RESUMEN
PURPOSE: To describe disclosure of HIV serostatus by infected youth to parents and sexual partners and to examine the association of disclosure with subject characteristics. METHODS: Baseline data on 317 HIV infected adolescents in national 15 site study were examined. Data sources included direct and computer-assisted interview, laboratory studies, and chart reviews. Examination of parental disclosure was restricted to subjects without parental permission requirements. Concordance in parental disclosure/support used McNemar's test. Associations between disclosure to parent(s) and subject characteristics were examined using logistic regression analysis. Repeated measure analysis was used for sexual partner disclosure. RESULTS: Subjects of both genders more often disclosed their HIV infection status to mothers than to their fathers (77% vs. 47%, p < .001). With disclosure, perceived support from either parent was high. In multivariate analyses, factors associated with maternal disclosure were length of time since diagnosis (OR = 1.43; 95% CI: 1.06-1.92), and Hispanic ethnicity (OR = .37; 95% CI: .15-.95). No factors were significantly associated with paternal disclosure in multivariate analysis, although length of time since diagnosis showed a trend (OR = 1.31; 95% CI: 1.00-1.74). Factors associated with disclosure to sexual partners were partner's HIV+ status (OR = 2.09; 95% CI: 1.11-3.93) and "main partner" status (OR = 3.17; 95% CI: 1.84-5.46). CONCLUSIONS: Although subjects were more likely to reveal their status to their mothers, parental support was perceived as high after disclosure to either parent. Since "time since diagnosis" was associated with parental disclosure, support systems are necessary for youth until such a disclosure can occur.
Asunto(s)
Infecciones por VIH/diagnóstico , Relaciones Padres-Hijo , Revelación de la Verdad , Adolescente , Femenino , Infecciones por VIH/psicología , Humanos , Masculino , Pruebas Serológicas , Conducta Sexual , Apoyo Social , Factores de TiempoRESUMEN
PURPOSE: To characterize sexual behaviors and sociodemographic factors that are associated with douching among geographically diverse adolescent women with and without HIV infection. METHODS: HIV infected subjects recruited preferentially and behaviorally comparable high-risk HIV uninfected subjects were enrolled in a prospective HIV study from 15 sites in 13 U.S. cities. Baseline interview data from 1996 to 1999 for females aged 12 to 19 years were analyzed using one-way analysis of variance and multiple logistic regression. RESULTS: Among the 342 females/young women, 74.9% were black (non-Hispanic), 11.1% Hispanic/Latina, and 14.0% white or other race/ethnicity; 63.5% were HIV infected. Young women who had dropped out of high school comprised 23.4% of subjects. In the 3 months before the interview, 179 (52.3%) adolescents had douched at least once. In a multivariable logistic regression model, recent douching was more common among sexually active females (OR = 2.2; 95% CI: 1.2-4.2), Blacks (OR = 2.2; 95% CI: 1.2-4.1 vs. Hispanics/Whites/others), females who dropped out of high school (OR = 2.1; 95% CI: 1.2-3.7), and HIV infected females (OR = 1.7; 95% CI: 1.04-2.7). CONCLUSIONS: In this nationwide study, adolescents who are sexually active, African-American, dropped out of high school, and HIV infected were most likely to douche. Interventions to discourage douching should pay special attention to these populations.
Asunto(s)
Conducta del Adolescente , Conducta Sexual , Irrigación Terapéutica/psicología , Adolescente , Negro o Afroamericano/psicología , Niño , Características Culturales , Escolaridad , Etnicidad , Femenino , Humanos , Estudios Prospectivos , Factores de Riesgo , Abandono Escolar/psicologíaRESUMEN
This seroprevalence report examines serologic evidence of hepatitis B immunization or infection and associated demographic/behavioral factors in adolescent (aged 12-20) subjects enrolled in a nontherapeutic clinical trial at 43 Pediatric AIDS Clinical Trials Group (PACTG) clinical centers. Subjects (n = 94) infected with the human immunodeficiency virus (HIV) through sexual activity were categorized as hepatitis B virus (HBV)-immunized, HBV-infected, or nonimmune by hepatitis B serology performed on specimens collected within the subject's first 48 weeks on study (1993-1995). Sixteen percent of the 94 serologically classified subjects were immunized; 19% HBV-infected; 65% nonimmune. Of the three risk factor scores examined (sociodemographic, sexual, and substance abuse), substance use alone demonstrated a significant difference among groups (despite virtually no reported injecting drug behavior), with the sexual risk score exhibiting marginally significant differences. Logistic regression analysis (restricted to nonimmunized subjects) showed that male-male sexual activity raised the odds of HBV infection by a factor of 5.14 (95% confidence interval [CI]: 1.45-18. 23) relative to heterosexual activity; and that for every one point increase on the substance abuse risk scale the odds of infection increased 5% (95% CI: 0.99-1.10). The HBV infection rate in PACTG 220 HIV-positive females is twice United States population-based rates; the rate in PACTG 220 HIV-positive males is nearly seven times higher. Past immunization efforts in this population appear to have been based on sexual activity volume without regard to injecting-drug use in sex partners.
Asunto(s)
Seropositividad para VIH/complicaciones , Vacunas contra Hepatitis B , Hepatitis B/complicaciones , Hepatitis B/epidemiología , Vacunación/estadística & datos numéricos , Adolescente , Adulto , Niño , Femenino , Hepatitis B/sangre , Hepatitis B/inmunología , Hepatitis B/prevención & control , Anticuerpos contra la Hepatitis B/sangre , Humanos , Modelos Logísticos , Masculino , Vigilancia de la Población , Valor Predictivo de las Pruebas , Factores de Riesgo , Estudios Seroepidemiológicos , Conducta Sexual/estadística & datos numéricos , Factores Socioeconómicos , Abuso de Sustancias por Vía Intravenosa/complicaciones , Estados Unidos/epidemiologíaRESUMEN
AIDS: Adolescent pregnancy rates are dropping overall, but a significant number of adolescent pregnancies occur in women infected with HIV. Pregnancy and parenting issues are intensified and more complex in this group than in the uninfected. Newly diagnosed young women with HIV face important life decisions but they are poorly prepared to address them. The significance of pregnancy is so potent in impoverished communities that many women want to become pregnant at a very young age. A study of HIV-infected women with substance abuse histories shows that they identify childbearing with independence and hope. Young mothers and their children benefit from services that help them build on their strengths and encourage skills development. They need vocational support, health care, case management, and counseling. Providers need to be careful, however, to remain professional and not become overly involved.^ieng
Asunto(s)
Seropositividad para VIH/psicología , Madres/psicología , Embarazo en Adolescencia , Adolescente , Consejo , Femenino , Humanos , EmbarazoRESUMEN
The Louisiana minor's consent statutes enable minors to consent for medical treatment, emergency treatment, treatment of sexually-transmitted diseases, and treatment of substance abuse. The legislative intent for permitting minors to consent to treatment without the express consent of a parent or guardian was to provide minors access to high-quality health care services in order to encourage the betterment of the health and welfare of the citizens of our state. A minor cannot consent for an abortion or sterilization. The statutes do not allow a minor to refuse treatment consented to by his parent or guardian. However, needed medical treatment can be provided to a consenting minor over the objections of a parent or guardian. Where a minor can consent, confidentiality from parent's or guardian's knowledge is permitted but not assured; confidentiality is granted at the discretion of the physician or medical staff.
Asunto(s)
Adolescente , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Consentimiento Informado/legislación & jurisprudencia , Legislación Médica , Confidencialidad , Humanos , Louisiana , Consentimiento por Terceros/legislación & jurisprudencia , Negativa del Paciente al TratamientoRESUMEN
PURPOSE: There is limited information regarding the clinical manifestations of human immunodeficiency virus (HIV) infection among adolescents. To better define the clinical presentation and course of HIV disease in this population, a retrospective review of all HIV-infected persons age 13-21 years at entry into a public, inner-city HIV outpatient clinic in New Orleans, Louisiana, was undertaken. RESULTS: A total of 141 adolescents were included in this study. The cohort was predominantly female (65%) and African-American (83%), and acquired HIV infection through sexual contact (89%). As many as 75% of the females and 48% of the males were diagnosed with at least one sexually transmitted disease (STD), respectively, and young African-American females with a CD4 cell count > 500/mm3 were at highest risk. The proportions of female adolescents having a gravida > or = 1 and 2 were 82% and 20%, respectively. A total of 55% of females were diagnosed with squamous intraepithelial lesions (SIL) at least once. Similar to adults, the majority of opportunistic processes occurred in adolescents with a CD4 cell count < 200/mm3. Known HIV-related symptoms (oral hairy leukoplakia, thrush, and zoster) were significantly predictive (p < .0001) for HIV disease progression. CONCLUSIONS: Although HIV-related symptoms and infections do not appear to be unique in the adolescent population, it is clear that STDs and pregnancies are common among female adolescents. Our results emphasize the need for aggressive STD and contraceptive protection counseling, and surveillance screening for STDs and cervical dysplasia.
Asunto(s)
Infecciones por VIH/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/fisiopatología , Adolescente , Adulto , Distribución por Edad , Antivirales/uso terapéutico , Recuento de Linfocito CD4 , Estudios de Cohortes , Intervalos de Confianza , Conducta Anticonceptiva , Progresión de la Enfermedad , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/fisiopatología , Infecciones por VIH/transmisión , Humanos , Modelos Logísticos , Louisiana/epidemiología , Masculino , Embarazo , Embarazo en Adolescencia/estadística & datos numéricos , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Riesgo , Distribución por Sexo , Conducta Sexual , Enfermedades de Transmisión Sexual/epidemiologíaRESUMEN
Chlamydial disease in adolescent women is a serious public health problem, but secondary preventive efforts through early detection and treatment are encumbered by the cost and complexity of mass screening. This study was undertaken to identify clinical predictors of infection that might narrow the scope of screening adolescent populations. Demographic/clinical data and endocervical smears for the direct-specimen fluorescein-conjugated monoclonal antibody test for Chlamydia trachomatis were collected from 244 consecutive women, 21 years of age or less, attending an adolescent health clinic. Positive direct-specimen fluorescein-conjugated monoclonal antibody test for C trachomatis results were associated with a past history of chlamydial infection, multiple sexual partners, sexual contact with men with urethritis, nonuse of condoms, metrorrhagia, exocervicitis, mucopurulent endocervical discharge, abnormal cervical cytologic features, and isolation of Neisseria gonorrhoeae from the endocervix. These variables were entered into a discriminant analysis to predict direct-specimen fluorescein-conjugated monoclonal antibody test for C trachomatis results. The discriminant function was statistically significant but explained only 17% of between-group variance. Two variables alone, exocervicitis and partners with urethritis, correctly predicted direct-specimen fluorescein-conjugated monoclonal antibody test for C trachomatis results in 79% of all cases (negative predictive value 90%; positive predictive value 35%). When routine screening with reliable laboratory tests is not feasible, selective testing or empirical treatment of adolescent women with either risk factor may be cost-effective alternatives.