Four Steps to Reduce HIV Transmission
|Expand age-appropriate, school-based sex education and condom availability within schools.|
|Increase government funding that targets adolescents, especially young gay men and young people of color.|
|Use private sector marketing tools to track values, trends and channels of communication to the young.|
|Establish private-sector partnerships by marketing HIV prevention in the same way advertising executives target today's youth when trying to sell merchandise|
SAN FRANCISCO A report released by AIDS researchers indicates the virus is fast becoming the domain of America's young and indicates current HIV prevention efforts are failing to bring home the seriousness of the epidemic to people younger than the age of 25.
Dangerous Inhibitions: How America is Letting AIDS Become an Epidemic of the Young, details why half of new HIV infections are occurring among people younger than the age of 25 and why AIDS is now the sixth leading cause of death among Americans 15 to 24 years of age.
The report calls for "emergency efforts" from both the private and public sectors to reach America's young people before the number of HIV-infected teens and young adults reaches epidemic proportions.
"AIDS is increasingly becoming the epidemic of America's young," said Chris Collins, a policy analyst at the Center for AIDS Prevention Studies (CAPS) at the University of California at San Francisco and author of the report. "New ideas and enlightened leadership are now needed to bring the message home to adolescents."
The actions called for included:
"Misguided prevention policies are literally costing us the lives of our young generation," said Thomas Coates, PhD, director of CAPS. "We find that as every hour ticks by, at least two Americans under the age of 25 become infected with the virus."
The report was unveiled to media and marketing executives recently at a forum sponsored by CAPS and the Harvard AIDS Institute, which collaborated on the project. Among those attending were writers and producers of prime-time television shows like Beverly Hills 90210 and ER, marketing executives from entertainment and retail industries like MTV and Levi Strauss as well as AIDS advocacy groups and public health officials.
The causes for the increase differed greatly among America's young men and women, as well as whites and minorities, the report found.
According to studies, the groups hardest hit are homosexual and bisexual men, along with heterosexual women. In 20- to 24-year-old men, close to two-thirds of all AIDS cases were men who were having sex with other men. Another 7% of AIDS cases were in men who had sex with men and were injecting drug users (IDUs). The study found that in all, three-quarters of reported AIDS cases among young men were from young gay men. In contrast, male heterosexual IDUs represented only 14% of the reported cases and heterosexual contact accounted for only about 8% of men aged 20-24.
While the report found HIV incidence to be falling among older gay men, many younger gay men are continuing to put themselves in harm's way. Various studies report that 33% to 43% of young gay men admitted to having had unprotected anal intercourse within the last two months, according to re searcher Susan Kegeles.
But by far, the most alarming findings to the researchers were the high infection rates among heterosexual women, whose numbers grew faster in the last decade than among any other group.
The proportion of young women among U.S. adolescent AIDS cases tripled from 14% in 1987 to 46% of the reported cases in 1995. Heterosexual sex accounted for three-quarters (75%) of cases in young women ages 20-24. Forty-one percent of women in this age group who were infected heterosexually identified the risk category of their partner; 79% were IDUs. Injecting drug use was the risk factor in 23% of reported cases among women in this age group. Heterosexual sex represents an increasing percentage of the epidemic among young women, while injection drug use is falling as a share of cases.
Some of these young people, gay or straight, were also homeless, which substantially increased their risk for acquiring HIV. Estimates of seroprevalence among homeless runaway youth range from 5.4% to 7%.
One-quarter of all high school students in a survey quoted in the report were found to be combining sex, drugs and alcohol. White male students were found to have the highest rates at 36%, while female black students had the lowest (11%). For young gay adults, alcohol and drugs were integral parts of the gay social scene, accounting for the high rates of risk and infection found among the group by the report. A focus group on urban black adolescents found that sex among this group was often un planned and usually followed by heavy drug use.
The report also documents a widening gap between the country's young minority populations at risk for AIDS and their white counterparts. Race has become a significant factor among minority adolescents than among their older contemporaries, said Collins.
Sixty-one percent of cumulative AIDS cases in Americans 20-24 years of age are among people of color. In the population as a whole, 53% of cumulative AIDS cases are among people of color according to a Centers for Disease Prevention and Control (CDC) surveillance report on AIDS.
An estimate by the Harvard AIDS Institute said that by 2000 more than half of all AIDS cases diagnosed in this country will be among blacks. By that time, blacks will also be nine times more likely to contract HIV.
The report recommends that all government and marketing officials offer young people better sex education as part of their daily classes. With information on protecting themselves against HIV and other STDs, themes like acceptance of homosexuality and establishing better access to condoms should be included.
"School-based sex curriculums should be presenting gay, lesbian and bisexual preferences as healthy and valid identities that should not be at the mercy of bigotry," Collins said. "Significant numbers of gay males, lesbians and bisexuals have reported increased verbal and physical abuse at the hands of fellow classmates."
Despite widespread support for easier access to condoms, it is still less of a struggle for young people to get drugs than to get contraceptives.
One-third of the stores in a survey cited by the report kept condoms behind the counter, forcing teens to ask for them. And of those, only 13% of the convenience stores clearly marked where the contraceptives were shelved. Young girls asking for help said they encountered insults from store clerks 40% of the time. The report strongly recommended that high schools make condoms and other forms of birth control more readily available.
Better marketing of STD testing and needle exchange programs were two more items the report believed needed strengthening. It called on the Department of Health and Human Services to follow the advice of previous government reports and fund needle exchange and STD screening programs.
Finally, the report found the government unable to fight the HIV epidemic alone and recommended media advertisers and public relations people form partnerships and take advantage of each other's resources to win the war against HIV/AIDS.
"Local TV producers can air more HIV prevention spots, TV writers and producers could make condoms more visible in their programming, supermarkets and pharmacies could ensure easier condom access without harassing young people," Coates said. "And in our own communities businesses could agree to sponsor local HIV-screening programs, churches could also provide prevention counseling and the health care community could deliver prevention messages to their old and young clients."
"Current AIDS prevention efforts are failing America's young people," said Collins. "Simply counseling abstinence or rational sexual behavior won't stop the epidemic. What is needed is a political and financial commitment from both government and the private sector to make another report like this one unnecessary."
For more information:
- Collins C. Dangerous inhibitions: How America is letting AIDS become an epidemic of the young. Center for AIDS Prevention Studies UCSF. Monograph Series #3. February 1997.
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