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Many adolescents with perinatal HIV infection engage in unprotected sex
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Numerous young patients who have perinatal HIV infection engage in risky sexual behaviors when they become sexually active, according to recent data from the Pediatric HIV/AIDS Cohort Study.
Of the 377 patients in the study, 330 completed at least one interview. Sexual intercourse was reported by 28% of the patients, and the proportion increased with age: 53% of 16-year-olds and 67% of 18-year-olds reported sexual intercourse.
“Perinatally HIV-infected youth are like other adolescents across the country — some are becoming sexually active, and they’re practicing similar behaviors, including unprotected sex,” Katherine Tassiopoulos, DSc, MPH, a research scientist at the Harvard School of Public Health Department of Epidemiology, told Infectious Disease News. “Their HIV infection adds another level of complexity to this time in their lives and has implications for both their own health and that of their sexual partners.”
Katherine Tassiopoulos
Tassiopoulos and colleagues conducted cross-sectional and longitudinal analyses that included patients aged 7 to 16 years with perinatal HIV infection. They had follow-up visits every 6 months and then yearly, in which they had clinical exams and completed audio computer-assisted self-interviews about sex and substance abuse behaviors.
At baseline, 269 patients reported no history of sexual intercourse. Of these, 160 completed a second interview: 19% reported initiating sexual intercourse. Nonadherance to ART at baseline was associated with initiating sexual intercourse.
Of the 92 patients who reported sexual intercourse, 62% reported having unprotected intercourse. In addition, 42% reported having anal intercourse; of those, 64% reported having unprotected anal intercourse. Patients who lived with a relative other than their biological mother had increased odds of unprotected intercourse.
Of 92 sexually active patients, 39 had HIV RNA measurements of 5,000 copies/mL or more after initiating sexual intercourse. Thirty of these had mutations conferring resistance to treatment. Among those who knew of their infection, 33% told their partner about the infection.
Tassiopoulos said there are implications for researchers and clinicians. Researchers may want to consider interventions that take advantage of adolescents’ growing desire for independent decision making and autonomy to frame medication adherence, disclosure to sexual partners and condom use as behaviors that protect their health and that of their partners. Clinicians can help their patients make choices that reduce risks to themselves and their partners by ensuring that the published guidelines for disclosure to children and adolescents are followed.
“As this group of perinatally infected youth ages into young adulthood, we will need to continue to examine behaviors and outcomes that are relevant for young adults,” Tassiopoulos said. “Evaluating outcomes of innovative health education initiatives aimed at perinatally infected youth will also be critical in establishing best practices for perinatally infected youth around the world.”
Disclosure: Tassiopoulos reports no relevant financial disclosures.
Perspective
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Allison Ross Eckard
Tassiopoulos, et al investigate sexual behavior among perinatally-infected youth in the US. Their study is a part of the Pediatric HIV/AIDS Cohort Study (PHACS), a cohort study which prospectively follows a group of HIV-infected patients who acquired HIV at birth. Many of these participants are now teenagers or in their early to mid-twenties. They represent a very distinctive group of HIV-infected patients in this country, as they have many unique social and behavioral issues that many other HIV-infected individuals do not have. For example, many of these patients were raised by relatives or foster families since their parents died of AIDS early in the AIDS epidemic when the children were still young. In addition, many have had years of uncontrolled HIV due to medication non-adherence, secondary to social and/or behavioral issues.
In this current study, the investigators looked at factors associated with initiation of sexual activity, as well as patterns and circumstances surrounding their sexual behavior. They found that 28% of participants reported sexual intercourse, some as young as 12 years old at sexual initiation. Strikingly, two-thirds reported a history of unprotected sex and one-third did not disclose their status to their first sexual partner. Many of these patients were not virologically-suppressed and had virus that was resistance to multiple classes of antiretrovirals.
These data, while striking, are actually very consistent with what many of us see in our pediatric and young adult HIV clinics, and underscore the serious problem we have in this country. The cavalier sexual attitude among the perinatally-infected individuals continue to fuel our HIV/AIDS epidemic, both by infecting their partners but also by infecting their babies who result from unplanned pregnancies. Many people do not appreciate the extent and seriousness of this problem, particularly in the south where epidemiologically, most of the new HIV infections among this age group occur. Interventions, such as intensive education programs and/or accountability for non-disclosure, are desperately needed to remedy this situation.
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