Mental health and risk behaviors of adolescents and young adults with perinatal HIV: a systematic review of literature

This systematic review synthesizes evidence on mental health outcomes and risk behaviors among adolescents and young adults with perinatally acquired HIV (PHIV+), particularly focusing on comparisons with perinatally exposed but uninfected (PHEU) and HIV-negative peers. Twenty-six studies (2006-2025) were identified through searches in PubMed, Scopus, and Web of Science and were appraised using the Critical Appraisal Skills Programme (CASP) checklists. Across studies, high prevalences of mental health difficulties were reported among PHIV + individuals, particularly anxiety (4-49%) and mood disorders (3-36%); however, most studies found no significant differences when compared with HIV-negative or PHEU peers. Risk behaviors, including substance use (4-34%), unprotected sex (19-62%), and self-harm (10-27%), were frequently reported but were not consistently associated with HIV status. Quality of life was generally reported as poorer among PHIV + individuals, with several studies indicating associations with caregiver illness and socioeconomic adversity. In contrast, evidence linking quality of life to stigma and trauma was limited and inconsistent. Considerable heterogeneity in study design, outcome measurement, and comparison groups constrained direct comparability across studies. Overall, the available evidence suggests that contextual and environmental factors may play a more prominent role in shaping mental health and behavioral outcomes than HIV status alone.