Major mental disorders, substance use disorders, comorbidity, and HIV-AIDS risk behaviors in juvenile detainees

Objectives: This study determined the prevalence of 20 HIV-AIDS risk behaviors of four groups of juvenile detainees: those with major mental disorders alone, those with substance use disorders alone, those with comorbid mental and substance use disorders, and those without any major mental or substance use disorder. Methods: Interviewers administered the AIDS Risk Behavior Assessment to 800 randomly selected juvenile detainees aged ten to 18 years who were initially arrested between 1997 and 1998. Diagnoses were determined with the Diagnostic Interview Schedule for Children, Version 2.3. Results: The sample included 340 females and 460 males. As with the other groups of detainees, youths with major mental disorders had a high prevalence of most HIV-AIDS risk behaviors, much higher than the rates found among youths in the general population. Comorbid substance use disorders substantially increased risk; 96 percent of youths in this group had been sexually active, 62 percent had had multiple partners within the past three months, and 59 percent had had unprotected vaginal sex in the past month. Among youths with a substance use disorder, either alone or with a comorbid major mental disorder, more than 63 percent had engaged in five or more sexual risk behaviors. Conclusions: Delinquents with substance use disorders, either with or without comorbid major mental disorders, are at particular risk of HIV-AIDS. The juvenile justice and public health systems must provide HIV-AIDS interventions as well as mental health and substance abuse treatment. Greater coordination between community services and correctional facilities can reduce the prevalence of HIV-AIDS risk behaviors of juvenile delinquents and stem the spread of HIV infection among young people.