Associations of Medically Documented Psychiatric Diagnoses and Risky Health Behaviors in Highly Active Antiretroviral Therapy-Experienced Perinatally HIV-Infected Youth

Abstract

The Longitudinal Epidemiologic Study to Gain Insight into HIV/AIDS in Children and Youth (LEGACY) study is a prospective, multisite, longitudinal cohort of U.S. HIV-infected youth. This analysis was limited to perinatally HIV-infected youth (n = 197), 13 years and older, with selected variables completely abstracted from HIV diagnosis through 2006. We evaluated relationships between ever having one or more nonsubstance related medically documented psychiatric diagnoses and three risky health behaviors (substance abuse, preadult sexual activity, and treatment adherence problems) recorded between 2001 and 2006. Logistic regression was used for all binary outcomes and participant age was included as a covariate when possible. All 197 participants included in the analysis were prescribed antiretroviral therapy during the study period; 110 (56%) were female, 100 (51%) were black non-Hispanic, and 86 (44%) were Hispanic; mean age at the last visit was 16.8 years, ranging from 13 to 24 years. One hundred forty-six (74%) participants had a history of at least one risky health behavior. There were 108 (55%) participants with at least one medically documented psychiatric diagnosis, 17 (9%) with at least one record of substance abuse, 12 (6%) with documented preadult sexual activity, and 142 (72%) participants with reported adherence problems. In the final model, a history of at least one psychiatric diagnosis was associated with having at least one of the three risky behaviors (odds ratio [OR] = 2.33, p = 0.015). There is a need for a continued close partnership between HIV specialty care providers and mental health services treating perinatally HIV-infected youth with an added focus on improving treatment adherence.

Individual and Contextual Factors of Sexual Risk Behavior in Youth Perinatally Infected with HIV

“…For PHIV + youth, other internal contextual factors, such as youth's HIV status, may be more influential in determining sexual activity and sexual risk than gender. Also, contrary to past findings in some other populations, 30,31,61 we found no association between youth's psychological distress and their sexual behavior, after considering youth alcohol and marijuana use. As seen in some other studies of high-risk youth, 62 one plausible explanation for an absence of a relationship between distress and sexual risk in multivariate analyses may be that substance use mediates, or accounts for the relationship between psychological distress and sexual behavior.…”

Risk factors associated with mental health issues in adolescents: a integrative review

“…Use of substances (tobacco, alcohol and other drugs) (11)(12)14,(16)(17)23,(25)(26)28,(32)(33)36,(38)(39)42,44,46,50,55,59,62) Psychosocial dysfunction associated with use of drugs (21) 41.5…”

“…HIV vertical transmition (40,42,(45)(46) Grave sexual violence (13,29,51) HIV risk behaviors (20,43,46) Early sexual activity (42) Problems to adhere to antiretroviral treatment (42) 16.9 function in its psychic structuring. The family relationships containing affection and good communication are protection factors determinants to the adolescent mental health (31) .…”

Caring for ‘underground’ kids: qualitative interviews with clinicians about key issues for young people growing up with perinatally acquired HIV in Australia

“…As the literature repeatedly stresses, when psychosocial and psychiatric problems in this population dovetail with teenage rebellion, impulsivity, experimentation, peer pressure and the desire to fit in, this can have critical implications for both individual and public health. This 'perfect storm' is believed to create a powerful barrier to continued adherence to HIV medication, with resultant implications in terms of developing viral resistance and reducing treatment options (Agwu & Fairlie, 2013;DeLaMora, Aledort, & Stavola, 2006;Foster et al, 2007;Malee et al, 2009), and to lead to increased sexual risk-taking, with consequences for preventing the transmission of HIV to others (Benton & Ifeagwu, 2008;Elkington et al, 2009;Kapetanovic et al, 2011). Adding to this concern, research suggests that disclosure of HIV to sexual partners is far from the norm among this population (Michaud et al, 2009;Peele, D'Angelo, Chandwani, Abramowitz, & Koenig, 2012;Wiener & Lyons, 2006).…”