Young Americans living with HIV are worse off - and having much more risky
sex - since powerful AIDS drugs came along.

You might think that the drugs, known as highly active antiretroviral
therapy (search) or HAART (search), would make life better for HIV-infected
youths. You might think that when teens learn they have the AIDS virus, they
would be more careful about unsafe sex and substance abuse. But you would be
wrong.

"Post-HAART youth living with HIV were more likely to engage in unprotected
sex and substance abuse, to be more emotionally distressed, and to have
lower quality of life than were pre-HAART youth living with HIV," UCLA
researcher Marguerita Lightfoot, PhD, and colleagues report in the February
issue of the American Journal of Health Behavior.

Lightfoot's team made an extraordinary effort to find young Americans living
with HIV - and to get honest information from them. In Los Angeles, San
Francisco, New York, and Miami, they recruited young people aged 13 to 24
through social service agencies, medical clinics, street outreach, and
community advertisements.

From 1994 to 1996 - before HAART became available - they recruited 349
youths. From 1999 to 2000, well after the 1997 advent of HAART, they
recruited another 175 youths. All underwent standardized two-hour
interviews. In both time periods, the average study participant was 21 years
old.

Youths in the before-HAART era averaged about six sex partners, with whom
they had unprotected sex 27 percent of the time. In the era after HAART
became available, this number shot up to more than 10 sex partners and
unprotected sex 42 percent of the time. The HAART-era youth also were twice
as likely to report sex with an injection drug user.

Surprisingly, youths in the HAART era were sicker than the kids interviewed
before HAART became available. They were twice as likely to have AIDS (21
vs. 10 percent) and significantly more likely to have had symptoms of HIV
disease (49 vs. 39 percent).

"It is surprising that the post-HAART youth experienced more symptoms,"
Lightfoot says, in a news release. "This suggests that although they are
being identified as HIV positive at a younger age, these youth are being
identified later in the progression of disease. Therefore, it is also likely
they were infected at a younger age."

Given these findings, it's not surprising that the HAART-era youth were two
to three times more likely to abuse drugs and alcohol, more likely to be
clinically distressed, had worse coping skills, and were more likely to
commit delinquent acts or spend time in jail.

Although three-fourths of the HAART-era youth had been prescribed HAART
drugs, only about half were still taking the lifesaving drugs.

"Targeted interventions for youth living with HIV that address risk
behaviors and aim to improve quality of life are needed now more than ever
before," Lightfoot and colleagues conclude.

By Daniel J. DeNoon, reviewed by Michael W. Smith, MD

SOURCES: Lightfoot, M. American Journal of Health Behavior, February 2005;
vol 29: pp 162-171. News release, Center for the Advancement of Health,
University of California, Los Angeles.