NIH-funded study underscores need for physician counseling on healthy practices
Roughly 20 percent of youth who have had HIV since birth did not know their HIV status when they first became sexually active, according to a study by a National Institutes of Health-supported research network.
The study also found that, of those youth who knew they had HIV and who were asked about disclosure of their HIV status to their first sexual partners, most reported that they had not told their partner prior to sexual activity.
Moreover, most of these sexually active youth reported some sexual activity without condom use.
The study authors recommend that families and caregivers inform children about their HIV status before they reach adolescence and become sexually active. The authors also urge physicians and other health care providers to make sure that youth living with HIV understand the importance of safer sex practices and of disclosing HIV status to prospective partners. The study authors called for additional studies to identify the most effective methods for helping youth with HIV adhere to recommendations for safer sex practices.
The study authors also noted that caregivers vary as to when they tell children about their HIV status, often waiting until the teen years, when they believe the youth will more mature and better able to cope emotionally with their diagnoses. The American Academy of Pediatrics recommends that health care providers discuss with parents and caregivers the issue of disclosing a child's HIV status.
Youth living with HIV who do not use condoms risk spreading HIV to prospective partners, as well as acquiring sexually transmitted infections from their partners. Like other youth, they also increase their own risk for other sexually transmitted infections.
The study, of 330 HIV-positive 10- to 18-year-olds, is the first to comprehensively examine factors associated with initiation of sexual activity among young people who have been HIV-positive since birth. The youth completed a computer-guided questionnaire twice a year and provided confidential answers to survey questions about their sexual experiences. Their responses included answers to questions about when they first had sex, whether they used condoms, and whether they revealed their HIV status to potential partners.
"Our findings show that these young people act very much like their HIV-negative counterparts across the country," said Rohan Hazra, M.D., of the Pediatric, Adolescent and Maternal AIDS Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). "However, because of their HIV status, it is extremely important for health care providers, school counselors and family members to reinforce the importance of practicing safe sex, taking medication regularly and disclosing HIV status to potential partners."
Young people participated at clinical sites nationwide as part of the Pediatric HIV/AIDS Cohort Study , which is funded by the NICHD and several other NIH institutes and offices.
First author Katherine Tassiopoulos, D.Sc., of the Harvard School of Public Health,Boston collaborated with Dr. Hazra and researchers at Harvard and the NICHD, National Institute of Mental Health (NIMH), Bethesda, Md.; University of California, San Francisco; Columbia University and the New York State Psychiatric Institute, both in New York City; Northwestern University in Chicago; University of Illinois at Chicago; Baylor College of Medicine, Houston; and Tulane University Health Sciences Center, New Orleans.
Their findings appear in Clinical Infectious Diseases.
Nearly 10,000 people in the United States are living with HIV acquired at or before birth, according to the Centers for Disease Control and Prevention.
On average, participants who had initiated sexual activity reported having their first sexual experience at age 14. One-third of these said they had disclosed their HIV status to their first partner. The researchers also found that 62 percent of those who were sexually active reported at least one sexual act without use of a condom. The researchers noted that young people who did not take anti-HIV medication regularly were more likely to subsequently initiate sexual activity than were those who took their medication as prescribed.
"Adolescence introduces many complications into children’s lives, and those of HIV-positive youth especially," said co-author Susannah Allison, Ph.D., of the Infant, Child and Adolescent HIV Prevention Program at NIMH. "As more HIV-positive infants survive childhood and become sexually active teens, it becomes increasingly important to emphasize how healthy behaviors can protect these teens, as well as their partners."
NIH institutes providing funding for the Pediatric HIV/AIDS Cohort Study are the National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases, NIMH, the National Institute of Neurological Disorders and Stroke, the National Institute on Deafness and Other Communication Disorders, the National Heart Lung and Blood Institute, and the National Institute on Alcohol Abuse and Alcoholism.
About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute's website at http://www.nichd.nih.gov/.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.