title: No change in health risk behaviors over time among HIV infected adolescents in care: role of psychological distress.
abstract: OBJECTIVE
  To investigate the association of psychological distress and health risk behaviors among HIV infected adolescents. It was hypothesized that higher levels of distress would be associated with increased sexual risk behaviors, and increased use of alcohol and drugs.
  
  
  METHODS
  HIV infected adolescents (N = 323) were recruited into an observational study in 15 clinical sites; for the 323 subjects, a total of 1212 visits were used in a repeated measures analysis. Data on depression (using the CES-D), anxiety (manifest anxiety scale), sexual behaviors and alcohol and marijuana use were obtained through computer-assisted self-administered interview.
  
  
  RESULTS
  Approximately 65% of the sample was sexually active across all six study visits, with approximately 43% consistently reporting having unprotected sex at last intercourse. Higher levels of depression were associated with frequent alcohol use and with unprotected sex at last intercourse, with depressed adolescents significantly more likely to have had unprotected sex than those who were not depressed. Health anxiety was associated with frequent marijuana use and with recent sexual activity, and physiological anxiety was also associated with recent sexual activity.
  
  
  CONCLUSIONS
  Despite the fact that these HIV infected adolescents are all engaged in primary care, overall the sample is maintaining its high-risk sexual behavior. In addition, these adolescents may be self-medicating to deal with health-related anxiety. Health interventions for HIV infected adolescents should examine whether psychological distress is contributing to maintenance health risk behaviors.
authors.affiliation: Health Risk Reduction Projects, Integrated Substance Abuse Program, Department of Psychiatry, University of California, Los Angeles, California 90025-7510, USA. dmurphy@mednet.ucla.edu
authors.forename: D A
authors.initials: DA
authors.lastname: Murphy
authors.forename: S J
authors.initials: SJ
authors.lastname: Durako
authors.forename: A B
authors.initials: AB
authors.lastname: Moscicki
authors.forename: S H
authors.initials: SH
authors.lastname: Vermund
authors.forename: Y
authors.initials: Y
authors.lastname: Ma
authors.forename: D F
authors.initials: DF
authors.lastname: Schwarz
authors.forename: L R
authors.initials: LR
authors.lastname: Muenz
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000294:Adolescent Behavior; D016497:Adolescent Health Services / Q000706:statistics & numerical data*; D000428:Alcohol Drinking; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D015438:Health Behavior; D006801:Humans; D008297:Male; D011320:Primary Health Care; D012309:Risk-Taking; D012725:Sexual Behavior; D013315:Stress, Psychological; D019966:Substance-Related Disorders