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Correlates of Sexual Activity and Sexually Transmitted Infections Among Human Immunodeficiency Virus-infected Youth in the LEGACY Cohort, United States, 2006

Setse, Rosanna W. MD, PhD*; Siberry, George K. MD, MPH; Gravitt, Patti E. PhD*; Moss, William J. MD, MPH*; Agwu, Allison L. MD, ScM; Wheeling, John T. MS§; Bohannon, Beverly A. MS, RN; Dominguez, Kenneth L. MD, MPHfor the LEGACY Consortium

The Pediatric Infectious Disease Journal: November 2011 - Volume 30 - Issue 11 - p 967-973
doi: 10.1097/INF.0b013e3182326779
Original Studies

Background: To determine the prevalence and correlates of sexual activity and sexually transmitted infections (STIs) among human immunodeficiency virus (HIV)-infected youth.

Methods: The Longitudinal Epidemiologic Study to Gain Insight into HIV/AIDS in Children and Youth (LEGACY) is an observational medical record study of perinatally and behaviorally HIV-infected (PHIV and BHIV) youth followed at 22 US HIV clinics. PHIV youth were HIV infected at birth or by breast-feeding. BHIV youth were HIV infected sexually or by injection drug use. We determined the prevalence of sexual activity during 2006 and examined correlates of sexual activity among 13- to 24-year-old PHIV youth using multivariable generalized linear models. Among sexually active persons, we determined the association between mode of HIV acquisition and non-HIV STI diagnosis using multivariable generalized linear models.

Results: In all, 34% (195/571) of PHIV and 89% (162/181) of BHIV youth were sexually active. Eighty percent (155/195) of sexually active PHIV youth reported ever using condoms. Ninety-three percent discussed sex with a health care provider. Increasing age (adjusted prevalence ratio [APR]: 1.17 per year of age, 95% confidence interval [CI] = 1.12–1.23), having a boyfriend/girlfriend (APR: 2.74, 95% CI = 1.75–4.29), and injection drug use (APR: 1.38, 95% CI = 1.06–1.79) correlated with sexual activity after adjusting for socio-demographic and HIV-related clinical variables. Among sexually active youth, after adjusting for relevant confounders, PHIV youth were less likely than BHIV youth to have been diagnosed with an STI in 2006 (APR: 0.25, 95% CI = 0.13–0.46).

Conclusions: Sexual activity among HIV-infected adolescents is common. Factors associated with sexual activity in this study should be taken into account in developing behavioral risk reduction interventions targeting PHIV youth.


From the *Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, MD; †Pediatric Adolescent Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD; ‡Department of Pediatric Infectious Diseases, Johns Hopkins Medical Institution, Baltimore, MD; §Northrop Grummon Inc., Atlanta, GA; and ¶Centers for Disease Control and Prevention, Atlanta, GA.

Accepted for publication May 16, 2011.

The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the Centers for Disease Control and Prevention or the institutions with which the authors are affiliated.

Sources of funding: The LEGACY project was funded by the Centers for Disease Control and Prevention, Atlanta, GA, contract number 200-2004-09976.

The authors have no conflicts of interest to disclose.

Address for correspondence: Rosanna Setse, MD, MPH, PhD, Formerly of Johns Hopkins School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205. E-mail:

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© 2011 by Lippincott Williams & Wilkins, Inc.