Youth and HIV/AIDS in the United States
An estimated one-fourth of all HIV infections occur in people age 21 and younger—a segment of the population that is among the most medically underserved.1 Experts estimate that only 11 percent of HIV-positive youth in the United States receive adequate health care.2 Most HIV-infected youth are asymptomatic, do not know they are infected, and are not enrolled in treatment.3
Surveillance
Given the power of today’s treatments and the average time from HIV infection to progression to AIDS, AIDS surveillance data do not reveal the scope of the epidemic among adolescents. Available data, however, reveal past trends in the epidemic.
- Only a small proportion of estimated AIDS cases have been among people in their teens. Given the time lapse from seroconversion to progression to AIDS, it is certain that a large number of people in their 20s—and some in their 30s—became infected with HIV while in their teens.4
- In 2004, there were 2,114 estimated AIDS cases among people ages 15 to 24, an increase of 30.5 percent since 2000.5
- Approximately one-half of new HIV infections are in people under 25 years old.6
- HIV diagnoses are disproportionately higher among women and non-Hispanic Blacks. Blacks ages 13 to 24 account for 56 percent of HIV diagnoses.6
- Large proportions of young adults, particularly minorities ages 18 to 29, report that they know someone with HIV/AIDS or someone who has died from AIDS. In one national survey, 61 percent of African-Americans said they knew someone infected, compared with approximately 42 percent of Latinos and 34 percent of Whites.7
CRITICAL ISSUES
Although parents of youth age 21 or younger are concerned about their children becoming infected with HIV, young people ages 18 to 29 are more likely than older people to call HIV/AIDS the most urgent health problem facing the Nation.7
African-American adolescent males are more likely than youth in any other racial or ethnic group to become sexually active at a young age, have multiple partners, and engage in high-risk activities. This behavior increases the risk for contracting and spreading sexually transmitted infections (STIs), a risk that African-American adolescent girls greatly underestimate, according to a study of 13,998 adolescents.6 Minority girls in particular lack access to preventive health care services. They also underestimate their risk of STIs by overestimating how safe their partners are.6
People age 24 and younger constitute the most uninsured population in the United States.8 Consequently, they are likely to lack preventive health care or access to important information about their health.
Youth and the Ryan White CARE Act
Youth ages 13 to 24 constituted approximately 7 percent of all Ryan White Comprehensive AIDS Resources Emergency (CARE) Act clients in 2004, a year in which CARE Act programs reached approximately 533,000 people. Many CARE Act-funded providers are reaching out to young people. For example, through the Title IV Program for Women, Infants, Children, Youth, and Families, 16 grants totaling $72.7 million were funded in 2006 as part of the Title IV Youth Initiative.
The CARE Act Special Projects of National Significance Program funded an initiative in which grantees received funds for developing innovative models for reaching HIV- positive adolescents not in care. Results from those activities have been disseminated across the country.
Lesbian and Gay Youth: Care and Counseling, by Donna Futterman and Caitlin Ryan (Columbia University Press, 1998), is the preeminent text on health care and well-being for sexual minority youth. Development of the publication was supported with funding from the Health Resources and Services Administration (HRSA).
HRSA conducted a nationwide conference call on youth and HIV disease called Reaching HIV-Positive Youth: Models That Work. Subsequent to the event, a report that provides information on an array of resources available to organizations serving youth at risk for HIV disease was made available at www.hab.hrsa.gov/.
For more information on young people and HIV/AIDS, see the May and July 2004 issues of HRSA CAREAction, available at www.hab.hrsa.gov/publications/news.htm.
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References
1 Office of National AIDS Policy. Youth and HIV/AIDS 2000: A New American Agenda. Washington, DC: Office of National AIDS Policy; 2000.
2 Steele RW. What are the special needs of adolescent patients with HIV/AIDS? Paper presented at the American Academy of Pediatrics Annual Meeting, Chicago, IL; 2000.
3 Futterman D. Youth and HIV: the
epidemic continues. Phys Res Network Notebook. 2003;8:21-4.
4 Centers for Disease Control and Prevention (CDC). HIV/AIDS Surveillance Report. 2004;16(1): 20. Table 10.
5 CDC. HIV/AIDS Surveillance Report. 2004;16(1):20. Table 3.
6 Halpern CT, et al. Implications of racial and gender differences in patterns of adolescent risk behavior for HIV and other sexually transmitted diseases. Perspect Sex Reprod Health. 2004;36(6):239-47.
7 Henry J. Kaiser Family Foundation. Survey of Americans on HIV/AIDS—Part Two: HIV Testing. Menlo Park, CA: Henry J. Kaiser Family Foundation; 2004. Available at: www.kff.org/kaiserpolls
/pomr061504pkg.cfm. Accessed December 2005.
8 U.S. Census Bureau. Income, Poverty, and Health Insurance Coverage in the United States: 2004. Washington, DC: U.S. Census Bureau; 2005. Table 7. Available at: www.census.gov/prod/2005pubs/
p60-229.pdf. Accessed February 9, 2006.
9 Henry Kaiser Family Foundation. Survey of Americans on HIV/AIDS. August 2004. Available at: www.kff.org/hivaids/upload/
Survey-of-Americans-on-HIV-
AIDS-Part-Three-Experiences-
and-Opinions-by-Race-Ethnicity
-and-Age.pdf. Accessed December 2005.
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