More HIV-Infected Youth Practice Risky Behavior Than Adults

Jan. 12, 2000 (Atlanta) -- Even after learning they are HIV positive, 20-year-olds are more than twice as likely as older infected adults to engage in such risky behavior as unsafe sex and sharing needles, according to a new study.

With at least half of all new HIV infections in the U.S. among people younger than 25, the problem is a substantial public health concern, Catherine Diamond, MD, MPH, tells WebMD. Diamond, a behavioral sciences epidemiologist with the University of California, Irvine School of Medicine, defines "continued risky behavior" as "occurring more than six months after the first known date of HIV infection." The results of the study appear in the January issue of the American Journal of Public Health.

The study focuses on data collected by the CDC in Seattle from 1990 to 1998 comparing about 140 youths with almost 3,000 adults. The average age of the youths was 21 when they entered the study. They were, on average, 20 years old at the time of diagnosis. The adults in the study were 32 years old when diagnosed and 34 when they joined the study, on average.

Among the findings, 70% of the young women were engaging in risky behaviors, compared with 50% of the adult women. Thirty percent of young men were involved in risky sexual behavior, compared with 20% of adult men.

"Women's sexual behavior, to some extent, is not entirely under their control," Ralph DiClemente, PhD, chairman of behavioral sciences at Rollins School of Public Health at Emory University, tells WebMD. "One issue is forced sex, but another is a little more insidious than that ... threats of abandonment, threats of withholding of resources, threats of withholding of affection."

The male's behavior is the real determinant of risky behavior, DiClemente's research has shown. "If the male doesn't want to use condoms, the situation is likely to be risky. A younger woman with an older male may have less leverage for negotiating safer behavior."

Nationwide, the problem could be much larger than studies show, says Diamond. "Evaluating the extent of HIV infection among youth is difficult because not all states report HIV cases. Some report only AIDS cases. Since HIV infection occurs on average more than a decade before AIDS develops, case reporting could be underestimated," she tells WebMD.

New HIV therapies may be giving false optimism to some, says Diamond. "People may be thinking they are no longer infectious because their viral load is suppressed." Her study showed that males with no symptoms of HIV infection, who had higher CD4 counts, and who used illegal drugs were more likely to engage in risky behavior than those with full-blown AIDS.

While various counseling programs target HIV-infected youth, "There's no national standard of care for this type of counseling," Diamond tells WebMD. "It may be that we are depending on individual physicians to address this larger public health issue, and that's not really working. They may not have the training to counsel someone about these things." Diamond adds that most young people require "a lot more individualized, focused attention because their risky behavior may be very different than someone else's."