Substance use and sexual risk behaviors in perinatally human immunodeficiency virus-exposed youth: roles of caregivers, peers and HIV status.

Purpose: To examine the association between sexual risk behaviors and substance use, as well as the impact of caregiver characteristics and perceived peer norms among perinatally HIV-exposed but uninfected and perinatally HIV-infected youth.

Methods: Using baseline data from a multisite study of psychosocial behaviors in perinatally HIV-exposed urban youth (N = 340; 61% HIV+; 51% female; aged 9-16 years). We conducted interviews with youth-caregiver dyads. Using hierarchical logistic regression, we explored the association between lifetime sexual risk behaviors, cigarettes, alcohol, marijuana, other drug use, caregiver relationship characteristics and peer influence.

Results: Cigarettes, alcohol, and marijuana were significantly associated with HIV sexual risk behavior; no youth reported other drug use. After accounting for peer norms, the relationship between substance use and risky sexual behaviors was somewhat diminished. Irrespective of substance use, perception that more peers were involved in risky sex was associated with sexual risk behavior. Caregiver relationship characteristics had no effect on the association between substance use and risky sexual behavior. In all analyses, we found no effect across HIV status.

Conclusions: Regardless of HIV status, perinatally exposed youth who use substances are more likely to engage in sexual risk behaviors. Although the current study shows that peer influence on risky sexual behavior is more robust, caregivers are still important. The pediatric and adolescent HIV community must develop multilevel prevention initiatives that target youth, their peers, and their families.