Original article
Multiple Risk Behaviors Among Youth Living with Human Immunodeficiency Virus in Five U.S. Cities

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Abstract

Purpose

To describe multiple risk behaviors (substance use, sexual risk, and medication adherence) in a multi-site sample of youth living with human immunodeficiency virus (HIV) in five U.S. cites.

Methods

Youth (N = 352) were recruited from four Adolescent Trials Network (ATN) sites (Philadelphia, Fort Lauderdale, Baltimore, and Los Angeles) and one non-ATN site in Detroit and screened for multiple problem behaviors for an intervention study. A substance abuse problem was determined with the CRAFFT, a six-item adolescent screener. Single items were used to screen for current sexual risk and for an HIV medication adherence problem. Of the youth, 239 (68%) had at least one of the three risk behavior problems based on the screener. A total of 186 (52.8%) completed longer, in-depth questionnaires for each problem behavior.

Results

Of the 352 youth screened, 60% had problem level substance use and 42% had a sexual risk problem. Of the 165 (47%) who were prescribed medications, 91 (55%) reported an adherence problem. A total of 112 (32%) reported no problem behavior, 123 (35%) reported 1 problem behavior, 95 (27%) reported 2 problem behaviors, and 20 (6%) reported 3 problem behaviors. Males were more likely to have a substance use problem. Younger youth living with HIV and those perinatally infected were more likely to have an adherence problem. Among the 186 (52.8%) completing longer measures, those with a substance abuse problem had higher substance use on a timeline follow-back procedure than those without. Participants who screened positive for a sexual risk problem reported more unprotected sex on an in-depth interview than those without. Those who screened positive for an adherence problem had higher viral loads than those without an adherence problem.

Conclusions

Results suggest high rates of problem behaviors among youth living with HIV, particularly in older youth. Younger and perinatally infected youth may require specialized adherence interventions. Associations between the screener and more in-depth assessment measures suggest potential clinical utility of screening youth for high-risk behaviors.

Section snippets

Methods

The study uses screening and baseline data from a multi-site randomized clinical trial examining the efficacy of a motivational intervention in reducing risk. Youth were recruited from four Adolescent Trials Network (ATN) sites located in Fort Lauderdale, Philadelphia, Baltimore, and Los Angeles, and one non-ATN site located in Detroit. All five adolescent medicine clinics offered multidisciplinary care including social work, case management, and access to mental health services. Youth with an

Demographic characteristic and descriptive statistics for full sample

Demographics for the full sample can be seen in Table 1. Of the 352 youth screened, 204 (58%) were male and 148 (42%) were female. The mean age was 20.36 (SD = 2.46). Sixty respondents (17%) reported they were born with HIV, whereas 281 (80%) reported behaviorally contracting HIV (11 participants were missing this data). Of the youth, 275 had complete data on substance use and, of those, 165 (60%) reported problem level substance use. A total of 283 youth had complete data on condom use, and of

Discussion

The Centers for Disease Control and Prevention reported in 2007 that nearly 40% of the persons living with HIV/AIDS, as of the 2005 national statistics, were older youth or young adults between the ages of 20 and 29 years. The Office of National AIDS Policy estimated in 2000 that half of new HIV infections occur in youth under the age of 25. The results of this study provide important information about problem behaviors in this population. The screener indicated that more than half of the youth

Acknowledgments

The Adolescent Trials Network for HIV/AIDS Interventions (ATN) supported this work [U01-HD040533 and U01-HD040474 from the National Institutes of Health through the National Institute of Child Health and Human Development (B. Kapogiannis, S. Lee)], with supplemental funding from the National Institutes on Drug Abuse (N. Borek) and Mental Health (P. Brouwers, S. Allison). The study was scientifically reviewed by the ATN's Behavioral Leadership Group. Network, scientific and logistical support

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