Penetrative sex vaginal and anal increased over time for both groups and was reported by 9. Similarly, unprotected sex also increased and was reported by 5. Among those who were sexually active, unprotected sex was reported by The most prevalent substance used by both groups across all time points was alcohol Use of marijuana was less frequent in both groups, but also increased over time 4.
There were no other differences in substance use or sexual behavior by HIV status at each of the time points. Table II presents the onset of penetrative sex and onset of unprotected sexual behavior over time and their association with alcohol and marijuana use across adolescence. We noted no baseline differences by Latino ethnicity or HIV status. The time-varying association between marijuana use and onset of penetrative sex did not differ by HIV status.
We noted no baseline differences in onset of unprotected sex by gender, HIV status, or living with a biological parent. The time-varying association between marijuana use and onset of unprotected penetrative sex did not differ by HIV status. In this article, we examined the onset of sexual behavior and unprotected sex across adolescence and the effect of substance use on the timing of these behaviors in a sample of youth perinatally HIV infected or uninfected but perinatally HIV exposed.
A large body of literature on resilience in youth suggests that despite exposure to adversity e. This process is aided by protective factors that can offset the effect of risk factors e. For youth in the current study, exposure to HIV may serve a protective role with respect to substance use. For example, faced with a life threatening illness youth may choose to avoid behaviors that further threaten their health e.
Further research that uses a resilience lens and examines the role of HIV in addition to other factors that offset substance use and other poor outcomes in youth affected by HIV is warranted. After adjusting for key demographic factors, we found no differences in rate of onset of penetrative sex or unprotected sex across time by youth HIV status. That said, the increase in unprotected sex across adolescence is concerning. Exacerbating this risk was the finding that alcohol and marijuana were strongly associated with the onset of sexual behaviors in this sample.
Youth who used alcohol or marijuana across adolescence were more than twice as likely to engage in sexual debut or unprotected sexual behavior; alcohol was associated with a sevenfold increase in sexual onset at each time point.
These findings are consistent with prior studies examining the link between alcohol and marijuana use and sexual risk in youth Elkington et al. There are likely different, but potentially related, mechanisms through which substance use increases the risk of engaging in unsafe sexual behavior in these youth. For example, reduced inhibition and impaired judgment due to the effects of intoxication Logan et al. Future studies that use event analysis in addition to social network analytic approaches may shed light on the specific links between sexual risk, alcohol, and marijuana in these youth.
The association between alcohol use, sexual onset, and sexual risk behavior varied by HIV status. While an important first step, these analyses did not disentangle reasons for the HIV status differences in sexual risk associated with alcohol use, a key step for future intervention development.
Therefore, they may be more vigilant about engaging in sexual risk if they are using alcohol. Moreover, given their HIV status, these youth may experience greater monitoring and supervision from caregivers e. Several limitations of this study should be noted.
Participants were recruited from HIV primary care clinics, and findings may not generalize to youth in other settings. We could not determine whether substance use and sexual risk are causally related, correlated traits, or are spuriously associated owing to the effect of other structural variables e. Due to power limitations, we were unable to address this issue by including family as a third level i. In our multivariate analyses, we adjusted for HIV status in both our baseline and time-varying estimates to reduce potential confounding.
The data are self-reported and are subject to issues of social desirability and other biases related to sex and drug use reporting. Given limited data on puberty for this study, we were unable to examine the role of pubertal development in the onset sexual behaviors. We did not capture sexual risk associated with multiple partners or partner HIV status, and as such our estimation of sexual risk may be conservative.
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We did not capture data on the role of childhood maltreatment or sexual abuse and so could not examine the influence of these variables on the development of sexual behavior and sexual risk over time. Relatedly, we did not ask participants to differentiate between consensual and nonconsensual sex encounters when reporting sexual behavior.
Despite these limitations, findings from the current study have important clinical and policy implications. The challenge for the field is to find these youth as they age to deliver targeted interventions before they fall out of traditional service systems. Similarly, substance use treatment and prevention interventions designed for these youth should also address sexual risk. Although rates of substance use are relatively low, our data suggest use is increasing rapidly over time.
The authors have no competing interests to declare. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In.
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Curtis Dolezal, PhD. Claude A. Mellins, PhD. Cite Citation. Permissions Icon Permissions. Table I. Open in new tab. Table II. American Psychiatric Association. A prospective study of the onset of sexual behavior and sexual risk in youth perinatally infected with HIV. Search ADS. Google Preview. Sexual initiation in early adolescence: The nexus of parental and community control.
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