PEDIATRICS Vol. 95 No. 1 January 1995, pp. 96-104
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Comparison of HIV + and HIV - Adolescents: Risk Factors and Psychosocial Determinants

Karen Hein MD1, Ralph Dell MD2, Donna Futterman MD1, Mary Jane Rotheram-Borus PhD2, and Nathan Shaffer MD3

1 Adolescent AIDS Program, Bronx, New York
2 Columbia University College of Physicians and Surgeons, New York, New York
3 Centers for Disease Control and Prevention

According to the World Health Organization, half of the 14 million people with human immunodeficiency virus (HIV) worldwide were infected between the ages of 15 and 24 years. However, details about HIV-positive (HIV+) youths' risk-related behavior and social context have not been previously reported.

Objectives. To outline detailed sexual and drug use practices, social and psychological status of HIV + youth compared with a cohort of HIV-negative (HIV-) youth; and to examine the ability of the health belief and risk-taking models to predict sexual and drug use acts of HIV + youth.

Methods. HIV testing was conducted on and a 207-item structured interview covering HIV risk-related acts, protective factors and background information was administered to 72 HIV + and 1142 HIV - adolescents aged 13 through 21 years receiving care in an adolescent clinical care unit of a large medical center in New York City. Data were analyzed for adolescents reporting sexual intercourse (71 HIV + and 722 HIV-) by logistic regression analysis of five domains to identify variables significantly associated with HIV seropositivity.

Results. Logistic regressions indicated significant differences in sexual risk acts based on serostatus and gender. Anonymous, blinded seroprevalence testing identified 11% more HIV + adolescents than would have been identified by current counseling and testing practices. HIV + adolescents were significantly more likely to be sexually abused (33 vs 21%, P < .05), engage in anal sex and survival sex (32 vs 4%, P < .01), unprotected sex with casual partners (42 vs 23%, P < .05), have had sex under the influence of drugs (52 vs 27%, P < .01), have a sexually transmitted disease (59 vs 28%, P < .01), use multiple drugs (43 vs 9%, P < .01) and engage in multiple problem behaviors (72 vs 30%, P < .01) than HIV - young people. HIV + females reported more oral (69 vs 45%, P < .01) and/or anal (42 vs 12%, P < .01) intercourse compared to HIV - females. HIV + males reported significantly higher rates of both insertive (82 vs 46%, P < .05) and receptive (51 vs 4%, P < .01) oral and anal (53 vs 13%, P < .01) intercourse than HIV - males. Protective factors were not significantly different for HIV + and HIV - young people.

Conclusions. Routine, confidential HIV counseling and testing should be considered for adolescents having unprotected sexual intercourse when age-specific services are available for HIV + youth. Prevention programs should consider adolescents' history of abuse, homelessness and other social as well as psychological dimensions in designing comprehensive care strategies to address HIV+ adolescents' multiple problem behaviors and living situations. Current theoretical models of health behaviors should be reconsidered, given the lack of their association to HIV risk acts of HIV + youth. Age-specific services and interventions for HIV + youth are urgently needed as HIV is spreading among youth worldwide.

Submitted on December 16, 1993
Accepted on April 13, 1994




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