Our data suggest that efforts to improve children's adherence to complex antiretroviral regimens requires addressing developmental, psychosocial and family factors.

Background The purpose of this study was to examine 1) the prevalence of psychiatric and substance use disorders in perinatally HIV-infected (HIV+) adolescents and 2) the association between HIV infection and these mental health outcomes by comparing HIV+ youths to HIV exposed but uninfected youths (HIV-) from similar communities. Methods Data for this paper come from the baseline interview of a longitudinal study of mental health outcomes in 9-16 year old perinatally HIV-exposed youths (61% HIV+) and their caregivers. Three hundred forty youths and their primary adult caregivers were recruited from four medical centers and participated in separate individual interviews. Youth psychiatric disorder was assessed using the caregiver and youth versions of The Diagnostic Interview Schedule for Children (DISC-IV). Results According to caregiver or youth report, a high percentage of HIV+ and HIV- youths met criteria for a non-substance use psychiatric disorder, with significantly higher rates among the HIV+ youths (61% vs 49%, OR=1.59; CI=1.03,2.47; p < .05). The most prevalent diagnoses in both groups were anxiety disorders (46% for total sample) which included social phobia, separation anxiety, agoraphobia, generalized anxiety disorder, panic disorder, obsessive- compulsive disorder, and specific phobias. One quarter of the sample met criteria for a behavioral disorder (ADHD, conduct disorders, and oppositional defiant disorders), with ADHD being most prevalent. HIV+ youths had significantly higher rates of ADHD (OR=2.45; CI=1.20, 4.99, p < .05). Only 7% of youths met criteria for a mood disorder and 4% for a substance abuse disorder. Several caregiver variables (caregiver type and HIV status) were also associated with both child HIV status and mental health outcomes. Conclusions Our data suggest that HIV+ youths are at high risk for mental health disorders. Further longitudinal research is necessary to understand the etiology, as well as potential protective factors, in order to inform efficacy-based interventions.

Increasing numbers of perinatally HIV-infected children are surviving into their teens and beyond. Research and clinical reports suggest that many HIV-infected children, particularly those younger than 13 years, do not know they are HIV infected owing to parental concerns about the impact on their mental health. This study examines patterns of HIV status disclosure to 77 perinatally HIV-infected ethnic minority children (aged 3-13 years), and explores the association between knowledge of HIV status and emotional and behavioral outcomes. The majority of children in this study (70%) did not know their HIV status. On average, children who knew their HIV status were older and tended to have lower CD4%. Child knowledge of HIV status was not associated with gender, ethnicity, caregiver education, parent-child relationship factors, type of placement (biological vs adoptive), or other health status indicators. As hypothesized, HIV status disclosure to infected children did not result in increased mental health problems. There was a statistical trend for children who knew their HIV status to be less depressed than children who did not know. Also, greater social disclosure (e.g. communication of child's status to family and friends) was found when the child had an AIDS diagnosis or lower CD4%, as well as when the caregiver was HIV negative, African American and not the child's biological parent. In conclusion, pediatric HIV infection remains a highly stigmatized issue that is difficult to discuss with the infected child and others. Yet, contrary to the beliefs of many caregivers, disclosure did not result in increased mental health problems.

Purpose-To examine the association between sexual risk behaviors and substance use, as well as the impact of caregiver characteristics and perceived peer norms among perinatally HIV-exposed but uninfected and perinatally HIV-infected youth.Methods-Using baseline data from a multi-site study of psychosocial behaviors in perinatally HIV-exposed urban youth (N = 340; 61% HIV+; 51% female; ages 9-16). We conducted interviews with youth-caregiver dyads. Using hierarchical logistic regression, we explored the association between lifetime sexual risk behaviors, cigarettes, alcohol, marijuana, other drug use, caregiver relationship characteristics and peer influence.Results-Cigarettes, alcohol and marijuana were significantly associated with HIV sexual risk behavior; no youth reported other drug use. After accounting for peer norms, the relationship between substance use and risky sexual behaviors was somewhat diminished. Irrespective of substance use, perception that more peers were involved in risky sex was associated with sexual risk behavior. Caregiver relationship characteristics had no effect on the association between substance use and risky sexual behavior. In all analyses, we found no effect across HIV status.Conclusion-Regardless of HIV status, perinatally-exposed youth who use substances are more likely to engage in sexual risk behaviors. While the current study shows that peer influence on risky sexual behavior is more robust, caregivers are still important. The pediatric and adolescent HIV community must develop multilevel prevention initiatives that target youth, their peers and families.

A large proportion of perinatally HIV-infected (PHIV) children are becoming adolescents and exploring their sexuality. This study explored the prevalence of sexual behaviors (kissing, touching, engaging in oral sex, or having vaginal/anal intercourse) in a sample of predominantly ethnic minority youths (N = 339; 54.1% Black and 30.4% Latino; 51% female; ages 9-16) perinatally exposed to HIV (61% HIV+). Using logistic regression, we tested the association between sexual behavior and HIV status, demographic characteristics, and peer influences regarding sexual behavior. PHIV youth were less likely to be sexually active. Among sexually active youth, PHIV youth were more likely to engage in touching behavior than HIV-negative youth and were less likely to engage in penetrative sex. Youths reporting that a greater number of their peers believed that sexually active boys were "cool" or "popular" were more likely to report sexual behavior. The association between sexual behavior and peers believing sexually active girls were "cool" or "popular" varied by age, gender, and HIV status. Furthermore, friends' sexual activity was associated with sexual intercourse. Prevention programs should strengthen messages addressing peer norms regarding sexuality, as well as address specific issues related to adolescent HIV. KeywordsPerinatal HIV-infection; Seroreverters; Adolescents; Sexual Behavior; Peer Norms With the advent of antiretroviral treatment (ART), many HIV-infected children are reaching adolescence and young adulthood (Gortmaker, Hughes, Cervia, Brady, Johnson, Seage et al., 2001). For example, in New York City, where this study takes place, over 67% of perinatally, HIV-infected (PHIV) children are 13 years and older (New York City Department of Health and Mental Hygiene [NYCDOHM], 2007). Sexual exploration typically begins during adolescence and most often includes sexual activities like kissing, touching, and sexual intercourse (Miller, Christopherson, & King, 1993). Adolescent sexual activity in the United States commonly begins because of a series of biological, psychological, and social transitions (Pedlow & Carey, 2004). These transitions include the onset of puberty, the exploration of intimate romantic relationships, and participation with peers in settings unsupervised by adults. In uninfected populations, adolescence has been considered a period of heightened risk for transmission of sexually transmitted diseases (STDs), including HIV/AIDS, as adolescents In the general population, health education programs have aimed to decrease adolescents' sexual risk-taking through delaying sexual initiation or teaching successful condom use; yet, the efficacy of these efforts has been inconsistent or insufficient (DiClemente, Salazar, & Crosby, 2007;Malow, Kershaw, Sipsma, Rosenberg, & Dévieux, 2007), as evidenced by the approximately 40,000 new HIV infections, mostly acquired via sexual behavior prior to age 25 (UNAIDS, 2008). Furthermore, there is a growing racial/ethnic disparity in HIV/AIDS incidence. Estimates...

Perinatally HIV-infected youths are reaching adolescence in large numbers. Little is known about their cognitive functioning. This study aims to describe and compare the receptive language ability, word recognition skills, and school functioning of older school-aged children and adolescents perinatally HIV infected (HIV-positive) and perinatally HIV-exposed but uninfected (seroreverters; HIV-negative). Participants included 340 youths (206 HIV-positive, 134 HIV-negative), 9–16 years old, and their caregivers. Youths completed the Peabody Picture Vocabulary Test, Third Edition (PPVT-III) and the Reading Subtest of the Wide Range Achievement Test, Third Edition (WRAT-3). Caregivers were interviewed regarding demographic characteristics and school placement of youths. Medical information was abstracted from medical charts. Both groups of youths scored poorly on the PPVT-III and WRAT-3 with about one third of youths scoring in less than the 10th percentile. The HIV-positive youths scored lower than the seroreverters (M = 83.8 versus 87.6, t = 2.21, p = 0.028) on the PPVT-III and on the WRAT-3 (M = 88.2 versus 93.8, t = 2.69, p = 0.008). Among the HIV-positive youths, neither CD4+ cell count, HIV RNA viral load or Centers for Disease Control and Prevention (CDC) classification were significantly associated with either PPVT-III or WRAT-3 scores. However, youths who were taking antiretroviral medication had lower WRAT-3 scores than youths not taking medication (M = 95.03 versus 86.89, t = 2.38, p = 0.018). HIV status remained significantly associated with PPVT-III and WRAT-3 standard scores after adjusting for demographic variables. Many youths had been retained in school and attended special education classes. Findings highlight poor language ability among youths infected with and affected by HIV, and the importance of educational interventions that address this emerging need.

There is a need for family-based mental health interventions for this population, particularly focusing on parent-child relationships, disclosure, and youth self-esteem.

Standardized assessments of mental health identified very high rates of psychiatric disorders, primarily in the anxiety and behavioral domains, in this sample of youth with perinatal HIV infection. Mental health interventions should be integrated into medical care to help members of this highly vulnerable population optimize their health and well-being.