HIV/Sexually Transmitted Infection Risk Behaviors in Delinquent Youth With Psychiatric Disorders: A Longitudinal Study

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Abstract

Objectives

To examine the prevalence and persistence of 20 human immunodeficiency virus (HIV)/sexually transmitted infection (STI) sexual and drug use risk behaviors and to predict their occurrence in four mutually exclusive diagnostic groups of delinquent youths: major mental disorder (MMD), substance use disorder (SUD), comorbid MMD and SUD (MMD+SUD), and neither disorder.

Method

At the baseline interview, HIV/STI risk behaviors were assessed in 800 juvenile detainees, ages 10 to 18 years; youths were reinterviewed approximately 3 years later. The final sample (N = 689) includes 298 females and 391 males.

Results

The prevalence and persistence of HIV/STI risk behaviors were high in all of the diagnostic groups. Youths with an SUD at baseline were greater than 10 times more likely to be sexually active and to have vaginal sex at follow-up than youths with MMD+SUD (adjusted odds ratio [AOR] 10.86,95% confidence interval [CI] 1.43-82.32; AOR 11.63,95% CI 1.49-90.89, respectively) and four times more likely to be sexually active and to have vaginal sex than youths with neither disorder (AOR 4.20,95% CI 1.06-16.62; AOR 4.73,95% CI 1.21-18.50, respectively). Youths with an MMD at baseline were less likely to have engaged in unprotected vaginal and oral sex at follow-up compared with youths with neither disorder (AOR 0.11,95% CI 0.02-0.50; AOR 0.07,95% CI 0.01-0.34, respectively), and with youths with an SUD (AOR 0.10,95% CI 0.02-0.50; AOR 0.10,95% CI 0.02-0.47, respectively). Youths with MMD+SUD were less likely (AOR 0.28,95% CI 0.09-0.92) to engage in unprotected oral sex compared with those with neither disorder.

Conclusions

Irrespective of diagnostic group, delinquent youths are at great risk for HIV/STIs as they enter into adulthood. SUD increases risk. Because detained youths are released after approximately 2 weeks, their risk behaviors become a community health problem. Pediatricians and child and adolescent psychiatrists must collaborate with corrections professionals to develop HIV/STI interventions and ensure that programs started in detention centers continue after youths are released. J. Am. Acad. Child Adolesc. Psychiatry, 2008;47(8):901-911.

Section snippets

Sampling and Consent Procedures

Data are from the Northwestern Juvenile Project. 4, 10, 17 We recruited a stratified random sample of 1,829 youths who were arrested between November 20, 1995, and June 14, 1998, and detained at the Cook County Juvenile Temporary Detention Center (CCJTDC) in Chicago, IL, before the final disposition of their case. Consistent with juvenile detainees nationwide, nearly 90% of detainees at CCJTDC were male and most were racial/ethnic minorities. To ensure adequate representation of key subgroups,

Results

Prevalence of HIV/STI Risk Behaviors at Baseline and Follow-up

Table 1 compares differences in the prevalence of HIV/STI risk behaviors at baseline and at follow-up in the four diagnostic groups.

Overall, 70.3% (MMD) to 98.3% (SUD) of youths were sexually active at baseline, and 73.5% (MMD) to 98.6% (SUD) were sexually active at follow-up. Among youths with MMD, the prevalence of all risky behaviors was not significantly different from baseline to follow-up. Among youths with SUD, significantly

Discussion

Three years after their detention, delinquent youths, irrespective of diagnostic group, had high prevalence rates of many HIV/STI sexual risk behaviors. One fourth to one half of youths reported engaging in unprotected vaginal sex at baseline and follow-up interviews. At baseline, more than two fifths of the sample reported engaging in sex while drunk or high, and almost two thirds of the sample reported this behavior at the follow-up interview.

Our findings are difficult to compare with those

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    This work was supported by National Institute of Mental Health grants R01MH54197 and R01MH59463 (Division of Services & Intervention Research and Center for Mental Health Research on AIDS), the National Institute on Drug Abuse grants R01DA22953 and R01DA019380 (AIDS Research Program), and grants 1999-JE-FX-1001 and 2005-JL-FX-0288 from the Office of Juvenile Justice and Delinquency Prevention. Major funding was also provided by the Substance Abuse and Mental Health Services Administration (Center for Mental Health Services, Center for Substance Abuse Prevention, Center for Substance Abuse Treatment), the NIH Center on Minority Health and Health Disparities, the Centers for Disease Control and Prevention (National Center on Injury Prevention and Control and National Center for HIV, STD, and TB Prevention), the National Institute on Alcohol Abuse and Alcoholism, the NIH Office of Research on Women's Health, the NIH Office of Rare Diseases, Department of Labor, Department of Housing and Urban Development, the William T. Grant Foundation, and the Robert Wood Johnson Foundation. Additional funds were provided by The John D. and Catherine T. MacArthur Foundation, the Open Society Institute, and The Chicago Community Trust. Dr. Elkington was also supported by Center grant P30 MH43520 to the HIV Center for Clinical and Behavioral Studies (Anke A. Ehrhardt, Ph.D., Principal Investigator), from the National Institute of Mental Health, and National Research Service Award grant T32 MH19139, Behavioral Sciences Research in HIV Infection, Dr. Ehrhardt, Program Director. The authors thank all of the agencies for their collaborative spirit and steadfast support.

    This study could not have been accomplished without the advice of Mina Dulcan, M.D., Lynda Erinoff, Ph.D., Celia Fisher, Ph.D., Jacques Normand, Ph.D., Delores Parron, Ph.D., and David Stoff, Ph.D. The authors thank all of the project staff, especially their field interviewers and their data manager, Lynda Carey, M.A. They also greatly appreciate the cooperation of everyone working in the Cook County and State of Illinois systems. Finally, they thank the participants for their time and willingness to participate.

    This article is the subject of an editorial by Dr. Larry K. Brown in this issue.

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