Sexual and drug use behavior in perinatally HIV-infected youth: mental health and family influences.
OBJECTIVE
As perinatally human immunodeficiency virus (HIV)-infected (PHIV+) youths enter adolescence, they are at high risk for poor behavioral and health outcomes. This study examines relations between youth mental health problems and sexual and substance use risk behavior, the impact of caregiver mental health and family functioning on youth mental health and risk behavior outcomes, and the role of youth HIV status in this process.


METHODS
Participants were recruited from four medical centers. Individual interviews were administered to 193 PHIV+ and 127 perinatally HIV exposed but uninfected (PHIV-) 9- to 16-year-old boys and girls and their primary caregivers. Participants were primarily African American and Latino. The interview assessed child sexual and drug risk behavior, child and caregiver mental health, and family functioning.


RESULTS
Exploratory latent-variable structural equation modeling revealed no differences in rates of sexual risk behavior or substance use between PHIV+ and PHIV- youths. However, adolescent mental health was significantly associated with sexual risk behavior and substance use. Caregiver mental health was associated with youth mental health and indirectly with sexual risk behavior and drug use through its impact on youth mental health. Family functioning did not significantly predict youth outcomes.


CONCLUSIONS
Over and above other key environmental factors and family functioning, youth and caregiver mental health problems are related to sex and drug use risk behaviors in PHIV+ and PHIV- youths. Given high rates of youth and caregiver mental health problems in this population, family-based mental health interventions may be a key component of HIV prevention programs for perinatally HIV-exposed youth.
Mellins
Claude A
CA
Drs. Mellins, Elkington, Brackis-Cott, and Dolezal are with the HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute. Dr. Bauermeister is with the Department of Health Behavior and Health Education, University of Michigan. Dr. McKay is with the Mount Sinai School of Medicine. Dr. Wiznia is with the Jacobi Medical Center, Albert Einstein College of Medicine. Dr. Bamji is with the NY Medical College, and Dr. Abrams is with the Harlem Hospital and Columbia University. Electronic address: cam14@columbia.edu.
Elkington
Katherine S
KS
Drs. Mellins, Elkington, Brackis-Cott, and Dolezal are with the HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute. Dr. Bauermeister is with the Department of Health Behavior and Health Education, University of Michigan. Dr. McKay is with the Mount Sinai School of Medicine. Dr. Wiznia is with the Jacobi Medical Center, Albert Einstein College of Medicine. Dr. Bamji is with the NY Medical College, and Dr. Abrams is with the Harlem Hospital and Columbia University.
Bauermeister
Jose A
JA
Drs. Mellins, Elkington, Brackis-Cott, and Dolezal are with the HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute. Dr. Bauermeister is with the Department of Health Behavior and Health Education, University of Michigan. Dr. McKay is with the Mount Sinai School of Medicine. Dr. Wiznia is with the Jacobi Medical Center, Albert Einstein College of Medicine. Dr. Bamji is with the NY Medical College, and Dr. Abrams is with the Harlem Hospital and Columbia University.
Brackis-Cott
Elizabeth
E
Drs. Mellins, Elkington, Brackis-Cott, and Dolezal are with the HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute. Dr. Bauermeister is with the Department of Health Behavior and Health Education, University of Michigan. Dr. McKay is with the Mount Sinai School of Medicine. Dr. Wiznia is with the Jacobi Medical Center, Albert Einstein College of Medicine. Dr. Bamji is with the NY Medical College, and Dr. Abrams is with the Harlem Hospital and Columbia University.
Dolezal
Curtis
C
Drs. Mellins, Elkington, Brackis-Cott, and Dolezal are with the HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute. Dr. Bauermeister is with the Department of Health Behavior and Health Education, University of Michigan. Dr. McKay is with the Mount Sinai School of Medicine. Dr. Wiznia is with the Jacobi Medical Center, Albert Einstein College of Medicine. Dr. Bamji is with the NY Medical College, and Dr. Abrams is with the Harlem Hospital and Columbia University.
McKay
Mary
M
Drs. Mellins, Elkington, Brackis-Cott, and Dolezal are with the HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute. Dr. Bauermeister is with the Department of Health Behavior and Health Education, University of Michigan. Dr. McKay is with the Mount Sinai School of Medicine. Dr. Wiznia is with the Jacobi Medical Center, Albert Einstein College of Medicine. Dr. Bamji is with the NY Medical College, and Dr. Abrams is with the Harlem Hospital and Columbia University.
Wiznia
Andrew
A
Drs. Mellins, Elkington, Brackis-Cott, and Dolezal are with the HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute. Dr. Bauermeister is with the Department of Health Behavior and Health Education, University of Michigan. Dr. McKay is with the Mount Sinai School of Medicine. Dr. Wiznia is with the Jacobi Medical Center, Albert Einstein College of Medicine. Dr. Bamji is with the NY Medical College, and Dr. Abrams is with the Harlem Hospital and Columbia University.
Bamji
Mahrukh
M
Drs. Mellins, Elkington, Brackis-Cott, and Dolezal are with the HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute. Dr. Bauermeister is with the Department of Health Behavior and Health Education, University of Michigan. Dr. McKay is with the Mount Sinai School of Medicine. Dr. Wiznia is with the Jacobi Medical Center, Albert Einstein College of Medicine. Dr. Bamji is with the NY Medical College, and Dr. Abrams is with the Harlem Hospital and Columbia University.
Abrams
Elaine J
EJ
Drs. Mellins, Elkington, Brackis-Cott, and Dolezal are with the HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute. Dr. Bauermeister is with the Department of Health Behavior and Health Education, University of Michigan. Dr. McKay is with the Mount Sinai School of Medicine. Dr. Wiznia is with the Jacobi Medical Center, Albert Einstein College of Medicine. Dr. Bamji is with the NY Medical College, and Dr. Abrams is with the Harlem Hospital and Columbia University.
D000293:Adolescent; D002648:Child; D005190:Family / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy; D008605:Mental Health Services / Q000706:statistics & numerical data; D012309:Risk-Taking; D012725:Sexual Behavior; D019966:Substance-Related Disorders / Q000453:epidemiology*