Teenagers infected with HIV are more likely to engage in risky sex and drug use since the introduction of powerful medicines that effectively keep AIDS at bay, a new study finds.
The trend, which began surfacing after highly active antiretroviral therapies (HAART) were introduced in 1996, points to the need for targeted interventions to reduce risky behavior and improve quality of life for those in this group, the researchers noted.
Roughly a quarter of the 40,000 new HIV infections in the United States each year occur in people under the age of 21, according to the federal Centers for Disease Control and Prevention.
“Young people, post-HAART, are engaging in more unprotected sex and engaging in more substance abuse, and are more emotionally distressed and have a lower quality of life,” said lead researcher Marguerita Lightfoot, an assistant research psychologist at the University of California, Los Angeles’ Center for Community Health.
This finding was surprising, Lightfoot added.
;I had a hypothesis that the young people who are taking HAART would be healthier, because they had more hope, they were living longer. And I was surprised that that wasn’t the case.”
In the study, Lightfoot and her colleagues compared behaviors among 349 teens with HIV from Los Angeles, San Francisco, New York City and Miami from 1994 to 1996, with 175 teens with HIV in the same cities from 1999 to 2000.
The two groups did not include the same people, but they were a similar mix of sex, age, race and ethnicity, as well as socioeconomic factors, according to the report in the March issue of the American Journal of Health Behavior.
The researchers found the post-HAART group was almost two times more likely to have had unprotected sex. The post-HAART teens had almost twice the number of sex partners, compared with pre-HAART teens.
And post-HAART teens were more likely to have a sexual partner who used injected drugs.
In addition, the post-HAART group was diagnosed with HIV at a younger age and was in worse health than the pre-HAART group, Lightfoot’s team found.
Lightfoot said there are a number of reasons for these findings. She noted the powerful drug regimen isn’t perfect. “There are increased expectations for HAART,” Lightfoot said. “But not everyone is successful on HAART.
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Lightfoot also noted that teens infected with HIV are more apt to be involved with the juvenile justice system and spend time in jail. “Maybe it says something about the kind of young people who are more likely to be infected with HIV. These are the people who are most at risk,” she said.
In addition, because being on HAART makes people feel safer, they are more likely to engage in unprotected sex. People also feel that HAART makes HIV a disease that they can live with, Lightfoot said. This attitude is also found among HIV-positive adults, she noted.
“The ones who are getting infected are the ones who are not getting the prevention messages,” Lightfoot said. “We are seeing that as a trend among people of color, who are the fastest-growing population getting HIV.”
“We need to be targeting these young people for interventions, not only to prevent them from transmitting the virus, but we need to be helping them with their emotional distress,” Lightfoot said. “We have a real opportunity to prevent the further spread of HIV if we focus on the young people who are actually living with it.”
Another expert found the study conclusions disturbing.
“It is distressing that things had gotten worse for the more recent group of teens living with HIV,” said Freya Sonenstein, a professor and director of the Center for Adolescent Health at Johns Hopkins Bloomberg School of Public Health.
Sonenstein focuses on the type of teens who are most likely to become infected with HIV to explain the findings. “An explanation for the study findings is that the teens living with HIV have become selectively more disadvantaged,” she said.
“HIV transmission is now more likely among disadvantaged teens than it was in the earlier period. Still, I think that we should expect the care and support systems for this group to improve, and the call for improved programming is justified,” Sonenstein added.
In some good news, a report in the Feb. 28 issue of the Archives of Internal .
