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Sexual and Drug Use Behavior in Perinatally HIV− Infected Youth: Mental Health and Family Influences

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Abstract

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.

Method

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.

Section snippets

Participants and Procedures

Data for this article come from the baseline interview of Child and Adolescent Self-Awareness and Health Study. The participants were recruited from four medical centers in New York City (NYC) providing primary care to HIV− affected families. Inclusion criteria for study participation were as follows: youths aged 9 to 16 years with perinatal exposure to HIV, adequate caregiver and youth cognitive capacity to complete the interview, English or Spanish speaking, and caregiver with legal capacity

Demographic Characteristics and Differences by HIV Status

PHIV+ (n = 193) and PHIV− (n = 127) youths were comparable for all child demographics and the majority of caregiver variables. Each group had approximately 50% boys and girls and younger (9–12 years) and older (13–16) age groups (mean 12.15 years, SD 2.26 years). The majority of youths in both groups were African American (55%) and Latino (31%) with predominantly female caregivers (87% women) who received a high school education (mean 11th grade) and had a mean age of 48.33 years (SD 12.15).

Discussion

Given the epidemiology of HIV disease in U.S. women, the majority of PHIV+ and PHIV− youths live in the inner city, confronted by stress, poverty, and disrupted families, all of which have been associated with risk behavior in other populations.4 Our data suggest that PHIV+ and PHIV− youths are engaging in sexual behaviors and substance use, although prevalence rates may be slightly lower than other populations, with no differences between PHIV+ and PHIV− groups. Among the modest number of

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  • Cited by (0)

    This work was supported by three grants from the National Institute of Mental Health: R01-MH069133 (PI: Claude Mellins, Ph.D.), P30 MH43520 (Center PI: A.A. Ehrhardt, Ph.D.), and T32 MH19139 Behavioral Sciences Research in HIV Infection (PI: A.A. Ehrhardt, Ph.D.).

    This article is the subject of an editorial by Dr. Alan Flischer in this issue.

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