This week the American Academy of Pediatrics (AAP) released a policy statement called “Adolescents and HIV Infection.” The title alone garners attention. Teens and HIV?
Well, yes, says the AAP, which is urging pediatricians to test all teens routinely for HIV starting at age 16 if they live in an area where more than 0.1% of the population has been diagnosed with the virus. Most of the nation’s metropolises fall into that category.
“Our youth are having sex and our youth are getting HIV,” says Patricia Emmanuel, a professor of pediatrics at the University of South Florida and co-author of the report.
More than 1 million Americans were living with HIV in 2006, and 5%, or more than 55,000, were between the ages of 13 and 24 — a number that has since been on the rise. Yet nearly half of infected teens aren’t aware of their status. Research has found that teens who are routinely tested for HIV are not as likely to spread it to others.
Emergency departments and urgent-care clinics in high-prevalence areas should also implement routine screening because many at-risk teens may not have a family physician and may rely instead on emergency services for regular medical care. Any teen tested for sexually transmitted diseases should automatically get an HIV test too, according to the policy statement, which was published this week in the journal Pediatrics.
In 2006, the U.S. Centers for Disease Control and Prevention recommended routine HIV testing for people between the ages of 13 and 64. The idea was to make HIV testing as standard as cholesterol screening. But many doctors didn’t follow their advice, particularly for adolescents, nor did the U.S. Public Health Service endorse it. For one thing, there were questions about cost-effectiveness. “If you look at the epidemiology of HIV and the numbers of infected youth, very few are infected at age 13,” says Emmanuel. “The key is for pediatricians to assess the overall risk in their patient population.”
Doctors are also being encouraged to talk about risky sexual behavior with their teen patients, even though many pediatricians have historically shied away from such conversations. “HIV is not just a grown-up disease,” says Emmanuel. “The greatest increase is in young gay men, mostly ethnic minorities. Many are 16, 17 and 18. They are not 13, but they are teenagers.”