Young and untested, HIV spread continues
Young and untested, HIV spread continues
In 2007 only 12.9% of high school students overall and 22.3% of students who ever had sexual intercourse had been tested for HIV, the Centers for Disease Control and Prevention reports.1 "Although the results of this report show that the prevalence of HIV testing was higher among female than male students and increased with increasing grade, 73% of female students who had sexual intercourse had never been tested for HIV," the CDC found.
In the United States, an estimated 1.1 million persons were living with human immunodeficiency virus (HIV) infection in 2006, of whom an estimated 232,700 were undiagnosed and unaware they were HIV infected. Adolescents and young adults aged 13--24 years represented 4.4% of the total but disproportionately comprised an estimated 9.9% of the undiagnosed cases.
These results are similar to those of the 2000 National Survey of Teens on HIV/AIDS that determined that 10% of adolescents overall and 27% of sexually active adolescents aged 15--17 years reported ever being tested for HIV. The results for non-Hispanic black students are especially relevant, because, as of 2007, non-Hispanic blacks accounted for 72% of HIV diagnoses among adolescents aged 13--19 years. This analysis indicated that non-Hispanic black students had the highest overall race/ethnicity-specific percentage of students tested (22%), and among all students who had sexual intercourse, non-Hispanic black students in 12th grade had the highest testing prevalence. These findings suggest that, with respect to race/ethnicity, students with the highest group risk are getting tested at higher rates.
Visits to health-care providers are opportunities for HIV testing. Data collected during 1994-1996 for the National Longitudinal Study of Adolescent Health reveal that two thirds of adolescents aged 15--17 years had a physical examination in the preceding 12 months. In the 2000 National Survey of Teens, two thirds of the adolescents who reported being tested for HIV had asked to be tested, and most had been tested in health-care settings, including general health clinics (50%), private physician offices (31%), and HIV clinics (9%).
In 2006, CDC recommended routine HIV screening for all patients aged 13-64 years. Certain persons at high risk for HIV should be tested at least annually: 1) injection-drug users and their sex partners, 2) persons who exchange sex for money or drugs, 3) sex partners of HIV-infected persons, and 4) men who have sex with men or heterosexual persons who have had more than one sex partner since their most recent HIV test or whose sex partners have had more than one sex partner since their most recent HIV test. In addition, all patients seeking treatment for STDs and those attending STD clinics should be screened routinely for HIV during each visit for a new health concern, regardless of known or suspected risk behaviors for HIV infection.
The Society for Adolescent Medicine recommends offering testing and effective risk-reduction counseling and assistance as part of routine care of sexually active adolescents, especially those who live in high HIV prevalence areas . The American College of Obstetricians and Gynecologists also recommends HIV screening for sexually active women under age 19.
Routine HIV screening in health-care settings, as recommended, could increase the proportion of adolescents who are tested for HIV among those who receive medical care, the CDC emphasizes. Adolescents who have had sexual intercourse or are considering having sexual intercourse should know their HIV status and the HIV status of their sex partners. Previously published data for 2007 showed that 15% of high school students had had sexual intercourse with four or more persons during their lifetime. Such students and adolescents at high risk for HIV infection should be tested at least annually.
"HIV testing among sexually active adolescents is an important strategy to reduce the incidence of HIV infection," the CDC concluded. "The results of this analysis showed that students who had been taught about AIDS or HIV in school were more likely to have had an HIV test than were those who had not been taught about AIDS or HIV. Although approximately 90% of high school students have been taught about AIDS or HIV, only 12.9% have had an HIV test."
High schools can enhance their HIV prevention curricula by including information on locations and procedures for obtaining free, confidential HIV testing. In accordance with state and local policies, school health professionals could refer at-risk students for HIV prevention, counseling, and testing services. Many schools collaborate with local health centers and community-based organizations to help students receive screenings and some school-based health clinics offer HIV testing on-site. Health-care providers, educators, and parents or guardians play critical roles in providing support and guidance to adolescents in making decisions about the timing and frequency of HIV testing. Because adolescents might be sexually active but unwilling to discuss this information, health-care providers should provide HIV testing routinely to all patients age13 and older, the CDC recommends.
Reference
- Centers for Disease Control and Prevention. HIV Testing Among High School Students --- United States, 2007. MMWR 2009; 2009 / 58;(24):665-668.
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