HIV/sexually transmitted infection risk behaviors in delinquent youth with psychiatric disorders: a longitudinal study

Abstract

Objectives: To examine the prevalence and persistence of 20 human immunodeficiency virus (HIV)/sexually transmitted infection (STI) sexual and drug use risk behaviors and to predict their occurrence in four mutually exclusive diagnostic groups of delinquent youths: major mental disorder (MMD), substance use disorder (SUD), comorbid MMD and SUD (MMD+SUD), and neither disorder.

Method: At the baseline interview, HIV/STI risk behaviors were assessed in 800 juvenile detainees, ages 10 to 18 years; youths were reinterviewed approximately 3 years later. The final sample (N = 689) includes 298 females and 391 males.

Results: The prevalence and persistence of HIV/STI risk behaviors were high in all of the diagnostic groups. Youths with an SUD at baseline were greater than 10 times more likely to be sexually active and to have vaginal sex at follow-up than youths with MMD+SUD (adjusted odds ratio [AOR] 10.86, 95% confidence interval [CI] 1.43-82.32; AOR 11.63, 95% CI 1.49-90.89, respectively) and four times more likely to be sexually active and to have vaginal sex than youths with neither disorder (AOR 4.20, 95% CI 1.06-16.62; AOR 4.73, 95% CI 1.21-18.50, respectively). Youths with an MMD at baseline were less likely to have engaged in unprotected vaginal and oral sex at follow-up compared with youths with neither disorder (AOR0.11, 95% CI 0.02-0.50; AOR 0.07, 95% CI 0.01-0.34, respectively), and with youths with an SUD (AOR 0.10, 95% CI 0.02-0.50; AOR 0.10, 95% CI 0.02-0.47, respectively). Youths with MMD+SUD were less likely (AOR 0.28, 95% CI 0.09-0.92) to engage in unprotected oral sex compared with those with neither disorder.

Conclusions: Irrespective of diagnostic group, delinquent youths are at great risk for HIV/STIs as they enter into adulthood. SUD increases risk. Because detained youths are released after approximately 2 weeks, their risk behaviors become a community health problem. Pediatricians and child and adolescent psychiatrists must collaborate with corrections professionals to develop HIV/STI interventions and ensure that programs started in detention centers continue after youths are released.