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CONTEXT: Since the advent of highly active antiretroviral therapy (HAART) in 1996, the incidence of HIV—especially among young men who have sex with men—and the prevalence of unprotected sex among HIV-positive persons have increased. The characteristics associated with unprotected sex among youth living with HIV since the advent of HAART have not been explored.

METHODS: Samples of HIV-positive youth aged 13-24 were taken from two intervention studies that targeted the sexual behaviors of HIV-positive youth—one from 1994 to 1996 (pre-HAART) and the other from 1999 to 2000 (post-HAART). Generalized estimating equations were used to identify characteristics associated with unprotected sex in each sample.

RESULTS: The prevalence of unprotected sex in the post-HAART sample was more than twice that in the pre-HAART sample (62% vs. 25%). Among the pre-HAART sample, being a man who has sex with men and having sex with a casual partner were negatively associated with the odds of unprotected intercourse (odds ratios, 0.5 and 0.2, respectively). Among the post-HAART sample, unprotected sex was negatively associated with knowing that a partner was HIV-negative (0.2) and positively associated with poorer mental health (1.02). In analyses among the post-HAART sample, poorer mental health was associated with increased odds of unprotected sex among youth living with HIV who were not receiving the treatment (1.02).

CONCLUSIONS: Interventions for HIV-positive youth must be designed to address the complex needs of those youth who simultaneously suffer from HIV and poor mental health.