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CONTEXT: Both perinatally and behaviorally infected HIV-positive youth engage in sexually risky behaviors, and a better understanding of the perceptions of these youth and of health care providers regarding disclosure of HIV status and risk reduction would aid in the development of behavioral interventions for such youth.

METHODS: In spring 2007, some 20 HIV-positive inner-city youth (aged 13–24) and 15 health care providers who work with HIV-infected youth participated in in-depth, semistructured interviews. Youth were recruited at an HIV clinic, AIDS clinics and an AIDS service organization, and had received care from participating providers. Detailed contextual and thematic discourse analysis was performed on interview transcriptions.

RESULTS: Eighteen of the 20 youth had disclosed their HIV status to another individual at least once. Eleven reported being sexually active, and three of these had been perinatally infected. Qualitative analysis revealed four subthemes related to disclosure: stigma and emotions, trust issues, reasons for disclosing and strategies for addressing disclosure. Five subthemes were identified related to sexual risk reduction: dating challenges, attitudes toward condom use, self-efficacy for condom use negotiation, pregnancy attitudes and sexual risk reduction strategies. Providers reported that access to more engaging and interactive educational tools within the clinic setting could enhance their risk reduction counseling with HIV-positive youth.

CONCLUSIONS: HIV-positive youth experience multiple challenges regarding disclosure and sexual risk reduction, and health care providers need innovative tools that can be used in clinic settings to improve adolescents' skills in reducing risky sexual behavior.