ABSTRACT
BACKGROUND: Incarcerated and detained youth are at high risk for sexually transmitted diseases (STD), including human immunodeficiency virus (HIV). GOAL OF THE STUDY: To compare the level of sexual activity and substance use-related risk and knowledge regarding HIV/STD among male adolescents with multiple (YMA) versus first admissions (YFA) to a detention facility as a basis for the development of specific intervention strategies. STUDY DESIGN: Sexual and substance use histories, HIV/STD knowledge, and perceived risk were collected through structured interviews of a consecutive sample of detained youth. Human immunodeficiency virus antibody seroprevalence was determined using a blind study of discarded blood. RESULTS: Overall, these youth (N = 486) reported high levels of noninjection drug use, sexual risk activities, and knowledge regarding HIV/STD prevention. Furthermore, most of these youth reported that their risk for HIV infection was low (68%). Eighty-one percent of all youth reported recent (past 6 months) vaginal sex, and 14% reported insertive anal sex. Controlling for age, YMA were more likely to initiate sex at age 13 or younger (OR 1.38; 95% CI, 1.11-1.70), to report eight or more lifetime sex partners (OR 1.36; 95% CI, 1.13-1.63), and to have ever exchanged drugs or money for sex (OR 1.54; 95% CI, 1.08-2.19). However, these youth were less likely to report condom use with their last sex partner (OR 0.74; 95% CI, 0.60-0.93). More than one third (34%) of all youth felt that consistent use of condoms would not provide a high level of protection against HIV. CONCLUSION: Youth with multiple versus first admissions are at higher risk of HIV/STD infections through their lifetime and recent sexual activities. Interventions targeted to this population will need to address the barriers to and facilitators of condom use, strategies to promote positive attitudes toward condoms, and strategies to reduce the high level of alcohol and substance use.
