Abstract
In a sample of perinatally HIV-infected (PHIV+) and perinatally HIV-exposed, uninfected (PHEU) adolescents, we examined the co-occurrence of behavioral health risks including mental health problems, onset of sexual and drug use behaviors, and (in PHIV+ youth) nonadherence to antiretroviral therapy (ART). Participants, recruited from 2007 to 2010, included 349 youth, ages 10-16 years, enrolled in a cohort study examining the impact of HIV infection and ART. Measures of the above behavioral health risks were administered to participants and primary caregivers. Nearly half the participants met study criteria for at least one behavioral health risk, most frequently, mental health problems (28%), with the onset of sexual activity and substance use each reported by an average of 16%. Among the sexually active, 65% of PHIV+ and 50% of PHEU youth reported unprotected sex. For PHIV +youth, 34% reported recent ART nonadherence, of whom 45% had detectable HIV RNA levels. Between 16% (PHIV+) and 11% (PHEU) of youth reported at least two behavioral health risks. Older age, but not HIV status, was associated with having two or more behavioral health risks versus none. Among PHIV+ youth, living with a birth mother (versus other caregivers) and detectable viral load were associated with co-occurrence of behavioral health risks. In conclusion, this study suggests that for both PHIV+ and PHEU youth, there are multiple behavioral health risks, particularly mental health problems, which should be targeted by service systems that can integrate prevention and treatment efforts.
Highlights
With the advent of highly active antiretroviral treatment (HAART), children with perinatally acquired HIV infection in the United States are reaching adolescence in large numbers.[1]
In a sample of perinatally HIV-exposed adolescents, including PHIV + and perinatally HIV-exposed but uninfected (PHEU) youth, participating in one of the largest United States-based studies of this population, this set of analyses examines the prevalence and co-occurrence of four behavioral health risks, mental health problems, onset of sexual activity, substance use, and in PHIV + adolescents only, ART nonadherence. We hypothesized that both PHIV + and PHEU youth are at high risk for the co-occurrence of mental health and substance use problems, as well as the onset of sex activity given shared vulnerable environments.We hypothesized that PHIV + youth would present with higher rates of co-occurring behavioral health risks than PHEU youth given the additional burden of perinatal HIV infection
In comparisons of youth with and without audio-computer assisted self-interview (ACASI) data, those younger than 13 years were less likely to have completed ACASIs than were youth 13 years or older (PHIV + : < 13 years, 69% completed versus ‡ 13 years, 81% completed, p < 0.01; PHEU: 87% versus 98%, p = 0.05), as were non-Hispanic youth compared to Hispanic youth (PHIV + : 73% versus 85%, p = 0.03; PHEU: 76% versus 91%, p < 0.001)
Summary
With the advent of highly active antiretroviral treatment (HAART), children with perinatally acquired HIV infection in the United States are reaching adolescence in large numbers.[1]. In a sample of perinatally HIV-exposed adolescents, including PHIV + and PHEU youth, participating in one of the largest United States-based studies of this population, this set of analyses examines the prevalence and co-occurrence of four behavioral health risks, mental health problems, onset of sexual activity, substance use, and in PHIV + adolescents only, ART nonadherence We hypothesized that both PHIV + and PHEU youth are at high risk for the co-occurrence of mental health and substance use problems, as well as the onset of sex activity given shared vulnerable environments (both groups recruited from the same clinical settings in similar sociodemographic communities).We hypothesized that PHIV + youth would present with higher rates of co-occurring behavioral health risks than PHEU youth given the additional burden of perinatal HIV infection. Note that the onset of sex by itself may not be a behavioral problem, a large number of studies have found that early onset of sex is associated with high rates of risky sex in youth, such as having multiple partners and failure to use condoms.[17,19] For youth living with HIV infection, this is a significant behavioral health risk for themselves and others and onset of sex is considered a behavioral health risk in this study in order to fully understand the secondary HIV prevention and intervention needs of this population
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