Young people between ages 13 and 24 make up less than 17 percent of the U.S. population. But they represent 26 percent of all new HIV infections. Worse, nearly half of them do not know they are infected. Because of this, the U.S. Centers for Disease Control and Prevention (CDC) recommends that all young people over 12 be screened for the virus. The organization first made that recommendation 10 years ago. Yet HIV testing in young people has not increased, a new study finds.
HIV is short for human immunodeficiency virus. It’s the virus that leads to acquired immune deficiency syndrome — AIDS. When the disease was first discovered in the 1980s, a diagnosis of HIV was something like a death sentence. That was because there were no treatments. But today there are drugs that can treat people with HIV and prevent them from developing AIDS. These drugs have turned HIV into a chronic, manageable condition. But before doctors can prescribe these life-saving medications, they first need to know that someone is infected.
That’s why, in 2006, the CDC recommended that doctors screen everyone between the ages of 13 and 64 for HIV. But that recommendation has been difficult to put into practice, especially among young people.
HIV testing in high-school students has remained at relatively low levels. In 2005, about 20 percent of high-school students who had ever had sex reported that they’d been tested for HIV. In 2013, that number had risen to only 22 percent. The numbers were slightly higher for students who reported having sex with more than four people: 32 percent in 2005 and 34 percent in 2013. Michelle Van Handel is a health scientist at the CDC in Atlanta, Ga. She and her colleagues reported their new findings January 19 in Pediatrics.There may be many reasons why teens and young adults don’t get tested. Pediatricians can find it difficult to start a conversation with teens about sex and the risks it can pose. And many teens who are having sex deny it when a doctor asks. Plus, unlike other sexually transmitted infections such as chlamydia , HIV still has a stigma associated with it. That leads both teenagers and their parents to resist testing. Sometimes, people refuse testing because they’re afraid they might be infected. They don’t want to think about that reality.
Doctors and their young patients also may downplay the risk of HIV and think testing is unnecessary, says Robert Garofalo. He’s a pediatrician who does HIV prevention research at Northwestern University’s Feinberg School of Medicine in Chicago. Teens aren’t considered a high-risk group. Drug users, the homeless, and people who are lesbian, gay, bisexual or transgender are seen as higher risk. “But [HIV/AIDS] doesn’t just affect those communities,” he says. “It can affect anyone who’s engaged in [unprotected] sex.”
Another reason young people may not be getting screened for HIV is because of fear that the test results won’t remain confidential.
Doctors can have a difficult time keeping patients’ requests confidential when all blood tests must be documented on the visit summary. And a positive test result could lead to families withdrawing emotional and financial support or even kicking someone out of the house, notes Wesley Thomas. He works at Advocates for Youth, a Washington, D.C.-based group that seeks to ensure students get access to information and services that address their sexual health. In fact, he notes, it is possible to get a confidential HIV test. “If you want to go to a community organization [for testing] at age 16, you can do that without your parents knowing.”
More than half of all teens and young adults in the United States who are HIV positive don’t know it, according to the CDC. “It breaks my heart when someone walks in who was never screened for HIV and [has been] living with the disease for many years without getting treatment,” Thomas says. “An HIV test should be part of routine screening for any young person who’s sexually active. Because, should they be positive, access to care and early treatment is truly a lifesaving measure.”
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AIDS (short for Acquired Immune Deficiency Syndrome) A disease that weakens a body’s immune system, greatly lowering resistance to infections and some cancers. It is caused by the HIV germ. (See also HIV)
bisexual A term relating to people who are sexually attracted to both men and women.
chronic A condition, such as an illness (or its symptoms, including pain), that lasts for a long time.
chlamydia A sexually transmitted infection that is caused by the bacterium Chlamydia trachomatis. It can be spread through genital or oral sex, and often has no symptoms. If left untreated, however, it can cause infertility in women.
gay (in biology) A term relating to homosexuals — people who are sexually attracted to members of their own sex.
Centers for Disease Control and Prevention, or CDC An agency of the U.S. Department of Health and Human Services, CDC is charged with protecting public health and safety by working to control and prevent disease, injury and disabilities. It does this by investigating disease outbreaks, tracking exposures by Americans to infections and toxic chemicals, and regularly surveying diet and other habits among a representative cross-section of all Americans.
HIV (short for Human Immunodeficiency Virus) A potentially deadly virus that attacks cells in the body’s immune system and causes acquired immune deficiency syndrome, or AIDS.
HIV-positive (or –negative) A designation given to people whose tested blood shows they have become infected with HIV (or not infected, if they are HIV-negative).
infection A disease that can spread from one organism to another.
lesbian A woman who is sexually attracted to other women.
pediatrics A field of medicine that has to do with children and especially child health. A doctor who works in this field is known as a pediatrician.
screening A health test that is done early, before any symptoms are present. That can help find disease when it is easiest to treat. Screenings can include blood tests (such as for HIV, diabetes or high cholesterol), X-rays or scans (such as mammograms for breast cancer).
STI (short for sexually transmitted infection) A virus or bacterium that is spread through sexual contact. Chlamydia, HPV (human papilloma virus), and HIV (human immunodeficiency virus) are examples of STIs.
transgender/trans-sexualism Someone who has a gender identity that does not match the one they were born with or assigned at birth.
virus Tiny infectious particles consisting of RNA or DNA surrounded by protein. Viruses can reproduce only by injecting their genetic material into the cells of living creatures. Although scientists frequently refer to viruses as live or dead, in fact no virus is truly alive. It doesn’t eat like animals do, or make its own food the way plants do. It must hijack the cellular machinery of a living cell in order to survive.