On National Youth HIV/AIDS Awareness Day we take a closer look at how the HIV/AIDS epidemic impacts younger individuals and what can be done to cut back on new diagnoses.
National Youth HIV & AIDS Awareness Day is observed annually on April 10, as a day dedicated to not only recognizing how the HIV/AIDS epidemic impacts younger individuals, but also what can be done to cut back on the number of younger individuals who are diagnosed each year.
The Centers for Disease Control and Prevention (CDC) reports that in the United States, young individuals between the ages of 13 and 24 accounted for one in five (or 22%) of new HIV diagnoses in 2015. A whopping 81% of those diagnoses occurred in young gay and bisexual men; 55% of these men who were newly diagnosed with the virus were black, 24% were Hispanic or Latino, and 16% were white. The CDC also notes that even though the population of young gay and bisexual men made up the majority of the new infections for 2015, the estimated annual HIV infections has fallen by 18% from 2008 to 2014 among this population.
According to the CDC, HIV testing is particularly low in youth who are between the ages of 13 and 24, compared with other age groups. In fact, only 10% of sexually-active high school students in the United States have ever been tested for the virus. Even more troubling is the fact that of the 60,900 younger individuals who were living with HIV in 2013, about half (51%) had not even received diagnosis; according to the CDC, that is “the highest rate of undiagnosed HIV in any age group.” Furthermore, out of all age groups, this group is the “least likely” to be linked with the care that they need, perhaps due to the lack of testing.
How can health care providers get more individuals tested? The answer may lie in making the HIV test part of routine care, Colleen Kelley, MD, associate professor of medicine for the Division of Infectious Diseases in the department of Medicine at Emory University School of Medicine, told Contagion ®.
"Just making it a normal part of routine care, just like testing for cholesterol or testing for diabetes, or other things that patients are expecting [may be key]," she said. "If we’re all testing for HIV in all of our patients, that’s what patients will start to expect, and it won’t be an anomaly for them. And if folks decline, I think I would explore very carefully why they’re declining, because more than likely they’re declining because they have some kind of internalized stigmatized beliefs about HIV that maybe you can help them to work through to get an HIV test."
There are several challenges when it comes to preventing HIV in this population. One of the biggest challenges concerns sexual health education. In fact, the CDC recommends that high schools teach 16 related sexual education topics, but it turns out that less than half of the high schools actually comply with this recommendation. Some concerns with the sexual education curricula that are already in place are that the education is not starting early enough, many curricula exclude prevention information for at-risk groups (such as gay/bisexual men), and sexual education has declined over the years.
Another challenge is that teenagers are engaging in risky behaviors that increase their risk of infection. Although the CDC reports that less high school students reported to be “currently sexually active” between 2005 and 2015, the prevalence of “risky” behaviors was still high. One such “risky” behavior is having sexual intercourse without the use of a condom. According to the CDC, “condom use has decreased among teens, with more than 43% of sexually active high school students not using a condom the last time they had sex.” Furthermore, the CDC notes that younger lesbian, gay, and bisexual (LGB), are often at increased risk of having negative health outcomes, as 15% of LGB students have had sex with 4 or more individuals in their life compared with 12% of high school students in general.
The stigma associated with HIV is another barrier to prevention. "HIV/AIDS-related stigma is a complex concept that refers to prejudice, discounting, discrediting, and discrimination directed at persons to have AIDS or HIV, as well as their partners, friends, families, and communities," according to the Centers for AIDS Prevention Studies (CAPS) at the University of California San Francisco.
The fear surrounding the social consequences of a positive HIV test can deter individuals from getting tested; fear of disclosing their status to a sexual partner or that suggesting the use of a condom might cause their partner to reject them could prevent individuals from practicing safer behaviors, and stigma surrounding HIV and homosexuality make it difficult to make prevention programs more accessible to those who need them most, as many community venues such as churches, businesses, jails, and schools have resisted their incorporation.
So, what can be done to overcome these obstacles? The answer lies first and foremost in strengthening and broadening educational efforts.
In-school education is key when it comes to promoting HIV awareness and the dangers that come with engaging in risky behaviors. Providing further education on HIV and other sexually-transmitted diseases, encouraging students to communicate with their parents and their friends about these important topics, and providing students with access to counseling and testing services are all key to achieving an AIDS-free generation.
To this end, the CDC have partnered up with several state and local education agencies to:
By working together to start educational discussions and encourage testing of all age groups, we can break the stigma and get a leg-up in the fight against HIV.