A Longitudinal Study of the Prevalence, Development, and Persistence of HIV/STI Risk Behaviors in Delinquent Youth: Implications for Health Care in the Community

Abstract

Our goal was to examine the prevalence, development, and persistence of drug and sex risk behaviors that place delinquent youth at risk for HIV and other sexually transmitted infections. At the baseline interview, HIV/sexually transmitted infection drug and sex risk behaviors were assessed in a stratified random sample of 800 juvenile detainees aged 10–18 years. Participants were re-interviewed approximately 3 years later. The final sample in these analyses (n = 724) included 316 females and 408 males; there were 393 African American participants, 198 Hispanic participants, 131 non-Hispanic white participants, and two participants who self-identified their race as “other.” More than 60% of youth had engaged in ≥10 risk behaviors at their baseline interview, and nearly two thirds of them persisted in ≥10 risk behaviors at follow-up. Among youth living in the community, many behaviors were more prevalent at follow-up than at baseline. Among incarcerated youth, the opposite pattern prevailed. Compared with females, males had higher prevalence rates of many HIV/sexually transmitted infection risk behaviors and were more likely to persist in some behaviors and develop new ones. Yet, injection risk behaviors were more prevalent among females than males and were also more likely to develop and persist. Overall, there were few racial and ethnic differences in patterns of HIV/sexually transmitted infection risk behaviors; most involved the initiation and persistence of substance use among non-Hispanic whites and Hispanics. Because detained youth have a median stay of only 2 weeks, HIV/sexually transmitted infection risk behaviors in delinquent youth are a community public health problem, not just a problem for the juvenile justice system. Improving the coordination among systems that provide HIV/sexually transmitted infection interventions to youth – primary care, education, mental health, and juvenile justice – can reduce the prevalence of risk behaviors and substantially reduce the spread of HIV/sexually transmitted infection in young people.

This work was supported by National Institute of Mental Health grants R01MH54197 and R01MH59463 (Division of Services and Intervention Research and Center for Mental Health Research on AIDS) and Office of Juvenile Justice and Delinquency Prevention grants 1999-JE-FX-1001 and 2005-JL-FX-0288. Major funding was also provided by the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration (Center for Mental Health Services, Center for Substance Abuse Prevention, and Center for Substance Abuse Treatment), the National Institutes of Health Center on Minority Health and Health Disparities, the Centers for Disease Control and Prevention (National Center on Injury Prevention and Control and National Center for HIV, STD and TB Prevention), the National Institute on Alcohol Abuse and Alcoholism, the National Institutes of Health Office of Research on Women’s Health, the National Institutes of Health Office on Rare Diseases, Department of Labor, the William T. Grant Foundation, and the Robert Wood Johnson Foundation. Additional funds were provided by the John D. and Catherine T. MacArthur Foundation, the Open Society Institute, and the Chicago Community Trust. We thank all of our agencies for their collaborative spirit and steadfast support.

Many more people than the authors contributed to this project. This study could not have been accomplished without the advice of Ann Hohmann, PhD, Kimberly Hoagwood, PhD, Heather Ringeisen, PhD, and Eugene Griffin, PhD. Jacques Normand, PhD, Helen Cesari, MS, Richard Needle, PhD, Robert Booth, PhD, David Huizinga, PhD, and David Ostrow, MD, PhD, generously offered their expertise in developing our instruments. David Stoff, PhD, Grayson Norquist, MD, and Delores Parron, PhD, provided support and encouragement. Celia Fisher, PhD, guided our human subject procedures. We thank Frank Palella, Jr, MD, and the anonymous reviewers for their many helpful comments. We also thank all of the project staff, especially Amy Mericle, PhD, for instrumentation development and project leadership and Lynda Carey, MA, for her superb data management. We thank Kate Elkington, PhD, for literature review. We also greatly appreciate the cooperation of everyone working in the Cook County and State of Illinois systems. Without their cooperation, this study would not have been possible. Finally, we thank the participants for their time and willingness to participate and our field interviewers for their commitment to excellence.