WASHINGTON, DC—At the age of 19, Marvelyn Brown, a college student, was sick in the hospital when she was confronted with the news that she was HIV positive. Now 26, and an activist who promotes HIV testing among young people, she recalls how shocked she was when the doctor told her of her diagnosis. “I had heard about HIV, but I never cared about it until that one moment when he told me I was HIV positive.”
As a young person with HIV, Brown is not alone. Nearly one third of all new HIV infections each year in the US occur among those between the ages of 13 to 29, according to CDC. Among those young people, men who have sex with men (MSM), and African-American men and women are especially impacted by the disease.
At an event held by the American Foundation for AIDS Research (amfAR) in September, the foundation, government, and policy experts expressed the need to reach young people who are vulnerable to HIV infection, but who do not always realize it. “Young people bear a disproportionate burden of the new HIV infections in the United States,” said Kevin Fenton, MD, PhD, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.
HIV Among Young People
In July of this year, the Obama administration released its “National HIV/AIDS Strategy for the United States,” which calls for expanded HIV testing and screening. One goal of the strategy is to lower the annual number of new infections by 25% (from 56,300 to 42,225) by 2015.
Jeffrey Crowley, MPH, director of the White House Office of National AIDS Policy, said that the strategy includes the youth population. He noted that there is a need to reach youth, particularly those in high-risk groups, including those who are gay and bisexual men. “One area we really need to focus on is reaching gay and bisexual youth.”
Crowley also said that strategies need to be developed to reach young people engaging in sexual activity with those who are older than them. “We know that when young people have sex with people much older than them they are much more likely to get HIV that way. We need to think about how we can come up with community strategies to address that.”
Crowley said that the president does not embrace an approach focused on abstinence-only programs. “We don’t believe that abstinence only, as it currently existed, is as effective as necessary. We have tried to move away from that.” For this year, Crowley said that a teen pregnancy prevention initiative has been funded for $110 million in place of an abstinence-only program.
Fenton said that among CDC’s efforts to educate youth is an effort to work with boards of education across the country to examine the content and quality of sex education programs. CDC is also preparing products to “help schools do a better job of delivering school-based sex education programs.”
Bill Kapogiannis, MD, medical officer for the Pediatric, Adolescent & Maternal AIDS Branch for the NIH’s National Institute of Child Health and Human Development, emphasized the importance of ongoing research in treating youth with HIV. The physical changes in adolescents can complicate treatment and doses of HIV medications cannot simply be scaled up or scaled down for youth, he explained. “Only through carefully controlled clinical research among youth can appropriate regimen and doses of a variety of medications and treatment strategies be determined.”
Kapogiannis said that the agency’s Adolescent Medicine Trials Network has been the only domestic research network dedicated to the emerging epidemic in teens. The primary mission of the ATN for HIV/AIDS Interventions is to conduct research to study promising behavioral, microbicidal, prophylactic, therapeutic, and vaccine modalities in HIV-infected and HIV-at-risk adolescents, ages 12 through 24 years.
Young People with HIV Speak
Brown and Christopher “Cree” Gordon, another youth with HIV, are hoping to make an impact on HIV transmission among youth by being transparent about their own stories. Brown said that she contracted HIV from unprotected sex that she had with a man whom she loved and trusted. She now promotes personal responsibility when it comes to sex and encourages young people to get tested. “I wasn’t raped, I wasn’t forced to do anything. I chose to have unprotected sex with a guy that I loved and trusted. It just so happened that he knew he had it and he did not tell me.”
Gordon was homeless and worked as a teen sex worker in New Orleans to support himself. After moving to Oregon he took an HIV test and discovered he is HIV positive. Homelessness among youth needs to be addressed since some are participating in risky sex or work as sex workers in order to have their basic needs met, he said.