him, you would see that he’s one of the most respectful young men that you would ever know. You know, so talks so very polite, he not rude or nasty at the mouth. He, you know, he gets up, around the house cleans up, cook dinner, I mean he does everything a female should be doing. He won’t even, he’ll let me do it, but he likes to do it for me. You know, that, that lets me know right there that I know I can trust him and I know that, you know, I can believe in him and everything. And he’s in church, for the mere fact that he got me back in church, I know that he’s not going to do it, he’s not going to cheat on me. You know, he still talk to his first love, Toya, but (portion lost due to tape change) his first love on the phone when I was there and I feel the same way when I’m on the phone with my first love and he’s there, so we say, hi, how you doing and everything’s going all right, make it

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235 quick and short, OK, well, I’ll talk to you later, bye, you know, we don’t sit there and just blab our mouth about stuff in between me and his relationship to them. So, but that’s how it is though, you know. Cheryl: OK. Let me just take a peek here and see if there’s anything else. Can you think of anything else about your life that we might want to talk about? Tarianna: Honestly, none, I pretty much done covered all the basics, so. Cheryl: I can’t think of anything else. Um Tarianna: What time is it? Cheryl: About quarter to one. We’re almost through here. You never have been pregnant, have you? Tarianna: Never have been pregnant. Cheryl: Let me ask you again just a few things. You mentioned that, um, he had gotten drunk one time, Alex, when he took the condom off, um do you have, um, do you drink at all? Tarianna: No. Cheryl Um Tarianna: Do I smoke? Time and time I smoke a little marijuana, but I haven’t smoked in two, about seven months, now. Cheryl: Do you use any other drugs, ecstasy, or Tarianna: No, I do not, only drug I’ve used is marijuana. Cheryl: OK. When you smoke marijuana, have you ever, like, had intercourse under the influence of marijuana, or felt that maybe it was affecting your Tarianna: No. Cheryl: (laughs) OKhormones or desire to have sex? Tarianna: Actually, weed does sorta make me horny, I ain’t gonna lie. But, at this time, you know, I wasn’t with anybody I smoke weed. But, see, even though you smoke weed, you know what you doing. It’s not like when you get drunk, you know you shouldn’t be doing it, and you do it anyways. When you smoke weed, you can automatically say no, you know, even though that urge is there and then you really want it, you can say no, because you know exactly what’s going on. Like, if you get high, you know, you stillif you get drunk to a certain point, you won’t remember nothing from the day before. You get high, you can get high as you want to and you still remember everything from the day before. Even though

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236 they say it kills brain cells, but you still remember what goes on, so. That’s it, you know, I don’t Cheryl: So, but you don’t drink at all? Tarianna: No, I don’t drink. Cheryl: How do you feel about Alex drinking? Tarianna: Um. He don’t do it every day. He doesn’t do it most of the time, (knock on door) it’s just, that’s not an ordinary thing for him. He does it (knock on door) when we’re having parties or something. Cheryl: Um hmm, but you felt that maybe him being under the influence of alcohol that one time might have influenced him deciding to take the condom off or Tarianna: Maybe because he, you know, how people say you can’t feel anything when you Probably, that’s probably what it was, you know, I’m not sure, but, or either he just want to pull it off cause he couldn’t feel nothing through the condom, I don’t know. Cheryl: Does he complain at all about when he uses condoms, about Tarianna: No, he does not. Cheryl: lack of feeling or Tarianna: No, he does not. Cheryl: What about yourself? Do, do the condoms bother you at all, either physically or emotionally? Tarianna: Well, there’s a certain kind of condom, well I can’t use, um, only kind of condoms that I can use is Durex and Trojans. The rest of them, I cannot use, cause it either, it’ll give me a (burp) excuse me, a irritation or, or it just won’t get me wet. It It’ll keep me from getting, you know, wet. Cheryl: Um hmm. Tarianna: But Trojans and Durex, those two condoms that we use cause they’re fine, you know, we don’t any complaints about it. Cheryl: OK, he doesn’t mind them either? Tarianna: He doesn’t mind them, no. Cheryl: OK, OK, uh, it doesn’t sound like you’ve ever been a situation where you’ve used sex for housing, or money or anything

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237 Tarianna: No. Cheryl: like that, I think I figured that out just by what you’ve told me already. Tarianna: No. Cheryl: OK, well I think I’ve about covered everything I need to, unless there’s anything else you’d like to share? Tarianna: No, that’s all. Cheryl: Well, I have really enjoyed talking with you. I appreciate you talking with me, and I just wish you the best of, of luck and success for your future. Tarianna: Thank you very much. Cheryl: Uh huh, you’re welcome.

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BIOGRAPHICAL SKETCH My name is Cheryl McGhan. I have been a nurse for 14 years, and I was a licensed midwife in Florida for 8 years before I became a nurse. My area of interest has always been providing care to women, especially adolescent girls. I received an associate degree in nursing from St. Petersburg Junior College in 1990. I then completed my bachelor’s degree in nursing at the University of Central Florida in Orlando, Florida in 1996. As a registered nurse, I specialized in obstetrical nursing and worked in a variety of hospital and community settings, including perinatal home health care. I completed my masters degree in nursing at the University of Florida in 1998, with a concentration in nurse-midwifery. I practiced as a nurse midwife in a hospital setting, and more recently provided women’s health care at the Duval County Health Department and Planned Parenthood. I have also been an adjunct clinical instructor in maternity rotations at a local community college. During my doctoral education, I focused on qualitative research methods. I also began to pursue another area of interest I have had for many years—mental health and psychiatric nursing. I am currently completing the requirements for certification as a psychiatric nurse practitioner. I want combine my love of both these areas in practice, teaching, and future research. I am particularly interested in working with disadvantaged adolescent girls; and want to use women’s health care and mental health care to increase the opportunity for these girls to have a chance in life. 252