Jailed youth at high risk of HIV, researchers find

Youngest kids also have high-risk behaviors

Investigators have found that among incarcerated youths in Chicago there are very high rates of behavior that place the children and teen-agers at risk for HIV infection.

The study included interviews with youth, ages 10 to 18, who were arrested and detained between 1995 and 1998 at the Cook County Juvenile Temporary Detention Center in Chicago.1

The longitudinal study included 1,829 youths, who were part of the Northwestern Juvenile Project and who were part of a random sample. Trained interviewers determined risk, using the AIDS Risk Behavior Assessment.1

Researchers found several surprises in the data, including high rates or risk behavior among the younger children, says Linda A. Teplin, PhD, an Owen L. Coon professor of psychiatry and behavior sciences and director of the Psycho-Legal Studies program at Feinberg School of Medicine at Northwestern University in Chicago.

"The very high risk behaviors among girls surprised me," she says. "The depths of these young women’s problems were disturbing."

Part of the problem is that a large number of the girls who end up in detention have been abused, neglected, and are likely to be runaways who take drugs and drink alcohol, Teplin adds.

"If you want to know what the most high-risk kids are doing — the drug abusers, kids who drink, kids in the foster care system — then the logical place to study them is in a detention center," she says.

A study that looks solely at jailed youth is rare and difficult to conduct because the children and teen-agers typically stay in detention facilities for an average of two weeks, Teplin explains.

Such research also is difficult to conduct because of the very strict human subjects requirements for research involving prisoners, she says. "It’s so difficult to do research on prison populations that it can be intimidating for researchers."

Nonetheless, it’s an important population to study because the problems that begin when people are youths will continue as they become adult offenders and adults who place themselves at high risk for HIV infection, Teplin notes.

"We’ve done research on adults in jails for the last 20 years; and we found in our studies that many first got into trouble when they were kids, and they first developed psychiatric symptoms when they were kids," she says. "So, for us, a logical [approach] was to study kids in detention."

Studying HIV/AIDS risk was only one part of the study. Investigators also looked at psychiatric disorders, drug use, alcoholism, sex abuse, physical abuse, violent victimization perpetration, and other issues, Teplin says.

Here are some of the HIV/AIDS risk results:

• Of the males interviewed, more than 90% reported being sexually active, and nearly 61% had more than one sexual partner within the past three months.

• Nearly 87% of females were sexually active, and 26.3% of females had more than one sexual partner within the past three months.

• Nearly 12% of males and 6.7% of females reported having anal sex.

• About one-third of males and slightly more than a third of females reported having unprotected sex when they were high or drunk.

• Among males, 28.2% had used alcohol and 27.6% had used marijuana before age 13; among females, 32.4% had used alcohol and 28.5% had used marijuana before age 13.

• Both males and females (greater than 40%) reported having tattoos.

• Use of other substances was reported by 14.6% of males and 21% of females, with white and Hispanics reporting far greater incidences of substance use than African-Americans (3.8% of African American males vs. 57.9% of whites and 49.8% of Hispanics, and 4% of African-American females vs. 58.4% of whites and 55% of Hispanics).

• On a more positive note, injection drug use, sharing needles, and trading sex and drugs were reported by very small percentages of the youths.

"What this tells us is that there’s still opportunity to intervene with these kids because many of them have not yet engaged in the highest-risk behaviors," Teplin says.

Since the study was conducted at a research university and received no local or state funding, it was not designed to include interventions or suggestions for interventions, she points out.

"If we start intervening locally and making trouble locally, then we couldn’t be able to do our research, and our research informs public health policy nationwide — not just in Cook County," Teplin says.

However, the study does suggest that interventions are needed for youths who end up in detention centers, she adds. "I think that we often neglect research intervention for correctional populations; and this research demonstrates that it’s a very high-risk population, and interventions can have a huge payoff."

Since the at-risk youths who can be found in detention centers are difficult to reach in communities and schools, HIV prevention programs directed at these populations in detention centers are probably the best strategy, Teplin notes.

"This is an innovative idea because people perceive that folks in detention are safely put away and so they’re not the responsibility of the community or a threat to community public health," she says.

"That’s a great misperception because they only stay in detention from a few days to a few weeks, and so they are a burden to the community," Teplin adds.

Reference

1. Teplin LA, Mericle AA, McClelland GM, et al. HIV and AIDS risk behaviors in juvenile detainees: Implications for public health policy. Am J Pub Health 2003; 93(6):6-12.