HIV-positive adolescents have 'strong' prevention needs

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Almost 50% of sexually experienced HIV-positive adolescents surveyed in the United States had had unprotected sex since learning of their diagnosis, investigators report in an advance online publication in the Journal of Acquired Immune Deficiency Syndromes.

Many of the girls had been pregnant, and few disclosed their HIV status to their sex partners.

The study included 13 to 21 year olds who had been infected with HIV at birth, or who had acquired HIV through sex.

Glossary

disclosure

In HIV, refers to the act of telling another person that you have HIV. Many people find this term stigmatising as it suggests information which is normally kept secret. The terms ‘telling’ or ‘sharing’ are more neutral.

adjusted odds ratio (AOR)

Comparing one group with another, expresses differences in the odds of something happening. An odds ratio above 1 means something is more likely to happen in the group of interest; an odds ratio below 1 means it is less likely to happen. Similar to ‘relative risk’. 

oral

Refers to the mouth, for example a medicine taken by mouth.

odds ratio (OR)

Comparing one group with another, expresses differences in the odds of something happening. An odds ratio above 1 means something is more likely to happen in the group of interest; an odds ratio below 1 means it is less likely to happen. Similar to ‘relative risk’. 

sample

Studies aim to give information that will be applicable to a large group of people (e.g. adults with diagnosed HIV in the UK). Because it is impractical to conduct a study with such a large group, only a sub-group (a sample) takes part in a study. This isn’t a problem as long as the characteristics of the sample are similar to those of the wider group (e.g. in terms of age, gender, CD4 count and years since diagnosis).

“These 2 groups have a common need for prevention services, including assistance with serostatus disclosure and condom negotiation skills”, comment the investigators.

A total of 166 HIV-positive adolescents were recruited to the study in New York City, Baltimore, and Washington DC between 2002 and 2005. They completed questionnaires asking about their lifetime and recent sexual experience. Information was also sought on their use of condoms and other barrier methods of protection for anal, oral and vaginal sex. The individuals were also asked to provide demographic information, to define their sexual orientation, state if they used drugs and alcohol, had ever bartered sex, or had been sexually abused as a child.

Most (73%) were black, 53% were female, and 60% had been infected with HIV at birth. Overall a third of the sample (and 57% of those who were infected with HIV through sex) defined their sexual orientation as gay, bisexual or other.

In all 113 individuals reported ever having sex. Detailed information on sexual behaviour was provided by 105 adolescents. Of these, 49 (47%) said that they had had unprotected sex since their diagnosis.

Most (72%) of those 105 individuals stated that they were currently sexually active.

Information on current condom use was provided by 65 individuals, and 41 (63%) stated that they had recently had unprotected sex.

Disclosure of HIV status was rare, and the youths had not informed 80% of their sex partners of their HIV status.

The investigators then looked at these results in more detail.

 A total of 45 adolescent who had been HIV-positive since birth provided had ever had sex, and they had had a median of three partners. The age of sexual debut was 13 for boys and 14 for girls. Eight of the 45 reported that they had never used condoms, and eight said that they had been sexually abused. Of the 24 sexually active girls, five reported having been pregnant. None of these pregnancies were full term.

Recent sexual activity was reported by 23 of those who had been HIV-positive since birth. Ten episodes of unprotected anal, oral or vaginal sex were reported. All the partners were HIV-negative or of unknown status.

Of the adolescents who had been infected with HIV through sex,  65 reported recent sexual activity. The mean age of sexual debut was 13 for boys and 14 for girls. Almost half reported experiencing sexual abuse. The median number of lifetime sex partners was 15.

Fifty-three of these youths reported sex within the last three month, and 33 said that they had had unprotected sex in their time period.

The investigators calculated that a total of 24 sex partners of these youths had been exposed to HIV via unprotected anal or vaginal sex.

For both those infected with HIV at birth and behaviourly, recent unprotected sex was significantly associated with sexual abuse in childhood (adjusted odds ratio [AOR], 9.61; 95% CI, 1.07-86.12, p = 0.04) and a better knowledge of HIV (AOR, 1.29; 95% CI, 1.00-1.66, p = 0.048).

Any sexual activity was associated with drug use (p = 0.02), alcohol consumption (p = 0.004), and a CD4 cell count between 200-300 cells/mm3.

“Nearly half of the sexually experienced adolescents had engaged in unprotected sex since learning that they had HIV”, write the investigators. They add, “over half of their recent sex partners had been exposed to HIV through unprotected sex…moreover, few recent sex partners had been told that their partners were HIV-positive.”

The investigators conclude that HIV-positive adolescents have a “strong” need for targeted HIV prevention, and believe that their findings “can be used in planning effective interventions needed for this young population of HIV patients.”

References

Koenig LJ et al. Sexual transmission risk behavior of adolescents with HIV acquired perinatally or through risk behaviors. J Acquir Immune defic Syndr, online edition, 2010 (for link to abstract and text click here).