HIV Infection in Adolescents and Young Adults

OVERVIEW
The AIDS epidemic among adolescents and young adults in the United States continues to be an increasing concern. The Centers for Disease Control and Prevention (CDC) reported 41,287 cumulative cases of AIDS among people ages 13 through 24 through December 2002. Health experts estimate the number living with HIV (human immunodeficiency virus) infection to be much higher.

Because the average duration from HIV infection to the development of AIDS is 10 years, most adults with AIDS were likely infected as adolescents or young adults. HIV infection is the seventh leading cause of death for those ages13 through 24.

58 percent were male
42 percent were female
27 percent were White, not Hispanic
51 percent were Black, not Hispanic
21 percent were Hispanic
Less than 21 percent were Asian/Pacific Islander or American Indian/Alaskan Native

Because the average period of time from HIV infection to the development of AIDS is 10 years, most young adults with AIDS were likely infected with HIV as adolescents. HIV infection is the sixth leading cause of death in this age group.

EXPOSURE AND TRANSMISSION
Most HIV-infected adolescents and young adults are exposed to the virus through sexual intercourse. Recent HIV surveillance data suggest that the majority of HIV-infected adolescent and young adult males are infected through sex with men. Only a small percentage of males appear to be exposed by injection drug use and/or heterosexual contact. The same data also suggest that adolescent and young adult females infected with HIV were exposed through heterosexual contact and a very small percentage through injection drug use.

Approximately 25 percent of cases of sexually transmitted infections (STIs) reported in the United States each year are among teenagers. This is particularly significant because the risk of HIV transmission increases substantially if either partner is infected with an STI. Discharge of pus and mucus as a result of STIs such as gonorrhea or chlamydia infection also increase the risk of HIV transmission three- to five-fold. Likewise, STI-induced ulcers from syphilis or genital herpes increase the risk of HIV transmission nine-fold.

TREATMENT
Adolescents and young adults tend to think they are invincible, and therefore, deny any risk. This belief may cause them to engage in risky behavior, delay HIV testing, and if they test positive, delay or refuse treatment. Doctors report that many young people, when they learn they are HIV-positive, take several months to accept their diagnosis and return for treatment. Health care providers may be able to help these adolescents and young adults understand their situation during visits by

Ensuring confidentiality
Explaining the information clearly
Eliciting questions
Emphasizing the success of newly available treatments