Substance Use Disorders and HIV/AIDS Risk Behaviors in Youth After Juvenile Detention: A 16-Year Longitudinal Study

Abstract

Purpose: To examine the association between substance use disorders (SUDs) and HIV/AIDS risk behaviors in detained youth as they age.

Methods: Prospective longitudinal study of a stratified random sample of 1,829 youth aged 10 to 18 years at baseline, sampled between November 1995 and June 1998 from the Cook County Juvenile Temporary Detention Center, Chicago, Illinois, and reinterviewed up to 13 times (to median age 32); 17,766 interviews overall.

Results: Youth had greater odds of engaging in every risk behavior when they had an SUD compared with when they did not have an SUD. For example, SUD was associated with condomless vaginal sex with a high-risk partner (OR: 2.28, 95% CI: 1.84-2.82). SUD was also associated with multiple partners, although the strength varied by time and sex (e.g., 16 years after baseline, OR: 3.58, 95% CI: 2.46-5.23 females; OR: 2.07, 95% CI: 1.48-2.88 males). Types of SUD-alcohol, comorbid alcohol and marijuana, drugs other than marijuana-were also associated with HIV/AIDS risk behaviors.

Discussion: SUDs and HIV/AIDS risk behaviors are linked among youth in the juvenile justice system and as they age. There is a longstanding need for targeted and integrated HIV and SUD services, but this need remains unmet.

Keywords: HIV/AIDS risk behaviors; Juvenile justice; Longitudinal; Substance use disorders.

Figure 1:

Estimated prevalence of Multiple Partners (>1 and >3) over time by type of SUD (yes/no or typology). Colored/dashed lines indicate prevalence estimates for different groups based on sex and type of SUD. For example, in the first column, solid blue lines indicate the prevalence of multiple partners among males who have an SUD at the time point; dashed blue lines indicate the prevalence of multiple partners among males who do not have an SUD at the time point. Red lines indicate the analogous estimates for females. In the second column (showing males) and the third column (showing females), pink lines indicate the prevalence of multiple partners among those who have alcohol and marijuana disorder at the time point. Purple, blue, green and gray lines indicate prevalence of multiple partners among those with a drug disorder other than marijuana, alcohol use disorder, marijuana use disorder, and no SUD at that time point, respectively. Marginal prevalence estimates were generated using generalized linear mixed effects models.

Figure 2:

Estimated prevalence of Condomless Vaginal Sex and Condomless Anal Sex over time by type of SUD (yes/no or typology). Colored/dashed lines indicate prevalence estimates for different groups based on sex and type of SUD. For example, in the first column, solid blue lines indicate the prevalence of the risk behavior among males who have an SUD at the time point; dashed blue lines indicate the prevalence of the risk behavior among males who do not have an SUD at the time point. Red lines indicate the analogous estimates for females. In the second column (showing males) and the third column (showing females), pink lines indicate the prevalence of the risk behavior among those who have alcohol and marijuana disorder at the time point. Purple, blue, green and gray lines indicate prevalence of multiple partners among those with a drug disorder other than marijuana, alcohol use disorder, marijuana use disorder, and no SUD at that time point, respectively. Marginal prevalence estimates were generated using generalized linear mixed effects models.

Figure 3:

Estimated prevalence of Vaginal Sex with a High-Risk Partner (Condomless and Not) over time by type of SUD (yes/no or typology). Colored/dashed lines indicate prevalence estimates for different groups based on sex and type of SUD. For example, in the first column, solid blue lines indicate the prevalence of the risk behavior among males who have an SUD at the time point; dashed blue lines indicate the prevalence of the risk behavior among males who do not have an SUD at the time point. Red lines indicate the analogous estimates for females. In the second column (showing males) and the third column (showing females), pink lines indicate the prevalence of the risk behavior among those who have alcohol and marijuana disorder at the time point. Purple, blue, green and gray lines indicate prevalence of multiple partners among those with drug disorder other than marijuana, alcohol use disorder, marijuana use disorder, and no SUD at that time point, respectively. Marginal prevalence estimates were generated using generalized linear mixed effects models.

Figure 4:

Estimated prevalence of Sex While Drunk or High (with a High-Risk Partner or Condomless) over time by type of SUD (yes/no or typology). Colored/dashed lines indicate prevalence estimates for different groups based on sex and type of SUD. For example, in the first column, solid blue lines indicate the prevalence of the risk behavior among males who have an SUD at the time point; dashed blue lines indicate the prevalence of the risk behavior among males who do not have an SUD at the time point. Red lines indicate the analogous estimates for females. In the second column (showing males) and the third column (showing females), pink lines indicate the prevalence of the risk behavior among those who have alcohol and marijuana disorder at the time point. Purple, blue, green and gray lines indicate prevalence of multiple partners among those with a drug disorder other than marijuana, alcohol use disorder, marijuana use disorder, and no SUD at that time point, respectively. Marginal prevalence estimates were generated using generalized linear mixed effects models.