CDC National AIDS Hotline Training Bulletin #114 - January 6, 1995
Centers for Disease Control and Prevention

The number of acquired immunodeficiency syndrome (AIDS) cases reported each year among U.S. adolescents (13-19 years of age) has increased from 1 case in 1981 to 588 cases in 1993. Through June 1994, a total of 1,768 AIDS cases among adolescents has been reported. Human immunodeficiency virus (HIV)/AIDS has been the sixth leading cause of death among 15- to 24-year-olds in the United States since 1991.

Although the number of adolescents with AIDS is relatively small, we know many more young people are infected with HIV. Since 1 in 5 reported AIDS cases is diagnosed in the 20-29 year age group, and the incubation period between HIV infection and AIDS diagnosis is many years, it is clear that large numbers of people who were diagnosed with AIDS in their 20s became infected with HIV as teenagers. (Through June 1994, more than 15,000 persons aged 20-24 and more than 60,000 persons aged 25-29 have been diagnosed with AIDS.)

Among adolescents reported with AIDS, older teens, males, and racial and ethnic minorities are disproportionately affected. However, the proportion of females among U.S. adolescent AIDS cases has more than doubled, from 14 percent in 1987 to 32 per- cent by June 1994.

Many American teenagers are engaging in behaviors that may put them at risk of acquiring HIV infection, other sexually transmitted infections, or infections associated with drug injection. Recent CDC studies conducted every 2 years in high schools (grades 9-12) consistently indicate that by the twelfth grade, approximately three-fourths of high school students have had sexual intercourse; less than half report consistent use of latex condoms, and about one-fifth have had more than four lifetime sex partners. Many students report using alcohol or drugs when they have sex and, in the most recent survey, 1 in 62 high school students reported having injected an illegal drug. Surveys conducted in 1992 show that reported condom use actually declines with age, often because other forms of contraception, such as birth control pills, are used more frequently in the older age groups, and/or many older youth are married or in long-term monogamous relationships.

To reach youth with HIV prevention messages and services, CDC provides numerous HIV prevention programs through three primary avenues:

School settings Community-based, regional, and national organizations, including minority organizations Programs for the general public

School-Based Programs

Ninety-one percent of all persons between the ages of 5 and 19 in the United States are enrolled in schools, providing an effective way to reach young people. School-based health education programs in the United States have had consistently positive effects in preventing students from engaging in health risk behaviors.

Since 1987, CDC has provided direct assistance to schools to develop, implement, and evaluate HIV/AIDS education programs. In 1988, only 17 states required such education--by 1992, the number of states requiring HIV education had increased to 34. CDC also helps train teachers, school administrators, and representatives from youth-serving community organizations from every state on the best ways to conduct HIV prevention education programs. CDC's Combined Health Information Database, which is accessible to any educator through the CDC National AIDS Clearinghouse, provides information on more than 1,000 curriculum guides, audiovisuals, and other relevant information for use in teaching young people about HIV infection and AIDS.

Community-Based, Regional, and National Prevention Programs

Not all youth can be reached through the schools. To reach teenagers and others not in school who may be at high risk for HIV infection, CDC funds (directly or through state and local health departments) HIV prevention activities by more than 500 community-based organizations. These efforts include street outreach; clinic-based education; counseling, testing, and referral programs; and programs that address the specific needs of runaway, incarcerated, migrant, homeless, and other youth in high-risk situations. Recent data indicate that street outreach activities are useful in providing HIV prevention messages and interventions to populations at high risk of infection, including youth. CDC also provides financial and technical assistance to 21 national organizations for educational programs and materials directed to youth in high-risk situations, particularly inner-city and minority youth.

The more recent HIV Prevention Community Planning Initiative represents a significant step forward in the planning of culturally competent and scientifically sound HIV prevention services that specifically address unique community needs. Community planning is a process whereby the identification of high priority prevention needs is shared between the health department administering HIV prevention funds and representatives of the communities for whom the services are intended. In addition, the community planning process embraces the notion that the behavioral and social sciences must play a critical role in the development, implementation, and evaluation of HIV prevention programs within a community. Many communities across the country have identified youth in high-risk situations as a group requiring intense prevention efforts. Through CDC's HIV Prevention Community Planning Initiative, they are working in partnership with state and local health departments, national and regional organizations, and community-based organizations to address this need.

Public Information/Education Programs

CDC also targets prevention efforts for young people through its public information and education campaigns. These programs include a number of activities designed to educate all members of the public, including adolescents, about how HIV is transmitted, who is at risk of acquiring the infection, and how the infection can be prevented. The programs include a national public information campaign, the CDC National AIDS Hotline, and the CDC National AIDS Clearinghouse.

Research has shown that most Americans, including teenagers, understand how HIV is transmitted and how they can avoid being infected. Therefore, confronting the belief that "it can't happen to me" was a primary goal of one series of CDC-sponsored public service announcements. Previous phases of the public information campaign have included many youth-oriented materials.

In 1989, CDC launched a special education effort called "Parents and Youth" designed to help parents, teachers, and other concerned adults talk to children about HIV and AIDS. The educational materials from that campaign, including a brochure called "The AIDS Prevention Guide," are still available to anyone who requests them from the CDC National AIDS Hotline.

Another activity targeting youth is CDC's Prevention Marketing Initiative (PMI), a large-scale social marketing program to influence behaviors that contribute to the sexual transmission of HIV and other diseases. It represents a shift from previous mass health communications programs, aimed at increasing general awareness of HIV/AIDS, to influence behavior changes among people at high risk for HIV infection or transmission. PMI is an application of marketing techniques and consumer-oriented communications technologies based on science and directed, in its first phase, to the prevention of sexual transmission of HIV and other diseases among young adults 18-25 years of age. The most visible PMI activity to date has been the national release of a series of public service announcements promoting abstinence as well as the correct and consistent use of latex condoms. To achieve the PMI behavioral objectives, CDC will work simultaneously at the national, state, and local levels through four components: (1) National Communications, (2) Prevention Collaborative Partners, (3) Local Demonstration Sites, and (4) Integration with HIV Prevention Community Planning.

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