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Youth with HIV may need sexual behavior counseling

Saturday November 10, 2012
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As youth infected at birth with HIV approach adolescence and young adulthood and potentially become sexually active, clinicians must promote healthy behaviors, according to a study.

Some of the 330 young people in the study from 15 sites across the U.S. had initiated sexual activity, with many reporting having unprotected sex. Of the youth who were asked about disclosure of their HIV status to their first sexual partners, the majority reported that they had not disclosed their status to their partner before sexual activity.

Although sexual activity is not uncommon among adolescents, HIV-infected or not, "HIV infection adds another level of complexity to the adolescence of youth who are infected and has implications for both their own health and that of their sexual partners," the study’s lead author, Katherine Tassiopoulos, DSc, MPH, of the Harvard School of Public Health, said in a news release.

The link between non-adherence to antiretroviral therapy medications and risky sexual behaviors, already recognized among HIV-positive adults, is coming to light in adolescents as this cohort emerges from childhood.

"Among youth, both non-adherence and sexual initiation may be expressions of independence or the desire to feel accepted by peers," the authors reported Nov. 7 on the website of the journal Clinical Infectious Diseases. Successful interventions may account for adolescents’ growing desire for independence by encouraging medication adherence, disclosure and condom use as behaviors that will protect the health of their sexual partners and their own health.

Early action by clinicians can help prepare these youth to make choices that reduce risk to themselves and to their partners, the researchers noted. A critical step is informing youth of their HIV status. In this study, 18% of the participants were unaware they were HIV-positive at the time they started sexual activity. Clinicians and families should ensure that young people with HIV are informed of their HIV status before or during early adolescence, according to current guidelines for disclosure of HIV infection to children and adolescents.

The researchers found that among sexually active youth with high viral load (greater than 5,000 copies/ml), 81% had drug-resistant virus. This issue raises the possibility of transmission of resistant virus to sexual partners and also limits treatment options for infected youth.

Informing young people "that ART can dramatically reduce the likelihood of sexual transmission of HIV" may be a critical step in encouraging optimal adherence, said study author George R. Seage III, DSc, MPH, of the Harvard School of Public Health.

Although the three-pronged message of safer sex practices, disclosure of HIV status to sexual partners and adherence to ART regimens is not new, targeted and innovative intervention strategies are needed to reach this important group of adolescents and reinforce healthy behaviors, the authors concluded.

The study abstract is available at http://cid.oxfordjournals.org/content/early/2012/10/24/cid.cis816.abstract.