Aids Guide-HIV is spreading rapidly among U.S. youth
Here's what you can do about it
HIV infection is spreading rapidly among youths ages 13 to 24 years in the United States, according to a recent study.
Last year, there were a total of 27,860 cases of AIDS among teens and young adults. But a study conducted by the Centers for Disease Control and Preven tion (CDC) in Atlanta highlighted a disturbing trend: Young people account for a much greater proportion of HIV than AIDS cases, and while the number of new AIDS cases diagnosed has declined, there has not been a comparable decline in the number of new HIV cases among youths ages 13-24.
The CDC analyzed data from 25 states between January 1994 and June 1997.
CDC data also show that half of AIDS cases reported among males in 1998 in the 13-24 age group were among men who had sex with men; 10% involved injection drug users; and 9% were men who were infected heterosexually. Among women, nearly half were infected heterosexually, and 14% were injection drug users. The remaining cases had no reported exposure risk.
When HIV infection rates increase among the nation's youth, it indicates there may be a problem with rising HIV rates among all age groups because younger Americans are the first to initiate high-risk behavior. Research supports the theory that Americans, particularly young people, are returning to the unsafe sex practices that first characterized the AIDS epidemic.
Also, if trends among youths with HIV are leading the rest of the population, then health care workers soon will see greater numbers of HIV-infected women. The CDC has found that females make up 48% of the HIV cases in the 13-24 age group reported from 30 regions with confidential HIV reporting for adults and adolescents in 1998. Even more alarming, females account for 62% of the HIV cases among people between the ages of 13 and 19. And African-Americans are suffering the biggest impact, because they account for 56% of all HIV cases reported in this age group.
The long-term implications of these studies are clear when one considers that many of the HIV-infected adults in the 25-44 age group had become infected while still in their teens or early 20s.
AIDS deaths have the greatest impact on young adults between the ages of 25 and 44, particularly among African-Americans in that age group. It's the fifth-leading cause of death for all Americans of that age group, and it's the leading cause of death for African-Americans in the 25 to 44 age group, the CDC says.
So how can you, a health care worker, help prevent the disease from spreading among the nation's youths? The CDC offers these suggestions:
• Health care workers and others can speak in schools. School-based programs are critical for reaching youths before their behaviors are set. Health care professionals can work with school administrators to provide programs on HIV, sexually transmitted diseases (STDs), unintended pregnancy, tobacco use, nutrition, and physical activity. These programs could be designed at several levels, so they could be presented to students from kindergarten through high school.
Research has shown that the most effective programs are comprehensive ones that include a focus on delaying sexual behavior and provide information on how sexually active young people can protect themselves.
• Reinforce prevention efforts targeted at young gay and bisexual men. Targeted, sustained prevention efforts are urgently needed for young men who have sex with men as they come of age and initiate high-risk sexual behavior. Health care workers might spend extra time with teen-age males who are seen for their first adult physical and discuss sexual risk behaviors with them. Studies continue to show that HIV prevalence and risk behaviors remain high among this population. In a sample in six urban counties of men ages 15 to 22 who have sex with men, researchers found that between 5% to 8% were infected with HIV. Among African-American youths, the HIV prevalence was 13%.
• Address sexual and drug-related risk. Many students say they used alcohol or drugs when they had sex, and one in 50 high school students say they have injected illegal drugs.
Injecting drug use accounts for 36% of all AIDS cases among African-American and Hispanic adults and adolescents, compared with 22% of all cases among white adults and adolescents. Plus, 59% of all AIDS cases among women have been attributed to injection drug use or to sex with partners who inject drugs, compared with 31% of cases among men. So health care workers need to be particularly aware of the potential risks faced by minority and female patients who inject drugs or belong to that culture.
Also, noninjection drugs, such as crack, contribute to the spread of HIV because users often trade sex for drugs or money, and they may engage in riskier sexual behaviors than they would if they were sober. One CDC study involving more than 2,000 young adults in three inner-city neighborhoods found that crack smokers were three times more likely to be infected with HIV than non-smokers.
Health care professionals who work in hospitals may see young people with drug problems as they come through the emergency room, and this could pose at least one opportunity to provide an intervention as well as drug and HIV education. Health care workers also could make HIV and drug use literature available in clinics or office waiting rooms. They might discuss how injection drug use is a common means of transmitting the virus, and they could recommend the following behaviors:
— Seek help from community agencies and clinics that provide substance abuse treatment.
— Always use sterile injection equipment.
— Never reuse needles, syringes, and other injection equipment.
— Use new sterile syringes, because cleaning syringes with bleach is not always effective.
— Always use a condom during any kind of sexual act.
• Counsel teens about STDs. About 12 million cases of STDs, besides HIV, are diagnosed each year in the United States. About two-thirds of these are among people under the age of 25. Teens may not realize that biological factors make a person who has an STD more susceptible to becoming infected with HIV if they're exposed to the virus. Also, people who have HIV and other STDs are more likely to infect their partners with HIV. When ever health care workers see teen-age patients who have an STD, it is an excellent opportunity to provide counseling and education about HIV and risky sexual behaviors.
• Provide a list of local and national resources. The CDC has a variety of free literature and hotline assistance available to the public, including the following:
— CDC National AIDS hotline: (800) 342-AIDS; Spanish: (800) 344-SIDA; hearing-impaired: (800) 243-7889.
— CDC National Preven tion Information Network, P. O. Box 6003, Rockville, MD 20849-6003. Telephone: (800) 458-5231.
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