title: Unprotected sex among youth living with HIV before and after the advent of highly active antiretroviral therapy.
abstract: BACKGROUND
  Since the advent of highly active antiretroviral therapy (HAART) in 1996, the incidence of HIV-especially among young men who have sex with men-and the prevalence of unprotected sex among HIV-positive persons have increased. The characteristics associated with unprotected sex among youth living with HIV since the advent of HAART have not been explored.
  
  
  METHODS
  Samples of HIV-positive youth aged 13-24 were taken from two intervention studies that targeted the sexual behaviors of HIV-positive youth-one from 1994 to 1996 (pre-HAART) and the other from 1999 to 2000 (post-HAART). Generalized estimating equations were used to identify characteristics associated with unprotected sex in each sample.
  
  
  RESULTS
  The prevalence of unprotected sex in the post-HAART sample was more than twice that in the pre-HAART sample (62% vs. 25%). Among the pre-HAART sample, being a man who has sex with men and having sex with a casual partner were negatively associated with the odds of unprotected intercourse (odds ratios, 0.5 and 0.2, respectively). Among the post-HAART sample, unprotected sex was negatively associated with knowing that a partner was HIV-negative (0.2) and positively associated with poorer mental health (1.02). In analyses among the post-HAART sample, poorer mental health was associated with increased odds of unprotected sex among youth living with HIV who were not receiving the treatment (1.02).
  
  
  CONCLUSIONS
  Interventions for HIV-positive youth must be designed to address the complex needs of those youth who simultaneously suffer from HIV and poor mental health.
authors.affiliation: Center for Community Health, University of California, Los Angeles, CA, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Rice
authors.forename: Philip
authors.initials: P
authors.lastname: Batterham
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Rotheram-Borus
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control / Q000523:psychology*; D006679:HIV Seropositivity / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D016017:Odds Ratio; D012307:Risk Factors; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D014342:Truth Disclosure; D047568:Unsafe Sex / Q000523:psychology / Q000706:statistics & numerical data*