Young Americans living with HIV are worse off — and having much more risky sex — since powerful AIDS drugs came along.

You might think that the drugs, known as highly active antiretroviral therapy (search) or HAART (search), would make life better for HIV-infected youths. You might think that when teens learn they have the AIDS virus, they would be more careful about unsafe sex and substance abuse. But you would be wrong.

"Post-HAART youth living with HIV were more likely to engage in unprotected sex and substance abuse, to be more emotionally distressed, and to have lower quality of life than were pre-HAART youth living with HIV," UCLA researcher Marguerita Lightfoot, PhD, and colleagues report in the February issue of the American Journal of Health Behavior.

Lightfoot's team made an extraordinary effort to find young Americans living with HIV — and to get honest information from them. In Los Angeles, San Francisco, New York, and Miami, they recruited young people aged 13 to 24 through social service agencies, medical clinics, street outreach, and community advertisements.

From 1994 to 1996 — before HAART became available — they recruited 349 youths. From 1999 to 2000, well after the 1997 advent of HAART, they recruited another 175 youths. All underwent standardized two-hour interviews. In both time periods, the average study participant was 21 years old.

Youths in the before-HAART era averaged about six sex partners, with whom they had unprotected sex 27 percent of the time. In the era after HAART became available, this number shot up to more than 10 sex partners and unprotected sex 42 percent of the time. The HAART-era youth also were twice as likely to report sex with an injection drug user.

Surprisingly, youths in the HAART era were sicker than the kids interviewed before HAART became available. They were twice as likely to have AIDS (21 vs. 10 percent) and significantly more likely to have had symptoms of HIV disease (49 vs. 39 percent).

“It is surprising that the post-HAART youth experienced more symptoms," Lightfoot says, in a news release. "This suggests that although they are being identified as HIV positive at a younger age, these youth are being identified later in the progression of disease. Therefore, it is also likely they were infected at a younger age."

Given these findings, it's not surprising that the HAART-era youth were two to three times more likely to abuse drugs and alcohol, more likely to be clinically distressed, had worse coping skills, and were more likely to commit delinquent acts or spend time in jail.

Although three-fourths of the HAART-era youth had been prescribed HAART drugs, only about half were still taking the lifesaving drugs.

"Targeted interventions for youth living with HIV that address risk behaviors and aim to improve quality of life are needed now more than ever before," Lightfoot and colleagues conclude.

By Daniel J. DeNoon, reviewed by Michael W. Smith, MD

SOURCES: Lightfoot, M. American Journal of Health Behavior, February 2005; vol 29: pp 162-171. News release, Center for the Advancement of Health, University of California, Los Angeles.