HIV
YOUNG PEOPLE AT RISK : HIV/AIDS AMONG AMERICA'S YOUTH
August, 1999

In the United States, HIV-related death has the greatest impact on young and middle-aged adults, particularly racial and ethnic minorities. HIV is the fifth leading cause of death for Americans between the ages of 25 and 44. Among African American men and women in this age group it is the leading cause of death. Many of these young adults likely were infected as teenagers. It is estimated that at least half of all new HIV infections in the United States are among people under 25, and the majority of young people are infected sexually. In 1998, 1,798 young people (ages 13 to 24) were reported with AIDS, bringing the cumulative total to 27,860 cases of AIDS in this age group. Among 13- to 24-year- olds, 51% of all AIDS cases reported among males in 1998 were among young men who have sex with men (MSM); 10% were among injection drug users (IDUs); and 9% were among young men infected heterosexually. In 1998, among young women the same age, 47% were infected heterosexually and 14% were IDUs.

A CDC study that analyzed data from 25 states with integrated HIV and AIDS reporting systems for the period between January 1994 and June 1997* found that young people (aged 13 to 24) accounted for a much greater proportion of HIV than AIDS cases. The study showed that even though AIDS incidence (the number of new cases diagnosed during a given time period, usually a year) is declining, there has not been a comparable decline in the number of newly diagnosed HIV cases among youth.

Scientists believe that cases of HIV infection reported among 13-to 24-year-olds are indicative of overall trends in HIV incidence (the number of new infections in a given time period, usually a year) because this age group has more recently initiated high-risk behaviors. Females made up nearly half (48%) of HIV cases in this age group reported from the 30 areas with confidential HIV reporting for adults and adolescents in 1998--and in young people between the ages of 13 and 19, a much greater proportion of HIV infections was reported among females (62%) than among males (38%). Cumulatively, young African Americans are most heavily affected, accounting for 56% of all HIV cases ever reported in this age group in these 30 areas.

Improving HIV Prevention for Young People

CDC research has shown that early, clear communications between parents and young people about sex is important in helping adolescents maintain protective sexual behaviors.

School-based programs are critical for reaching youth before behaviors are established. Because risk behaviors do not exist independently, topics such as HIV, STDs, unintended pregnancy, tobacco, nutrition, and physical activity should be ongoing for all students in kindergarten through high school.

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. Evidence of prevention success can be seen in 6-year trends from the Youth Risk Behavior Survey, which show both a decline in sexual risk behaviors and an increase in condom use among sexually active youth. The percentage of sexually experienced high school students decreased from 54.1 percent in 1991 to 48.4 percent in 1997, while condom use among sexually active students increased from 46.2 percent to 56.8 percent. These findings represent a reversal in the trend toward increased sexual risk among teens that began in the 1970s and point to the success of comprehensive prevention efforts to both delay first intercourse among teens and increase condom use among young people who are sexually active.

Prevention efforts for young gay and bisexual men must be sustained. Targeted, sustained prevention efforts are urgently needed for young MSM as they come of age and initiate high-risk sexual behavior. Ongoing studies show that both HIV prevalence and risk behaviors remain high among young MSM. In a sample of young MSM ages 15-22 in six urban counties, researchers found that, overall, between 5% and 8% were infected with HIV, with higher prevalence among young African American (13%) and Hispanic (5%) men than among young white men (4%). Sexual and drug-related risk. Many students report using alcohol or drugs when they have sex, and 1 in 50 high school students reports having injected an illegal drug. Surveillance data from the 25 states with integrated HIV and AIDS reporting systems between January 1994 and June 1997 showed that drug injection led to 6% of HIV diagnoses reported among those aged 13-24 during that time period, with an additional 58% attributed to sexual transmission (both heterosexual and MSM).

STD treatment must play a role in prevention programs for young people. An estimated 12 million cases of STDs other than HIV are diagnosed annually in the United States, and about two-thirds of those are among people under the age of 25. Biological factors make people who are infected with an STD more likely to become infected with HIV if exposed sexually; and HIV-infected people with STDs also are more likely to transmit HIV to their sex partners. Expanding STD treatment is critical to reducing the consequences of these diseases and helping to reduce risks of transmitting HIV among youth.

Ongoing evaluation of factors influencing risk behavior. Both broad-based surveys of the extent of risk behaviors among young people and focused studies of the factors contributing to risk and behavioral intent among specific groups of adolescents must be conducted and analyzed. For young people, it is critical to prevent patterns of risky behaviors before they start. HIV prevention efforts must be sustained and designed to reach each new generation of Americans.
* See Diagnosis and Reporting of HIV and AIDS in States with Integrated HIV and AIDS Surveillance-- United States, January 1994-June 1997, MMWR 1998, Vol. 47, No. 15 (April 24, 1998) .

For more information...
CDC National Prevention Information Network:
P.O. Box 6003 Rockville, Maryland 20849-6003
Internet Resources:
NCHSTP: http://www.cdc.gov/nchstp/od/nchstp.html
DHAP: http://www.cdc.gov/hiv
NPIN: http://www.cdcnpin.org

18.07.200

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