Arlene Schneir

Risk Acts, Health Care, and Medical Adherence Among HIV+ Youths in Care over Time

The level and consistency of HIV-related sexual and substance-use risk acts, health status, and medical adherence were examined among 102 HIV+ youths aged 14 to 23 years (27% African American, 33% Latino). Over their lifetime, youths engaged in unprotected sexual acts with multiple partners (M = 284; Median = 44; consistent condom protection, 5%) and substance use (21% injecting drug use; 68% hard drugs). When current risk behaviors were assessed twice over two consecutive 3-month periods, almost one third had been sexually abstinent. Among youths who were currently sexually active, most had multiple sexual partners (M = 5.7, Time 1; 4.9, Time 2) and used condoms (72-77% sexual acts protected); most of the youths (63-64%) always used condoms. Use of alcohol (63%), marijuana (41%), hard drugs (36%), and injecting drugs (12%) was substantial. Youths were relatively healthy (M T cells = 521.4; 14% T cells < 200; 1.9 diseases and 3.7 physical symptoms in the previous 3 months); they attended about one third of their medical appointments. While all youths were linked to adolescent HIV programs, unhealthy behavior and risk acts remained common. More effective and intensive intervention appears required.

Childrens Hospital Los Angeles: a model of integrated care for HIV-positive and very high-risk youth.

Childrens Hospital Los Angeles (CHLA) provides an integrated care model for youth with and at high risk for human immunodeficiency virus (HIV) infection, through a grant from the Special Projects of National Significance Program, HIV/acquired immunodeficiency syndrome (AIDS) Bureau, Health Resources and Services Administration. The project has provided outreach to 8400 youth at risk and has provided clinical services to 296 young men (16.6% HIV positive) and 352 young women (9.1% HIV positive). Situated within the Division of Adolescent Medicine at Childrens Hospital Los Angeles, the project consists of a general medical clinic for youth along with psychosocial services including case management, counseling, and related ancillary services. A key part of the model is to provide health services within a general medical clinic for youth where participation in the clinic does not serve to identify a youth to his or her peers in the waiting room as having HIV. Another key part of the model is to provide extensive outreach within the community including contacts at bars and social clubs where high-risk youth congregate, on the street, and through the social networks of youth already identified as having HIV who participate in the CHLA clinics. In the last 2 years of the program, the peer outreach component has been strengthened and peer support activities have also been implemented. The program also has developed a Computer-Assisted Adolescent Referral System (CAARS), available on diskette and on the Internet, for the referral of youth to services in the Hollywood area.

Modeling HIV Risk in Highly Vulnerable Youth

This article examines the structure of several HIV risk behaviors in an ethnically and geographically diverse sample of 8,251 clients from 10 innovative demonstration projects intended for adolescents living with, or at risk for, HIV. Exploratory and confirmatory factor analyses identified 2 risk factors for men (sexual intercourse with men and a general risk factor) and 3 factors for women (sexual intercourse with men, substance abuse, and a high risky sex behavior factor). All factors except women engaging in risky sex with men strongly predicted known HIV status of clients for men and women. The findings from this investigation highlight the use of structural equation modeling for applied problems involving overlapping and complex sets of risk behaviors in youth who present at community health programs.

Service Use Patterns of Youth with, and at High Risk for, HIV: A Care Typology

This paper uses confirmatory structural equation models to develop and test a theoretical model for understanding the service utilization history of 4679 youth who received services from 10 national HIV/AIDS demonstration models of youth-appropriate and youth-attractive services funded by the Special Projects of National Significance (SPNS) Program, HIV/AIDS Bureau, Health Resources and Services Administration. Although the projects differ from one another in the areas of emphasis in their service models, each is targeted to youth at high risk for HIV, or those youth who have already contracted HIV. Collectively, the projects represent a comprehensive adolescent HIV service model. This paper examines the characteristics of the services provided to young people ranging from outreach to intensive participation in medical treatment. Major typologies of service utilization are derived empirically through exploratory factor and cluster analysis methods. Confirmatory structural equation modeling methods are used to refine the exploratory results using a derivation and replication strategy and methods of statistical estimation appropriate for non-normally distributed service utilization indicators. The model hypothesizes that youth enter the service system through a general construct of connectedness to a comprehensive service model and through service-specific methods, primarily of outreach or emergency services. Estimates are made of the degree to which a comprehensive service model drives the services as opposed to specific service entry points.