A Prospective Study of the Onset of Sexual Behavior and Sexual Risk in Youth Perinatally Infected with HIV

Abstract

Perinatally HIV-infected (PHIV+) youth are surviving into adolescence and young adulthood. Understanding the sexual development of PHIV+ youth is vital to providing them with developmentally appropriate HIV prevention programs. Using pooled data (N = 417) from two longitudinal studies focused on HIV among youth (51% female; 39% HIV+) and their caregivers (92% female; 46% HIV+), we compared the rate of sexual onset during adolescence across four youth-caregiver combinations: PHIV+ youth with HIV+ caregivers (12%); PHIV+ youth with HIV− caregivers (27%); HIV− youth with HIV+ caregivers (34%); and HIV− youth with HIV-caregivers (27%). Youth with HIV− caregivers were more likely than other youth-caregiver groups to have had their sexual onset. Youth with HIV+ caregivers reported a slower rate of onset of penetrative sex across the adolescent years. We discuss our findings by highlighting the role that both youth and caregiver HIV status play in the onset of sexual behavior across adolescence.

The Reproductive Health Behaviors of HIV-Infected Young Women in the United States: A Literature Review

“…8,[33][34][35] Nine studies had HIV-uninfected counterparts as part of the analytic sample to serve as a comparison group. 14,25,28,31,[36][37][38][39][40] Ten studies focused on samples of only young women, 8,9,14,19,25,28,31,33,39,41 while the remainder had samples that included both young men and women. Eight studies included only BHIV.…”

“…8,9,19,21,[25][26][27][28] Because of a recently published review article on PHIV adolescents, 7 we only included eight articles focused on just PHIV. 33,[35][36][37][38][40][41][42] Those were published since the review or were outside the scope of the review; one was included in the review, but is highlighted here from a different perspective. 41 The remaining studies 670 CARTER ET AL.…”

“…32 Among samples of PHIV, a smaller proportion were sexually experienced, but the proportion increased with age (as is also the case for HIV-uninfected youth), with estimates ranging from 27% to 46% among samples of youth ranging in age from 13 to 24 years. 7 In a set of recent studies that compared PHIV adolescents with HIVuninfected but perinatally exposed adolescents (i.e., with an HIV-infected mother), PHIV initiated sexual activity of any kind (e.g., kissing) at an earlier age than HIV-uninfected youth, but initiated penetrative sex (vaginal or anal) at a slower rate 37,38 However, some studies found largely similar percentages between those two groups in the percent reporting experience with oral sex 37 and penetrative sex. 36,40 A large proportion of HIV-infected youth reported being sexually active at the time of survey.…”

“…40 One longitudinal analysis of unprotected sex across the adolescent years found increasing prevalence for PHIV, but the increase over time was not as steep as it was for most HIV-uninfected youth. 37 A qualitative study of PHIV adolescent girls highlighted the complexity of condom use among this population, reporting, for example, that some girls become adamant, consistent (100%) condom users, while others struggled with disclosure of their status to partners and discussions about condom use. 33 Moreover, for some girls, disclosing their HIV status to partners led them to shift condom use decisionmaking to their male partners.…”

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

“…3,4 Some researchers examining PHIV + youths' sexual behaviors have found rates of sexual activity to be the same or lower than in other populations, with a delayed age of onset. [7][8][9] In contrast, other studies and clinical data suggest that there is a group of PHIV + youth who are initiating sexual activity early and engaging in unprotected sex in combination with other HIV risk behaviors such as substance use. 10,11 One cross-sectional study found that 33% of 13-to 24-year-old PHIV + youths had initiated vaginal intercourse, 35% of whom had reported their first occurrence before age 16 years.…”