Tag Archives: Vital Signs HIV Infection Testing and Risk Behaviors Among Youths — United States

Many young people don’t know they are infected with HIV

27 Nov

Moi wrote about HIV in the article, People MUST talk: AIDS epidemic in Black community:

Aside from the devastation that a poor economy has wrecked upon the Black community, a scourge that few are talking about is the AIDS epidemic in the Black community. NPR reports in the story, AIDS In Black America: A Public Health Crisis:

Of the more than 1 million people in the U.S. infected with HIV, nearly half are black men, women and children — even though blacks make up about 13 percent of the population. AIDS is the primary killer of African-Americans ages 19 to 44, and the mortality rate is 10 times higher for black Americans than for whites.

A new Frontline documentary, Endgame: AIDS in Black America, explores why the HIV epidemic is so much more prevalent in the African-American community than among whites. The film is produced, written and directed by Renata Simone, whose series The Age of AIDS appeared on Frontline in 2006.

On Thursday’s Fresh Air, Simone is joined by Robert Fullilove, a professor of clinical sociomedical studies at Columbia University’s Mailman School of Public Health, and chairman of the HIV/AIDS advisory committee at the Centers for Disease Control and Prevention.

“When I started doing this work in 1986, roughly 20 percent of all of the people in the United States who were living with AIDS were African-American,” Fullilove tells Fresh Air‘s Terry Gross. “The most recent statistics from the Centers for Disease Control indicate that 45 percent of all the new cases of HIV infection are amongst African-Americans. … If we continue on the current trend, in the year 2015, especially in the South, it will probably be the case that 5 to 6 percent of all African-American adults who are sexually active will be infected with the virus.”

Endgame explores how politics, social factors and cultural factors allowed the AIDS epidemic to spread rapidly in the African-American community over the past three decades. The film — shot in churches, harm-reduction clinics, prisons, nightclubs and high school classrooms — tells personal stories from children who were born with the virus, public health officials and educators who run HIV clinics, and clergy members around the country, many of whom have been divided on their response to the epidemic.

The film also explores how the war on drugs in the 1980s and 1990s affected the spread of HIV in communities where large percentages of African-American men were incarcerated. http://www.npr.org/2012/07/05/156292172/aids-in-black-america-a-public-health-crisis

The Centers for Disease Control (CDC) and Preventions studies a variety of diseases. https://drwilda.com/2012/08/02/people-must-talk-aids-epidemic-in-black-community/

Nirvi Shah is reporting in the Education Week article, Disproportionate Numbers of Young People Have HIV, Don’t Know It:

About 1 in 15 people living in the United States who has HIV is 13 to 24 years old—and more than half of these young people don’t know they have the disease, new estimates from the Centers for Disease Control and Prevention show, and the agency says schools must work harder to prevent HIV’s spread.

These estimates, shared today by the CDC, are from 2009. In all, about 1.1 million people in the United States have HIV, the agency reported.

The CDC estimates that about 70 out of 100,000 teenagers and young adults have HIV and they accounted for 12,000 cases—about 26 percent—diagnosed in 2010. Meanwhile, 13- to 24-year-olds represent only about 21 percent of the total population. The majority of the new cases, about 60 percent, were among black teens and young adults. Another 20 percent of the new cases were among Latinos of the same age.

The infection rate among young people is disproportionately high, the CDC said, while the percentage of people in the same age group tested was disproportionately low.

In 2009, people ages 13 to 24 comprised 6.7 percent of persons living with HIV, but more than half, nearly 60 percent, didn’t know they were infected, the CDC said, the highest rate for any age group. http://blogs.edweek.org/edweek/rulesforengagement/2012/11/disproportionate_numbers_of_yo.html

Here is a portion of press release from the Centers for Disease Control:

Vital Signs: HIV Infection, Testing, and Risk Behaviors Among Youths — United States

Early Release

November 27, 2012 / 61(Early Release);1-6

Abstract

Background: In 2009, 6.7% of the estimated 1.1 million persons living with human immunodeficiency virus (HIV) infection in the United States were youths (defined in this report as persons aged 13–24 years); more than half of youths with HIV (59.5%) were unaware of their infection.

Methods: CDC used National HIV Surveillance System data to estimate, among youths, prevalence rates of diagnosed HIV infection in 2009 and the number of new infections (incidence) in 2010. To assess the prevalence of risk factors and HIV testing among youths, CDC used the 2009 and 2011 Youth Risk Behavior Surveillance System for 9th–12th grade students and the 2010 National Health Interview Survey (NHIS) for persons 18–24 years.

Results: Prevalence of diagnosed HIV was 69.5 per 100,000 youths at the end of 2009. Youths accounted for 12,200 (25.7%) new HIV infections in 2010. Of these, 7,000 (57.4%) were among blacks/African Americans, 2,390 (19.6%) among Hispanics/Latinos, and 2,380 (19.5%) among whites; 8,800 (72.1%) were attributed to male-to-male sexual contact. The percentage of youths tested for HIV overall was 12.9% among high school students and 34.5% among those aged 18–24 years; it was lower among males than females, and lower among whites and Hispanics/Latinos than blacks/African Americans.

Conclusions: A disproportionate number of new HIV infections occurs among youths, especially blacks/African Americans, Hispanics/Latinos, and men who have sex with men (MSM). The percentage of youths tested for HIV, however, was low, particularly among males.

Implications for Public Health: More effort is needed to provide effective school- and community-based interventions to ensure all youths, particularly MSM, have the knowledge, skills, resources, and support necessary to avoid HIV infection. Health-care providers and public health agencies should ensure that youths are tested for HIV and have access to sexual health services, and that HIV-positive youths receive ongoing health-care and prevention services.

Introduction

The risk for acquiring human immunodeficiency virus (HIV) infection during adolescence and early adulthood starts with initiation of sexual behavior or injection drug use, and initiation of contributing behaviors such as use of alcohol and other drugs. The prevalence of HIV in potential sex partners, the percentage of HIV-infected persons unaware of their status, and the frequency of risky sexual behaviors and injection drug use contribute to the level of risk. In 2009, youths (defined in this report as persons aged 13–24 years), who represented 21% of the U.S. population, comprised 6.7% of persons living with HIV. More than half (59.5%) were unaware of their infection, the highest for any age group (1). All persons need to understand the threat of HIV and how to prevent it (2). Youths, particularly those at highest risk, need effective school-based, school-linked, and community-based interventions (3) that make them aware of their risk for HIV and help delay initiation of sexual activity, increase condom use for those who are sexually active, and decrease other behaviors, such as alcohol and drug use, that contribute to HIV risk. This report describes, among youths, 1) rates of those living with a diagnosis of HIV infection at the end of 2009, 2) the estimated number of new HIV infections in 2010, 3) the percentage that have been tested for HIV, and 4) the percentage that engage in selected risk behaviors.

Conclusions and Comment

Based on the most recent data available from 2009 and 2010, youths represent 6.7% of persons living with HIV in the United States and account for 25.7% of new HIV infections. Of new HIV infections among youths, 45.9% were among black/African American males, the majority of which were attributed to male-to-male sexual contact. Nationwide, the percentage of youths who had ever been tested for HIV was low compared with other age groups (1): 12.9% among high school students (22.2% among those who ever had sexual intercourse) and 34.5% among persons aged 18–24 years.

The higher HIV prevalence among blacks/African Americans overall (nearly three times higher than among Hispanics/Latinos and nearly eight times higher than among whites [1]) and MSM overall (nearly 40 times higher than other men [5]) contributes to the disproportionate number of new HIV infections among black/African American youths and young MSM. Because of this disparity, black/African American youths are at higher risk for infection even with similar levels of risk behaviors (6). Other research has found that among young MSM, other factors such as stigma, discrimination (7), less condom use, more alcohol and drug use, and having sex with older partners (8) contribute to even higher risk for HIV acquisition. This analysis also found that young MSM were significantly less likely to use condoms during last sexual intercourse, more likely to drink alcohol or use drugs before last sexual intercourse, and more likely to have four or more partners during their lifetime compared with young men who had sexual intercourse only with females. These behaviors are associated with substantial risk for infection. In one study among MSM, the attributable risk for new HIV infection was 29% for using alcohol or drugs before sex and 32% for having four to nine sex partners (9). Further, in a study of primarily young MSM, 75% of those with acute HIV infection reported sex under the influence of drugs or alcohol compared with 31% of HIV-uninfected MSM. Moreover, the risk for HIV infection doubled for MSM with a sex partner 5 years older and quadrupled with a sex partner 10 years older (8).

More than half (59.5%) of youths with HIV are unaware of their infection (1). Although the number of new HIV infections is highest among males, fewer males have been tested for HIV than females. Routine HIV testing as part of regular medical care is recommended by CDC for all persons aged 13–64 years (10) and by the American Academy of Pediatrics for all youths by age 16–18 years and all sexually active youths regardless of age (11). Better adherence to these guidelines, especially for males, is needed to increase early HIV diagnosis and facilitate treatment that improves health and reduces transmission.

Interventions for youths have been proven effective for delaying initiation of sexual activity, increasing condom use, and reducing other risk behaviors, such as drug and alcohol use.¶¶ The Community Preventive Services Task Force recommends risk reduction interventions in school and community settings to prevent HIV among adolescents (3). Individual- and group-level HIV prevention interventions provide knowledge, skill building, and increased motivation to adopt behaviors that protect against HIV infection, and some are designed specifically for youths at high risk for HIV.

For young MSM (those aged 18–29 years), “Mpowerment” is an effective community-level intervention that has been shown to reduce unprotected anal intercourse, the sexual behavior that carries the greatest risk for HIV transmission (12). However, additional individual- and group-level interventions specifically designed for young MSM, and young black/African American MSM in particular, are needed. Evidence-based behavioral HIV interventions for high risk youths can be adapted to address the unique needs of young MSM and to communicate the substantial risks associated with having sex with partners who are more likely to be infected, particularly those who are older.

Multicomponent school-based interventions, including classroom-based curricula and school-wide environmental changes, have been shown to decrease unprotected sex and increase condom use among youths (3). Policies can support these efforts by promoting in schools an inclusive environment for sexual minorities that reduces stigma and discrimination (13) and requiring evidence-based HIV prevention education (3) for all students. In addition, community organizations, schools, and health-care providers can establish procedures that reduce barriers and protect confidentiality (i.e., procedures that do not disclose information to unauthorized persons unless required under state law) for youths seeking sexual health services (14) and facilitate access to education and other HIV prevention services.

Early diagnosis and treatment can reduce HIV progression and prevent transmission, but youths are less likely to be tested, access care, remain in care, and achieve viral suppression (15). Youth-friendly, culturally competent, confidential, and convenient health services facilitate access to and retention in care.*** Comprehensive health services, including HIV/sexually transmitted infection screening, treatment, and prevention services, and adjunct services, such as mental health, drug and alcohol treatment, and housing assistance, are necessary for youths at highest risk of acquiring or transmitting HIV. Because young MSM often acquire HIV from older, HIV-positive partners (8), regular testing, care, and treatment for adult MSM also are essential to prevent HIV infections among youths.

Limitations of the estimates of new HIV infections have been described previously (15). In addition, the findings in this report are subject to at least three more limitations. First, YRBS data apply only to youths who attend school and therefore are not representative of all persons in this age group. Nationwide, in 2009, of persons aged 16–17 years, approximately 4% were not enrolled in a high school program and had not completed high school (4). Second, NHIS excludes active military personnel and those who live outside of households (e.g., persons who are incarcerated, in long-term–care institutions, or homeless), who might be at greater risk for HIV infection than persons in households. Finally, data from YRBS and NHIS are self-reported and subject to recall bias and potential underreporting of sensitive information, such as HIV risk factors and HIV testing.

To achieve the goals of the National HIV/AIDS Strategy for the United States (i.e., to reduce the number of persons who become infected with HIV and reduce disparities), public health agencies, in conjunction with families, educators, and health-care practitioners, must educate youths about HIV before they begin engaging in risk behaviors, especially young gay and bisexual males, particularly blacks/African Americans, who face a disproportionately higher risk (2). To delay the onset of sexual activity, increase condom use among those who are sexually active, and decrease injection drug use, multicomponent school- and community-based approaches that provide access to condoms, HIV testing and treatment, and behavioral interventions for those at highest risk are needed.

Reported by

Suzanne K. Whitmore, DrPH, Laura Kann, PhD, Joseph Prejean, PhD, Linda J Koenig, PhD, Bernard M. Branson, MD, H. Irene Hall, PhD, Amy M. Fasula, PhD, Angie Tracey, Jonathan Mermin, MD, Linda A. Valleroy, PhD, Div of HIV/AIDS Prevention, Div of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Corresponding contributor: Suzanne K. Whitmore, swhitmore@cdc.gov, 404-639-1556. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm61e1127a1.htm?s_cid=mm61e1127a1_e

The Centers for Disease Control has many resources about HIV testing:

Positive? Negative? Not sure?

What You Need to Know About HIV:

Frequently Asked Questions About HIV and STD Testing

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