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Hemophiliacs are at considerable risk for harboring and transmitting the human immunodeficiency virus (HIV). The National Hemophilia Foundation and the Public Health Service have recommended that hemophiliac men, who have tested positive for HIV or who have not been tested, refrain from unprotected sexual intercourse. It is also recommended that their partners not become pregnant until more is known about the transmission of the virus. Despite these warnings, there are many pregnancies among sex partners of hemophiliac men who are HIV-positive. In a study of 24 completed pregnancies, it was determined that 37.5 percent of the pregnant women learned of their partners' HIV-positivity and received counseling prior to the fifth month of pregnancy, when abortion was an option; at least nine women knew they were HIV-positive prior to their fifth month of pregnancy. Despite recommendations to the contrary, the pregnancies were carried to term; 37 percent of these pregnancies had been planned. Thirty percent of the children born were HIV-positive. Breast milk was considered an important source of HIV transmission. Three infants contracted pneumonia and two died. Two children had HIV-related symptoms of lymphadenopathy (lymph node disease) and idiopathic thrombocytopenic purpura (abnormal decrease in blood platelets). These findings are thought to represent the minimal level of HIV transmission, since they were based solely on clinical symptoms; there is increasing evidence that infected children, unlike infected adults, may test negative. This study demonstrates that infants of HIV-infected women are at extremely high risk for HIV infection, even if the infected mother is healthy, and does not engage in high risk activities such as sexual promiscuity or intravenous drug use. (Consumer Summary produced by Reliance Medical Information, Inc.)

Purpose. To determine the factors associated with the adoption or maintenance of consistent safer sexual behaviors among human immunodeficiency virus-positive adolescents and young adults with hemophilia. Methods. One hundred eleven adolescents at 10 hemophilia care sites participated in an intervention program designed to increase safer sexual behaviors (abstinence, condom use, or nonpenetrative behavior). The theory-based intervention spanned 1 year. Adolescents attended individual sessions, small group activities, and an intensive group retreat. Results. Patients who maintained or improved safer sexual behaviors were compared with those who relapsed or did not improve. Logistic regression analyses found that improvement and maintenance of safer sexual behavior were significantly associated with perceived peer support for outercourse (odds ratio [OR]: 5.47; confidence interval [CI]: 1.4-20.8), perceived peer support for abstinence (OR: 5.08; CI: 1.2-20.1), and decreased general emotional distress (OR: 4.65; CI: 1.04-20.6). Perceived health status and previous sexual behavior were unrelated to change in safer sexual behavior. Conclusions. These longitudinal data indicate that improvement and maintenance of safer sexual behavior among adolescents during an intervention is strongly associated with perceptions of peer support for safer sex and lesser degrees of emotional distress. Programs for human immunodeficiency virus-infected adolescents may require developmentally appropriate social and psychological approaches to impact peer norms and emotional well-being. Pediatrics 2000;106(2). URL: http://www. pediatrics.org/cgi/content/full/106/2/e22; human immunodeficiency virus, sexual behavior, stages of change, peer norms, emotional distress, transtheoretical model.