As World AIDS Day approaches Dec. 1, public health experts are turning the focus on teens and young adults who make up a remarkably high proportion of HIV infections in the U.S.
According to a recent report from the U.S. Centers for Disease Control and Prevention (CDC), too few youth are getting tested for HIV. People ages 13 to 24 make up more than a quarter of new HIV infections in the U.S. each year, and over half of those youth infected with HIV are unaware that they are HIV-positive.
“Given everything we know about HIV and how to prevent it after more than 30 years of fighting the disease, it is just unacceptable that young people are becoming infected at such high rates,” CDC director Dr. Thomas R. Frieden said in a teleconference.
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Published online as part of the Morbidity and Mortality Weekly Report, the latest analysis looked at a diverse population of youth in the 2009 and 2011 Youth Risk Behavior Surveillance System for 9th to 12th grade students and the 2010 National Health Interview Survey (NHIS) for young adults between ages 18 to 24. The reports shows an estimated 12,200 new HIV infections among them in 2010. Groups with the highest rates include bisexual and gay young men and African-Americans. In 2010 alone, 72% of new infections were among young men who have sex with men (MSM) and 57% were among African Americans.
Rates of HIV vary significantly by population and are most common in lower income communities, where lack of access to health care, stigma and discrimination as well as a prevalence of unrecognized and untreated infections allow the virus to spread. “As we work to drive down new HIV infections in all populations, we have to give particular attention to the next generation, especially African Americans and gay and bisexual young men,” Frieden said. “Every young person should know how to protect themselves from HIV and should be empowered to do so.”
The CDC has long pushed for widespread testing, most forcibly in 2006 when the federal agency recommended testing among patients as young as 13. Yet despite this advice, which also has the support of other health professionals, the CDC reports that only 35% of young adults ages 18 to 24 have been tested for the virus and only 13% of high school students and 22% of sexually active students have undergone testing. Most likely because of these low testing levels, the report also found that infected people under age 25 are significantly less likely to seek treatment and stick with drug therapy that is most effective if patients comply with the daily dosing. Public health experts see that trend as another lost opportunity to keep the epidemic in check, since studies consistently show that anti-HIV drugs can suppress viral growth and prevent disease progression, especially if started soon after exposure to HIV.
The CDC’s push for more widespread testing gained support last week when the U.S. Preventive Services Task Force (USPSTF) released a draft recommendation urging that everyone between ages 15 to 65 get tested for HIV as part of their routine health exam, even if they are not at high risk of infection. The advice signaled what many public health experts view as a much needed shift toward better prevention measures to dovetail the now-robust treatment strategies against HIV.
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The low HIV testing rates are of concern, given the number of young MSM engaging in high risk behaviors. The CDC report reveals that young MSM are more likely than their heterosexual peers to have sex with four or more partners, inject illegal drugs, use alcohol or drugs before their last sexual experience, forgo using a condom and less likely to report learning about HIV and AIDS in school. Some AIDS experts note that the current generation of young at-risk people were not alive during the early days of the epidemic in the 1980s, when public health messages focused on safe sex and avoiding high risk behaviors. As the potent anti-HIV drugs became more effective at suppressing the virus, the importance of these preventive measures waned, and a new generation of potential patients may need to be targeted with these campaigns.
But while HIV rates among youth remain concerning, there are some encouraging trends as well. A survey released by the Kaiser Family Foundation shows greater awareness of HIV, particularly among higher risk populations, among a group of 1,437 youth ages 15 to 24. Compared to white youth, nearly three times as many African American teens and young adults and twice as many Latino youth cite HIV and AIDS as issues of personal concern. These higher risk groups were also more likely to cite HIV as an important issue for their communities.
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“We saw striking differences, most notably among race. This is a generation that has never known a time without AIDS and may see the end of it,” says Tina Hoff, senior vice president and director of of health communication and media partnerships at Kaiser Family Foundation. “I think there is a lot of hope for this generation. They are motivated to respond and ready to be active about it.”
Both reports cite stigma as one of the factors keeping young adults in the dark about their status, although such discrimination has lessened through the years. In the Kaiser survey, one in three young people say there is still “a lot” of stigma around HIV/AIDS in the U.S., while 52% say there is still “some.”
“All Americans can talk honestly and open about HIV to help combat the stigma and fear that keep people from seeking prevention and treatment,” Frieden said. “Dramatically reducing HIV among young people is going to require that all of us do our part.” Frieden says the CDC is pushing for more widespread testing and education about the virus both in healthcare settings and in communities since young people often do not seek health care on a regular basis.
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While talking to trusted adults about HIV and sexual health is important, Frieden hopes that teens and young adults start to educate themselves. “Young people themselves need to get the facts about HIV, resist pressure to have sex, drink and inject drugs, talk to parents, doctors and other trusted adults about HIV and sexual health and get tested,” he said.