High-risk subgroups for teens at risk for HIV

Sat Jul 8, 2006 04:03 AM ET

By Anne Harding

NEW YORK (Reuters Health) - Among teens who engage in unsafe sex, there are different patterns of behavior, with some subgroups being much more at risk of HIV infection than others, a new study shows.

The findings suggest that prevention programs tailored to the needs of these subgroups may have a better chance of success, Dr. Christopher D. Houck of the Bradley/Hasbro Children's Research Center in Providence, Rhode Island, the study's lead author, told Reuters Health.

"If we can develop programs to target adolescents' sexual risk in the context of having mental health crises, or also using substances, those are the ways that we're more likely to have an effect on their risk behavior," he said in an interview.

To investigate whether it would be possible to characterize different subgroups among at-risk kids, Houck and his colleagues surveyed 1,153 people aged 15 to 21 who reported having had unprotected sex in the past 90 days.

Among boys, the researchers found, there were three distinct subgroups: those who had mental health crises and engaged frequently in unprotected sex, representing 10 percent of all males; those who used alcohol and marijuana and had unprotected sex, representing about half the group; and a lower-risk group that engaged in unprotected sex much less frequently.

Boys in the first group had an average of about 27 unprotected sex acts in the past 90 days, compared to about 19 for the second group and 7 for the third group.

For girls, risk factors were different. Fourteen percent reported having had unprotected sex 64 times over the past 90 days, but did not report heavy drug and alcohol use or mental health crises. Eleven percent reported higher drug and alcohol use and more mental health crises, along with 13 acts of unprotected sex over the past 90 days. The remaining 75 percent of girls had about eight acts of unprotected sex and did not report heavy substance use or mental health crises.

Forty-three percent of the girls in the first group were living with their sexual partner, which may help explain why they had unprotected sex so frequently, Houck said. However, he added, the reasons behind the other patterns he and his colleagues identified are not so easily explained.

Programs to help people reduce their risk of contracting HIV and other sexually transmitted diseases can include individual counseling or group counseling sessions, Houck noted. "We have to really understand who the audience for these programs is -- the better we understand that audience the more we can target the programs to them."

SOURCE: Journal of Pediatric Psychology, July 2006.

Teen sex assault victims rarely finish HIV meds

Mon Jul 3, 2006 09:49 PM ET

NEW YORK (Reuters Health) - Findings from a new study suggest that just 15 percent of adolescents who have been sexually assaulted and started anti-HIV postexposure prophylaxis (PEP) actually complete the recommended 28-day course of treatment.

"The use of PEP in this population can be difficult because of patient uncertainty regarding exposure, high rates of psychiatric comorbidity, and low rates of follow-up," Dr. Elyse Olshen, from Columbia University in New York, and colleagues note.

PEP is often advised when someone thinks they may have been exposed to HIV through sex.

The study, in the Archives of Pediatrics & Adolescent Medicine for July, involved 145 adolescent patients who were seen at one of two urban emergency departments within 72 hours of a sexual assault.

Ninety-six percent of patients were female; 37 percent were white, 38 percent black, 14 percent Hispanic, and 10 percent were of other ethnic background, the authors note.

Uncertainty regarding exposure was a common theme among the study group. Twenty-seven percent of subjects did not know if a condom had been used, 54 percent were uncertain if ejaculation had occurred, and 21 percent reported blacking out during the incident.

PEP was offered to 129 subjects and 110 agreed to use it, the report indicates. Of the 86 patients who begun PEP and were seen for follow-up, just 13 completed the full course.

Nearly half of patients who used PEP and returned for follow-up experienced an adverse reaction.

Psychiatric comorbidity was seen in 47 percent of the assault victims and, as noted, was associated with lower adherence to PEP.

"We agree with published recommendations that PEP be offered to adolescent sexual assault survivors for exposure that pose a risk of HIV transmission. Patient education and a comprehensive follow-up system with extensive outreach and case management are necessary to encourage PEP adherence and return for follow-up care among adolescent sexual assault survivors," the authors conclude.

SOURCE: Archives of Pediatrics and Adolescent Medicine July 2006.