Young motherhood and social functioning among a national cohort of HIV-infected female adolescents in the LEGACY study, USA, 2006

Background: As perinatally HIV-infected youth become adults and sexually active, reproductive health issues must be considered. We examined the association between social functioning and young motherhood among HIV-infected females aged 13-24 years.

Methods: We analyzed cross-sectional data from female enrollees age 13-24 years as of 2006 in CDC's LEGACY study, a longitudinal cohort of HIV-infected children/adolescents, in care at 20 U.S. HIV clinics. Data included socio-demographic information; sexual/reproductive histories, substance use, mental health and HIV-related factors. Positive social functioning (PSF) index measured living with family, steady partners, school achievement, having insurance and using condoms. Negative social functioning (NSF) index measured unstable housing, sexual abuse, referral to mental health services, substance use, and biological parent death. The independent variable was live birth (Yes/No).

Results: Of 500 participants, 324 (64.8%) were Black, 134 (26.8%) were Latina, 327(65.4%) had perinatally acquired HIV, 146 (29.2%) had ever been pregnant, and 99 (19.8%) had a live birth. Mean age was 18 years (sd = 3.4). In univariate analyses, young women who had live birth and those who did not had median PSF index scores of 5.0 and 3.0, respectively; both groups had median NSF index scores of 1.0. In multivariate analyses, after adjusting for age, higher PSF index (AOR =1.25, CI=1.05-1.50) was associated with live birth; NSF index was not significant.

Conclusions: Young motherhood was associated with PSF. Social support, educational achievement and insurance coverage facilitated keeping a pregnancy. Further analyses exploring interactions among service providers and clients may further explain this relationship.