Before and After HAART

The introduction of highly active antiretroviral therapy (HAART) in 1996 quickly transformed the prognosis of HIV-positive individuals for the better. With the treatment, people living with HIV finally had a way to avoid developing AIDS and a chance to live longer, healthier lives. Although HAART was an unquestionably good thing from the perspective of the individual, some public health advocates worried that recipients of the treatment who felt healthy might be more likely to have unprotected sex with uninfected partners—possibly perpetuating the spread of the virus.

To examine this issue among young people, a population particularly burdened by the HIV epidemic, researchers from UCLA compared sexual behavior data from two samples of HIV-positive 13–24-year-olds: one from before the advent of HAART (1994–1996) and one from after (1999–2000). According to their study, published in the September 2006 issue of Perspectives, the proportion of the post-HAART sample who reported recent unprotected sex was more than twice that of the pre-HAART sample (62% vs. 25%). Importantly, poorer mental health was not linked to unprotected sex among the pre-HAART sample, but was positively associated with unprotected sex among the post-HAART sample. In analyses among just the later cohort, however, the relationship between poor mental health and unprotected sex was significant only for youth not receiving HAART—leading the authors to recommend that to reduce unprotected sex among young people living with HIV, interventions “must be designed to address the complex needs of those youth who simultaneously suffer from HIV and poor mental health.”

Cover illustrations of Margaret Sanger © Matthew and Eve Levine