COMPARISON OF HIV- ADOLESCENTS - RISK-FACTORS AND PSYCHOSOCIAL DETERMINANTS( AND HIV)

According to the World Health Organization, half of the 14 million peo ple with human immunodeficiency virus (HIV) worldwide were infected be tween 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 dru g use acts of HIV+ youth. Methods. HIV testing was conducted on and a 207-item structured interview covering HIV risk-related acts, protecti ve factors and background information was administered to 72 HIV+ and 1142 HIV- adolescents aged 13 through 21 years receiving care in an ad olescent 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. R esults. Logistic regressions indicated significant differences in sexu al risk acts based on serostatus and gender. Anonymous, blinded seropr evalence testing identified 11% more HIV+ adolescents than would have been identified by current counseling and testing practices. HIV+ adol escents 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 se x under the influence of drugs (52 vs 27%, P < .01), have a sexually t ransmitted 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 inser tive (82 vs 46%, P < .05) and receptive (51 vs 4%, P < .01) oral and a nal (53 vs 13%, P < .01) intercourse than HIV- males. Protective facto rs were not significantly different for HIV+ and HIV- young people. Co nclusions. 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 program s should consider 'adolescents' history of abuse, homelessness, and ot her social as well as psychological dimensions in designing comprehens ive care strategies to address HIV+ adolescents' multiple problem beha viors and living situations. Current theoretical models of health beha viors should be reconsidered, given the lack of their association to H IV risk acts of HIV+ youth. Age-specific services and interventions fo r HIV+ youth are urgently needed as HIV is spreading among youth world wide.