Unsafe sexual behaviors, such as having unprotected sex or multiple sex partners, greatly increase the risk of contracting a sexually transmitted infection (STI), such as HIV—the virus that causes AIDS.

Depression, says Bridgette M. Brawner, an assistant professor in the School of Nursing, has a unique influence on the sexual risk behaviors of adolescent African-American girls when compared to other mental health diagnoses. She says some teenage African-American girls who suffer from depression have a higher number of sexual partners, begin having sex at a younger age, and are less likely to use condoms, all practices that could put them at risk for STIs.

For the past decade, Brawner has been working in HIV prevention with a focus on adolescents who are dealing with mental illnesses. Her “Project GOLD: We are Kings and Queens” program provides HIV/STI prevention and safe sex training to 14- to 17-year-old black youth who are seeking outpatient mental health treatment.

Funded by a nearly $1 million grant from the Centers for Disease Control and Prevention, Project GOLD is a two-day intervention program that gives youth comprehensive information about HIV and other STIs, dispersed from a culturally, developmentally, and psychologically relevant perspective. Penn Nursing’s Loretta Sweet Jemmott and Emory University's Gina Wingood, two of the country’s leading scholars on HIV/AIDS prevention among African American adolescents, are the project’s co-investigators

“What we’ve done really uniquely in this intervention is tailor the best of worlds for what we know works in HIV prevention science with what we know works in mental health treatment,” Brawner says.

Each of the two days lasts for four hours, which are broken down into shorter segments of activities. The teenagers begin by getting to know one another, and discuss gender and cultural pride before delving into the particulars of HIV and other STIs. Brawner says facts are presented in an engaging, inclusive mode, such as through group projects, song and dance, games, and role-playing.

Participants are recruited into Project GOLD through a partnership with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, the School District of Philadelphia, and via community outreach and social media efforts. The majority of teenagers enrolled have been diagnosed with depression, ADHD, or generalized anxiety disorder.

To keep the study as methodologically sound as possible, Brawner says the Project GOLD staff is conducting structured diagnostic interviews, taking participants through a standardized psychiatric assessment in order to get a clear sense of their condition. The program also offers free testing for HIV, chlamydia, and gonorrhea.

Brawner says Philadelphia, like many other urban environments, exposes the city’s youth to a variety of stressors, such as dysfunction at home, violence in their communities, or the lack of resources in the school system.

“From the community advocate side of me, I don’t think we provide them with enough opportunities to buffer some of the stress that they’re under,” she says.

In her interviews with some of the adolescent girls, Brawner says those who were dealing with loneliness, abandonment, or rejection often use sexual intimacy as a way of connecting with someone else.

“If they are using sex as a means of either stress relief or to try to deal with the negative emotions that they’re feeling, they might be more inclined to do something that could bear a greater risk for HIV/STIs because the object is just to feel better,” she says.

The media, Brawner says, has a major influence on how the teenagers perceive themselves, what they think is supposed to happen in a relationship, and their thoughts about different sexual practices.

“Developmentally, they’re coming into their own and they’re starting to do more independently, but at the same time, what they see matters and what they’re exposed to matters,” she says.

Brawner says one of her favorite parts of the intervention is when the teenagers have to act out the roles of partners in a relationship. She says the role-playing enables the participants to try out a newly learned skill in preparation for a real-world setting, and receive feedback and suggestions.

“When you come into the real-world setting, all of that will be in the back of your mind and maybe you will be better able to insist that your partner use a condom,” she says.

Thus far, more than 100 youth have gone through the Project GOLD program, which is in its final grant year.

Teenagers who participate in the project are followed for three, six, and 12 months, and receive HIV/STI testing at each subsequent visit.

For more information about Project GOLD, the research team can be reached by email at madeawarewithcare@gmail.com or by phone at 215-746-6080.