Increased public awareness and advancements in medicine over the past three decades have led to remarkable strides in preventing the spread of HIV and improving the quality of life of those living with HIV or AIDS in the U.S. For instance, because of better screening and access to medication, there are far fewer cases of HIV-positive pregnant women transferring the virus to their newborn babies. Fewer than 100 infants were born with HIV last year, compared to more than 900 in 1992.1 This and other areas of progress are worth celebrating--yet major challenges remain in combating HIV and AIDS among all Americans.
The National HIV/AIDS Strategy for the United States (NHAS), released in 2010, is the nation’s first-ever comprehensive and coordinated plan for guiding efforts in the fight against HIV/AIDS. The first of four objectives of the NHAS is to reduce the number of individuals infected each year. A focus on preventing the spread of HIV/AIDS among adolescents must be a major part of the effort.
A Snapshot of HIV in Adolescence
Despite stable rates of HIV diagnosis in older populations, the rate of HIV diagnoses from 2006 to 2009 increased in teens 15-19 and youth 20-24 years of age, and was highest in the 20-24 year-old age group. Undiagnosed HIV cases are thought to be highest among young people. Of the approximately 1.2 million people living with HIV, approximately one in five, or 220,000, doesn’t know they’re infected. The U.S. Centers for Disease Control and Prevention (CDC) estimates more than half of all undiagnosed HIV infections are youth ages 13 – 24.3
- Of HIV diagnoses among 13 to 19 year olds, almost 70 percent are to black teens, even though they constitute a much smaller proportion of the adolescent population in the U.S.
- Almost 80 percent of all adolescent infections are to males. Nine out of 10 adolescent male HIV infections result from male-to-male sexual contact. The same proportion of adolescent females is infected from heterosexual contact.
- The highest concentrations of HIV diagnoses among adolescents are in the Southeastern United States and, specifically, Florida, South Carolina, and Louisiana.4
Although HIV testing is widely available, self-reported rates of HIV testing have remained flat in recent years.5 Forty-six percent of high school students have had sex at least once, yet only 13 percent report ever having had an HIV test.6
Answering the Call to Action
To propel progress in addressing HIV/AIDS among adolescents, the newly launched National Resource Center for HIV/AIDS Prevention among Adolescents (Center) provides tools and resources to assist youth-serving agencies and professionals with implementing evidence-based prevention programs. With funding from the Secretary’s Minority HIV/AIDS Initiative Fund, OAH competitively awarded a cooperative agreement to the University of Medicine and Dentistry of New Jersey to develop and operate the Center. Visit the Center website (www.preventyouthHIV.org) to find the latest HIV/AIDS youth prevention resources, access technical assistance and links to training opportunities, exchange information with colleagues, and join the listserv to stay up to date on developments.
FYI: Screening Recommendations for HIV
Sexually active adolescents at high risk should be tested for HIV. According to the U.S. Preventive Services Task Force, being at risk includes factors such as males who have sex with other males; having unprotected sex with multiple partners; trading sex for money or drugs; using injection drugs or having partners who do; and adolescents having other STDs. At risk also include sexually active adolescents who receive health care in a setting in which HIV prevalence is high.8
The Affordable Care Act provides for many private insurance plans to offer HIV screening tests for at risk people at no additional cost to them—making it more likely they will get tested and, if necessary, get access to life-saving treatment more quickly.9 And starting this year, the law also requires many plans to provide coverage without cost- sharing of HIV and other STI counseling for all sexually active females.10
What Communities Can Do
- Find out the prevalence of HIV infection in your state and community.AIDSvu displays state and county level data on persons living with HIV infection in the United States.
- Work with schools to implement sexual education programs. Nationally, the percentage of secondary schools delivering HIV/AIDS, other STD, and pregnancy prevention education in grades 6-8 has declined.11 Curious about the percent of high school students ever taught about HIV/AIDS in your state? Check out OAH’s state fact sheets for information on this and many others facts on your state's teens. Also, check out the new tip sheet from the CDC: HIV Testing Among Adolescents: What Schools and Education Agencies Can Do.
- Identify effective prevention programs for youth. Several Federal agencies list evidence-based HIV prevention programs on their websites. (The evidence reviews have been conducted for different purposes and so employ different methods, which are on the websites). CDC’s Diffusion of Effective Behavioral Interventions offers HIV prevention intervention for youth packaged with training guides and implementation tools. In addition, four interventions featured in the OAH evidence-based database are proven to prevent HIV, and several others have positive outcomes, such as condom use or delaying sexual initiation. The Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-based Programs and Practices includes programs which address HIV prevention as well as mental health or alcohol and drug use by adolescents.
What Parents Can Do
- Talk with their teen about their sexual health and contraception decisions.Talking with Teens, OAH’s site for parents and other caring adults, can help parents start and maintain a conversation with adolescents about their sexual decisions that includes facts about HIV and AIDS. Access strategies for talking with adolescents about their dating and sexual behavior, abstinence and contraception, avoiding teen pregnancy, sexually transmitted diseases, and having healthy relationships.
- Allow teens confidential time with healthcare providers. Teens are more likely to be forthcoming about their sexual activity and other risky activities, such as drug use, when alone with healthcare providers.12
- Help their adolescent get tested. The HIV/AIDS Prevention & Service Provider Locator is a first-of-its-kind, easy-to-use, location-based search tool that helps you find testing services, housing providers, health centers and other service providers near your current location. For more national HIV and STD testing resources, visit http://HIVTest.CDC.Gov.
What Healthcare Providers Can Do
- Talk to adolescent patients about their sexual behavior. These discussions should be thorough and non-judgemental in order to identify whether an adolescent is sexually active, and then to screen for high-risk behaviors, like unprotected sex, multiple partners, and drug use.
- Screen sexually active adolescent patients for STDs. The presence of other STDs, including chlamydia, gonorrhea, herpes, and trichomoniasis, increases an individuals susceptibility to contracting and transmitting HIV.13 For HIV screening guidance, a policy statement from the American Academy of Pediatricians includes 13 specific recommendations for how pediatricians can optimize HIV testing in adolescents.
- Test HIV-positive teens for other STDs. Evidence suggests that having additional STDs increases the infectiousness of HIV-positive men. For instance, males infected with both gonorrhea and HIV are more than twice as likely to transmit HIV to a sexual partner than males infected only with HIV.
- Increase frequency of tests for some adolescent males who have sex with other males. Males who have multiple or anonymous partners, and/or who use illicit drugs (particularly methamphetamines) or have partners that do, are encouraged by the CDC to be tested every three to six months.
- Recommend screening for HIV in early-pregnancy to expecting teen patients. In one study of pregnant women, 93 percent who felt their providers strongly recommended an HIV test were screened.14 It’s also critical for them to be screened early – females screened at their first obstetrical visit are less likely to pass HIV on to their babies. Another screening during the third trimester is also encouraged.15
- Get basic information about HIV/AIDS here from AIDS.gov. Information specific to HIV/AIDS in adolescence can be found here. Click here for more information on Federal policies regarding HIV and AIDS.
- Check out OAH’s database. The database has evidence-based programs that help reduce teen pregnancy and the transmission of STDs among adolescents (including four shown to reduce rates of HIV).
- Find family planning services. Federally funded Title X family planning clinics offer low-cost testing services for income-qualifying patients. Some also accept insurance. The link also describes additional Title X screening and healthcare services
- Access easy-to-read brochures. The CDC has a series of brochures providing facts about various STDs.
Also, the Federal government is working to eliminate HIV and AIDS in adolescence and for all ages. Here are some of the strategies that are helping the country to get there:
- National HIV/AIDS Strategy for the United States
- HHS Action Plan to Reduce Racial and Ethnic Health Disparities
- The National Prevention Strategy
- Healthy People 2020’s goals related to HIV and AIDS
1 Centers for Disease Control and Prevention. (2011). One Test. Two Lives. HIV screening for prenatal care. Available here.
2 Centers for Disease Control and Prevention. (2011). HIV Surveillance Report, 2009; Volume 21. Available here. Calculations based on information from 40 states and 5 dependent areas with confidential name-based HIV infection reporting, Table 3b.
3 Centers for Disease Control and Prevention. HIV Surveillance—United States — 1981–2008. MMWR 2011; 689-693. Available here.
4 Centers for Disease Control and Prevention. (2012). Slideshow: HIV surveillance in adolescents and young adults. Available here.
5 The Kaiser Family Foundation. (2011). HIV/AIDS at 30: A public opinion perspective. Available here.
6 Centers for Disease Control and Prevention. (2012). Youth Risk Behavior Surveillance - 2011. MMWR 2012; 61 (No. SS--4). Available here.
7 Centers for Disease Control and Prevention. (2011). HIV Surveillance Report, 2009; Volume 21. Available here.
8 U.S. Preventive Services Task Force. (2005). Screening for HIV. Available here.
9 U.S. Department of Health and Human Services. (2010). How Does the Affordable Care Act Impact People Living with HIV/AIDS? Available here.
11 Centers for Disease Control and Prevention. (2012). HIV, Other STD, and Pregnancy Prevention Education in Public Secondary Schools — 45 States, 2008–2010. MMWR 2012; 61(13) ; 222-228. Available here.
12 National Research Council and Institute of Medicine. (2008). Adolescent health services: Missing opportunities. Available here.
13 Centers for Disease Control and Prevention. (2010). The role of STD detection and treatment in HIV prevention- CDC Fact Sheet. Available here.
14 Centers for Disease Control and Prevention. (2011). One Test. Two Lives. HIV screening for prenatal care. Available here.
15 Centers for Disease Control and Prevention. (2010). Sexually transmitted diseases treatment guidelines, 2010. HIV Infection: Detection, counseling, and referral. Available here.