A University of California-Los Angeles School of Medicine study of two HIV-positive youth cohorts found that a youth cohort surveyed in the 1999-2000 post-HAART era reported more sex partners, more unprotected sex and more drug abuse than a 1994-1996 pre-HAART cohort. The study does not prove the increase in risk behavior is HAART-related, but "these findings indicate the need for continued attention to the issue of sexual risk and the impact" of the new drugs, said lead author Marguerita Lightfoot.

Both pre- and post-HAART cohorts (n=349 and 175, respectively) enrolled teens from Los Angeles, San Francisco, New York, and Miami, and both groups were similar in terms of age, gender, race, and sociodemographic characteristics. Compared to the pre-HAART group, the post-HAART teens were almost twice as likely to have engaged in unprotected sex in the prior three months, had almost double the number of sex partners, and were more likely to have had an injection drug-using sexual partner.

Despite having been diagnosed earlier, the post-HAART cohort was in surprisingly worse shape and experienced more symptoms than the earlier group, and only 53 percent were on combination drug therapy. "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 that they were infected at a younger age," said Lightfoot.

As HIV therapies have improved patients' lives, patients who live longer also have potentially more opportunities to transmit the virus, said Lightfoot. "Simultaneously, evidence suggests that many people living with HIV believe that sexual behaviors that could lead to transmission of HIV, like unprotected sex, are less risky" if viral loads are low, she said.

The full report, "Risk Behaviors of Youth Living with HIV: Pre- and Post-HAART," was published in the American Journal of Health Behavior (2005;29(2):162-171).

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