Barcelona 2013
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| Abstract #273 - Drugs and Alcohol | ||||
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Session: 22.4: Drugs and Alcohol (Parallel) on Monday @ 16.30-18.30 in Mirador Chaired by Sam Friedman, Rosa Mansilla Authors: Presenting Author: Prof Katherine Elkington - Columbia University and New York State Psychiatric Institute, United States |
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| Additional Authors: Dr. Patricia Solomon, Mr. Larry Baxter, Dr. Alan Casey, Mr. Will Chegwidden, Mr. Duncan MacLachlan, Dr. Joy MacDermid, Ms. Anne-Marie Tynan, Dr. Greg Robinson, Dr. Barry Trentham, Ms. Janet Wu, Ms. Elisse Zack, | ||||
| Aim: In a sample of perinatally HIV-infected (PHIV+) and perinatally-exposed but uninfected (PHIV-) youth, the current study 1) examined the onset of sexual and unprotected sexual behavior over 5 years by HIV status, and 2) determined associations between substance use and sexual risk behavior over time, examining differences by HIV status. | ||||
| Method / Issue: Data are from three waves of a US longitudinal study of mental health and risk behavior outcomes in an urban sample of PHIV+ and PHIV- youth (n=340; 60.6% PHIV+; 50.5% male; 9-22 years; 45.9% African American, 50.0% Hispanic). Sexual behavior was assessed with the Adolescent Sexual Behavior Assessment (Dolezal et al., 2012). Alcohol and marijuana use was assessed using the Diagnostic Interview Schedule for Children-IV (youth version). We used HLM to design multilevel logistic growth curve models, estimating the cumulative onset of penetrative (vaginal and/or anal) and unprotected penetrative sex across time, adjusting for key demographic covariates. We modeled the changes in sexual onset over time, adding the alcohol and marijuana use trajectories, respectively, as time-varying covariates. | ||||
| Results / Comments: By the third wave (mean age = 17yrs), 53.75% of adolescents had engaged in sexual intercourse, 28.85% had unprotected sex, 53.31% used alcohol and 27.69% used marijuana. The odds of commencing penetrative (AOR = 2.42; 95% CI [1.77, 3.32], p < .001) or unprotected penetrative sex (AOR = 2.52; 95% CI [1.94, 3.27], p < .001) was more than twice as likely at each additional follow-up. Alcohol (AOR = 6.98; 95% CI [3.53, 13.83], p < .001) and marijuana (AOR = 2.63; 95% CI [1.23, 5.69], p < .05) use significantly increased the odds of engaging in sex over time. There were no differences in prevalence of sexual behavior or substance use, or in likelihood of onset of penetrative sex over time by HIV status. The odds of engaging in unprotected sex over time were over 4 times greater if youth reported using alcohol (AOR = 4.19; 95% CI [2.08,8.44], p < .001) and twice as likely if the youth used marijuana (AOR = 2.29; 95% CI [1.05, 5.02], p < .05). The magnitude of the association between alcohol and unprotected sex was significantly less for PHIV+ youth than for PHIV- youth (AOR = 0.83; 95% CI [0.51, 1.37], p < .05); there was a similar trend for sexual debut. | ||||
| Discussion: As expected, rates of sexual behavior and substance use increased in both groups as they aged; rates of sexual behavior were consistent with US national trends. Counter to expectations, rates of substance use were lower than national data. Nonetheless, both groups experienced increases in sex and unprotected sex with age, with alcohol and marijuana playing a key role in the onset of sexual behaviors. Although the risk between alcohol use and unprotected sex was still present for PHIV+ youth, the magnitude of that association was significantly lower compared to PHIV-youth. Given the problematic implications of SUDs and sexual risk for HIV+ individuals, treatment and policy implications for a population coping with chronic illness and the transition to young adulthood are discussed. | ||||
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