Prevalence of and risk factors for substance use among perinatally human immunodeficiency virus-infected and perinatally exposed but uninfected youth

Abstract

Purpose: This study examined risk factors associated with recent substance use (SU) among perinatally human immunodeficiency virus (HIV)-infected (PHIV+) and perinatally exposed, uninfected (PHEU) youth and compared SU lifetime prevalence with the general population of United States (U.S.) adolescents.

Methods: We conducted cross-sectional and longitudinal analyses of 511 PHIV+ and PHEU youth (mean age at study entry, 13.2 years; 51% female; 69% PHIV+; and 72% African-American) enrolled in a U.S. multisite prospective cohort study between 2007 and 2009. Substance use data were collected by audio computer-assisted self-interview. Youth Risk Behavior Surveillance System and Monitoring the Future data were used to compare SU lifetime prevalence with U.S. samples.

Results: Perinatal HIV infection was not a statistically significant risk factor for alcohol or marijuana use. Risk factors for alcohol use among PHIV+ youth included higher severity of emotional and conduct problems and alcohol and marijuana use in the home by the caregiver or others. Risk factors for marijuana use among PHIV+ youth included marijuana use in the home, higher severity of conduct problems, and stressful life events. Similar SU risk factors among PHEU youth included SU in the home and higher severity of conduct and emotional problems. Overall lifetime prevalence of SU by age was similar to that in national surveys.

Conclusions: Although SU lifetime prevalence and risk factors for PHIV+ and PHEU adolescents were similar to national norms, the negative consequences are potentially greater for PHIV+ youth. Prevention efforts should begin before SU initiation and address the family and social environment and youth mental health status.

Keywords: Adolescent risk behavior; Adolescents; Human immunodeficiency virus; Perinatal human immunodeficiency virus exposure; Substance use.

Figure 1. Lifetime Prevalence of Substance Use: Adolescent Master Protocol, Monitoring the Future, and Youth Risk Behavior Surveillance System Cohorts ^{1, 2}

CI Confidence Interval, PrbEst Probability Estimate, PHIV+ Perinatally HIV-Infected, PHEU Perinatally HIV-Exposed but Uninfected, MTF Monitoring the Future, YRBSS Youth Risk Behavior Surveillance System ¹AMP PHIV+ and PHEU cohorts reported by age; MTF and YRBSS cohorts reported by school grade. ²Estimates of lifetime prevalence of SU at specific ages were calculated with prevalence modeled as a continuous function of age. Therefore (for model-fitting purposes only), the model includes subjects older than 17.5 years.