Sexual risk behavior among youth with perinatal HIV infection in the United States: Predictors and implications for intervention development

Katherine Tassiopoulos, Anna Barbara Moscicki, Claude Mellins, Deborah Kacanek, Kathleen Malee, Susannah Allison, Rohan Hazra, George K. Siberry, Renee Smith, Mary Paul, Russell B. Van Dyke, George R. Seage

Research output: Contribution to journalArticlepeer-review

59 Scopus citations


Background. Factors associated with initiation of sexual activity among perinatally human immunodeficiency virus (HIV)-infected (PHIV+) youth, and the attendant potential for sexual transmission of antiretroviral (ARV) drug-resistant HIV, remain poorly understood.Methods. We conducted cross-sectional and longitudinal analyses of PHIV+ youth aged 10-18 years (mean, 13.5 years) enrolled in the US-based Pediatric HIV/AIDS Cohort Study between 2007 and 2009. Audio computer-assisted self-interviews (ACASI) were used to collect sexual behavior information.Results. Twenty-eight percent (95% confidence interval [CI], 23%-33%) (92/330) of PHIV+ youth reported sexual intercourse (SI) (median initiation age, 14 years). Sixty-two percent (57/92) of sexually active youth reported unprotected SI. Among youth who did not report history of SI at baseline, ARV nonadherence was associated with sexual initiation during follow-up (adjusted hazard ratio, 2.87; 95% CI, 1.32-6.25). Youth living with a relative other than their biological mother had higher odds of engaging in unprotected SI than those living with a nonrelative. Thirty-three percent of youth disclosed their HIV status to their first sexual partner. Thirty-nine of 92 (42%) sexually active youth had HIV RNA ≥5000 copies/mL after sexual initiation. Viral drug resistance testing, available for 37 of these 39 youth, identified resistance to nucleoside reverse transcriptase inhibitors in 62%, nonnucleoside reverse transcriptase inhibitors in 57%, protease inhibitors in 38%, and all 3 ARV classes in 22%.Conclusions. As PHIV+ youth become sexually active, many engage in behaviors that place their partners at risk for HIV infection, including infection with drug-resistant virus. Effective interventions to facilitate youth adherence, safe sex practices, and disclosure are urgently needed.

Original languageEnglish (US)
Pages (from-to)283-290
Number of pages8
JournalClinical Infectious Diseases
Issue number2
StatePublished - Jan 15 2013
Externally publishedYes


  • adolescents
  • disclosure
  • perinatally HIV-infected
  • sexual initiation
  • viral drug resistance

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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