Unprotected sex among youth living with HIV before and after the advent of highly active antiretroviral therapy.
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.
Rice
Eric
E
Center for Community Health, University of California, Los Angeles, CA, USA.
Batterham
Philip
P
Rotheram-Borus
Mary Jane
MJ
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*