Profiles of Risk Among HIV-Infected Youth in Clinic Settings

Abstract

Despite the rising number of new HIV infections among youth, few tailored interventions for youth living with HIV (YLH) have been developed and rigorously tested. Developing tailored interventions necessitates identifying different profiles of YLH and understanding how risk and protective factors cluster together. Obtaining this critical information requires accessing a sufficiently large sample of YLH from diverse geographic settings such as those available through the Adolescent Trials Network for HIV Interventions (ATN). We recruited a cross-sectional sample of 1,712 YLH from ATN clinics; participants completed a survey on psychosocial and health factors. Using latent class analysis on nine composite variables representing risk factors, we identified five classes distinguished by substance use, sexual behavior, and pregnancy history and differing on health outcomes. Findings suggest a need for tailored interventions addressing multiple risky behaviors of HIV-infected youth and research to clarify how intervention effectiveness may differ by risk profile.

Prevalence and correlates of substance use among youth living with HIV in clinical settings

“…Consistent with previous research documenting the substance use and HIV risk behaviors among people living with HIV, including youth (4, 14, 35), we found that engaging in any condomless intercourse was significantly associated with an increased odds of engaging in weekly alcohol and tobacco use, whereas there was no significant association of condomless intercourse with marijuana use and other illicit drug use. Alcohol use may impair young people’s decision making and lower their inhibitions, which has the potential increase their potential for engaging in high-risk behaviors (36).…”

“…Consistent with prior studies (14), and to reflect the distinction between those who meet the public health goal of 100% medication adherence versus those who do not, adherence was dichotomized to indicate less than 100% adherence (1) versus 100% adherence (0).Within one week of participants completing the survey, viral load and CD4 count values were collected through a chart review. A range of viral load assays were used at different sites and the lower limit of detectability for these assays varied.…”

“…These correlates are important to understand since they can help elucidate who is most at risk for substance use and what types of interventions might be needed to reduce risk. A range of social and structural factors including lower socioeconomic position, juvenile justice involvement, unstable housing, and lack of social support also may be important to consider, since they have been associated with increased substance use and HIV risk behaviors (12-14). Youth who are homeless or who are unstably housed are demonstrate high HIV risk behaviors due to the street-associated behaviors, which may include substance use and trading sex for drugs or money (15).…”

Receipt of clinical and prevention services, clinical outcomes, and sexual risk behaviors among HIV-infected young adults in care in the United States

“…Considering these sobering statistics and recognizing the unique challenges facing many HIV-infected youth—which include still-developing reasoning and decision-making capacity, ongoing identity formation, and economic instability—some experts have stressed the importance of tailored, youth-focused care and prevention services (Fernandez et al, 2015; Hussen et al, 2015; Zanoni & Mayer, 2014). To inform development and implementation of these services across diverse care settings, we present clinical and treatment characteristics, risk behaviors, and receipt of prevention services among HIV-infected young adults receiving care in the United States.…”

Acceptability and Feasibility of a Cell Phone Support Intervention for Youth Living with HIV with Nonadherence to Antiretroviral Therapy

“…Many youth living with HIV struggle with fundamental problems like housing, substance abuse, mental illness, and poor social support. [18][19][20] Because many youth living with HIV are preoccupied with meeting life's basic needs (either chronically or episodically), taking medications becomes a secondary priority, particularly during the asymptomatic phases of their disease.…”