Can adolescents get HIV?
Unfortnately, yes. HIV infection is increasing most rapidly among young people. One in four new infections in the US occurs in people younger than 22.(1) In 1993, 588 new AIDS cases were diagnosed among people 13-19 years old, and 3,911 new cases in 20-24 years old.(2) Since infection may occur up to 10 years before an AIDS diagnosis, most of those people were infected with HIV either as adolescents or pre-adolescents.
Adolescents are experiencing skyrocketing rates of sexually transmitted diseases. In California, 15-19-year-olds have the highest rates of gonorrhea and chlamydia of any age group in the state.(3) Experts fear that if these diseases are being transmitted, then HIV is too.
What puts adolescents at risk?
Part of being a teenager is taking risks. Teens may act as though they're invincible. They test limits and question authority. But in this day and age, the impact of unsafe sex can be irreversible. It's like playing a game of Russian roulette: maybe you won't get infected, but maybe you will. Thankfully, most STDs can be treated. But no one has yet been cured of AIDS.
Teenagers are having sex earlier than ever, often with multiple partners. By the time they reach age 20, 77% of girls and 86% of boys have had sex.(4)
And most teens do not consistently use condoms. The 1991 National Survey of Adolescent Males found that condom use is likely to be highest at the beginning of a relationship and then decline once the partner is perceived as "safe."(5) Teenagers with the largest number of sexual partners were the least likely to use condoms.(6)
African-American adolescents are especially vulnerable to HIV. For youths aged 13-19, African-American females accounted for 73% of new HIV infections in 1993; African-American males accounted for 48%.(2)
Especially vulnerable to HIV and other STDs are teens who are gay, drug users, juvenile offenders, school dropouts, runaways, homeless or migrant youth. These youth are often hard to reach for prevention and education efforts, and have limited access to health care and service-delivery systems.(7)
Can education help?
Yes. Schools offer a window of opportunity to educate about how HIV/STDs are spread. But education can't be a one-time thing; it should be an ongoing process, growing more sophisticated as children mature. When should HIV/STD education start? The sooner, the better. Early discussion of germs, disease transmission and normal public health precautions--for example, washing hands before eating--can set the stage for later education in STD prevention.
One common argument against HIV/STD education programs is that exposing teens to information about sex will encourage them to engage in sexual activity. But a comprehensive review of 23 school-based programs found quite the opposite was true: teens who received specific AIDS education were less likely to engage in sex, and those who did were more likely to have sex less often and have safer sex.(8) Elements of successful programs included: narrow, specific focus; instruction on social influences and pressures; age- and experience-appropriate reinforcement of values and norms against unprotected sex; and skills-building activities.
Are schools the only answer?
No. Schools alone can't do the job. There remain major obstacles to good HIV/STD education. Some schools lack properly trained personnel. Others refuse to discuss homosexuality. And many offer inadequate instruction on condom use. Although three-quarters of sex education curricula in the nation's schools mention condoms, only 9 percent include information about how to use them.(9) Significantly, studies show that for teens to wear condoms, they must not only believe that sex with a condom can be enjoyable, but trust their technical ability to use condoms in a confident way.(10)
In 1993 an estimated 3 million adolescents (12.7%) had dropped out of high school. Youth drop-outs have higher frequencies of behaviors that put them at risk for HIV/STDs, and are less accessible by prevention efforts. More intensive STD/HIV and substance abuse prevention programs should be aimed at students at risk for dropping out of school. For example, in Miami, a dropout prevention program in an urban neighborhood offers a peer education activity as a course for high school credit.(11)
Programs targeting hard-to-reach adolescents at high risk for HIV are necessary in many different venues outside of schools. In New York City, runaway youths in residential shelters who received intensive education, skills training and counseling sessions reported an increase in consistent condom use and a decrease in high-risk sexual behavior.(12)
A study of African-American children 9-15 years old living in public housing in a large US city found that although knowledge about the hazards of sex increased with age, their sexual activity also increased (from 12% sexually active at 9 years old, to 80% at 15). Parental monitoring and perceived behavior of friends influenced sexual activity. The early onset and prevalence of sexual behavior stresses the need for youth-focused interventions that influence both the parents and peers in children's social networks.(13)
Gay and bisexual youth often benefit from individual counseling, peer education, and skills building. One program found that 6 months after such an intervention, 60% fewer youths reported unprotected anal intercourse. More consistent use of condoms, and less use of amphetamines and amyl nitrate were also reported.(14)
What needs to be done?
Teenagers are the future of our society, and everything possible should be done to safeguard their lives. A comprehensive HIV prevention strategy uses many elements to protect as many people at risk for HIV as possible. Explicit school-based education that is started at an early age and repeated throughout adolescence is crucial. Education should not only give facts about HIV/STD transmission, but should include information on how to use condoms, skills building and role playing to help teens delay the onset of sexual activity, and sensitive information about homosexuality and drug and alcohol use.
Programs for hard-to-reach youth who are most at risk of HIV infection should be implemented in venues outside of schools, such as runaway shelters, dropout centers, shopping malls, and neighborhood centers.
Young people should receive two messages: one promoting abstinence and the delay of sexual activity, the other warning against high-risk behaviors and teaching teens how to protect themselves. These messages are not contradictory, but they are complex. "Don't drink, but if you do drink, don't drive" is a similarly complex message which has saved many people from death on the highway.
References:
Prepared by Lisa Krieger
Reproduction of this text is encouraged; however, copies may not be sold. The Center for AIDS
Prevention Studies at the University of California San Franciso is the source of this
information. For additional copies of this and other HIV Prevention Fact Sheets, please call the
National AIDS Clearinghouse at 800/458-5231. Comments and questions about this Fact Sheet may
be e-mailed to prevention_factsheets@quickmail.ucsf.edu. ©1996, University of California
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