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Use of HAART Among Young People Living with HIV
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American Journal of Health Behavior (07./08.03) Vol. 27; No.4: P. 389-400 W. Scott Comulada, MS; Dallas T. Swendeman, MPH; Mary Jane Rotheram-Borus, PhD; Kathy M. Mattes, BA; Robert E. Weiss, PhD
The authors conducted the current study to examine the use of highly active antiretroviral therapy among young people living with HIV (YPLH), who account for about 50 percent of new HIV infections worldwide. Acknowledging that there may be selection bias in who chooses HAART or gains access to HAART, they also examined factors associated with HAART use and adherence, particularly sexual and substance-use transmission acts.
From June 1999 to December 2000, YPLH were recruited from HIV/AIDS clinical care sites, street outreach programs, and through advertisements and community announcements in New York, Los Angeles, and San Francisco. A total of 258 participants answered questions about medications/adherence, health status, sexual behavior, substance use, life expectancies, negative life events, mental health symptoms, quality of life, social support and coping style. Subjects ranged in age from 14 to 29; most were male (71 percent); and 82 percent self-identified as gay or bisexual. Nineteen percent were white, 42 percent Latino, 32 percent African American, and 8 percent of other ethnicities. On average, YPLH had known they were infected for about 3.8 years. At recruitment, 24 percent were diagnosed with AIDS and 55 percent were symptomatic for HIV infection.
The study found 54 percent of the sample currently using HAART, and 77 percent having used HAART at some point. Reasons for discontinuing HAART included side effects and feeling they were on too many medications. Nonusers cited fear of side effects or that HAART would make them feel worse. Females (66 percent) were more likely than males (49 percent) to use HAART. African American, Latino, and other ethnicities tended to use HAART more often than white YPLH. There were no age differences between users and nonusers.
HAART users were less likely than nonusers to have more than 9 sexual partners, to barter sex, and to have IDU sexual partners. Users reported lower levels of STDs over their lifetimes, lower substance-abuse rates and said they anticipated a longer life than nonusers. Users were less likely than nonusers to have spent time in jail. Users reported higher levels of social support and expressed higher life satisfaction than nonusers. Users had coping styles high on positive action and low on self-destructive escape-coping styles.
Among those currently using HAART, 63 percent indicated adherence to 90 percent or more of their medications during the past three months. The sociodemographic profiles of adherers were similar to those of nonadherers. The frequency of recent drug use was lower among adherers than nonadherers.
The authors found that 45 percent of YPLH studied had recently engaged in unprotected sex acts. "These patterns suggest that social expectations concerning the consequences of transmission acts may be changing among YPLH in the United States," they wrote. "The potential reasons for increasing rates must be the focus of further research."
Self-selection appears to operate for HAART use, rather than preselection by doctors, according to the study. "These data suggest that young people who are using and adhering to HAART medications are those who have a lifetime of responsible behaviors and effective coping styles. YPLH whose behavioral styles are safer continue to be highly responsible and consistent in their health behaviors," the authors concluded. However, they noted that the higher rates of recent transmission behaviors, compared to those of youth studied in 1993, "suggest a cultural shift is occurring among gay men. Higher rates of transmission behaviors are occurring among youth who show extremely responsible lifestyles."
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