SEPTEMBER 1998

NUMBER ONE

Youth is Risk Factor

HIV is still spreading rapidly among America's youth, particularly minorities. Half of new infections are among people under 25, and a disproportionate number-60 percent-are African-American and Latino youth, including teenage girls having unprotected sex with IV-drug-using partners. HIV also hits hard among gay and bisexual male youth, who have made up half of AIDS cases this year. Recent surveys continue to show that many infected teenagers had no idea their partner had HIV.

HIV is associated with two socially linked risk factors that begin in adolescence: sexual activity and drug use. Youth itself is also viewed a risk factor, making young people both vulnerable to peer pressure concerning sex and drugs and unsure of how to reach out for help, information, or access to care for HIV. Studies of at-risk teenage girls suggest that emotional issues such as being in love, fear of rejection by a partner or friends, and low self-esteem reduce their ability to negotiate condom use, avoid alcohol and drug use, and seek HIV counseling, testing, and treatment. These problems also affect teenagers struggling with their sexual identity who often face hostility, homophobia, and violence if they come out. Counseling for at-risk teens is vital but often not available in schools or -communities.

Economic factors also play an important role. While new drugs offer hope to HIV-positive teenagers, advocates argue that care providers must face the underlying social and emotional realities facing youths, such as fear of violence, sexual abuse, poverty, foster care, drug addiction, and prostitution, that limit teens' access to proper care, education, and treatment. Getting a runaway teen access to housing, counseling, or a case manager may be a key first step toward treatment.

If you're a teenager worried about AIDS, it's important to talk to someone you can trust-a school counselor, relative, priest, doctor-about safer sex, drug use, general health maintenance, and STD prevention. If you're HIV positive, find a doctor in your local area who treats young people with HIV. Check with your local AIDS organizations for help. If you're living on the streets, there are street outreach programs to help you get housing, food, and into a drug-treatment program, as well as access to medical care. But you have to reach out.

Preventive Care: Caring for HIV-positive adolescents is more demanding than for adults, often requiring multiple visits. Ideally, a medical team should include physicians, nurses, social workers, psychologists, nutritionists, outreach workers, and a pharmacist. Teens with HIV need regular, comprehensive medical evaluation using the Tanner staging method to determine physical and sexual maturity. Include a review of medical history, psychosocial history (current living situation, work and school circumstances, attitudes toward illness and treatment), need for psychosocial support, and referral for entitlements. STD prevention and screening is important.

Vaccinations: Recommended shots for HIV-positive youths pneumococcal vaccine, annual flu shots, age-appropriate diphtheria and tetanus, MMR and HIB immunization, hepatitis B vaccination for those without immunity.

Antiviral Therapy: Studies to date show that successful HIV-combination therapy can benefit youths. Experts recommend that adolescents with HIV follow the same guidelines as adults (see "Uncle Sam Says"). For now, pediatricians use the Tanner staging method for for physical and sexual maturity to determine antiviral dosing for adolescents: Those in Stage I or II should receive pediatric doses; those in Stage III should receive adult doses with careful monitoring; those in Stage IV or V should receive adult doses, regardless of age.

Adherence: HIV-positive teens face special hurdles when it comes to taking HIV drugs on schedule, including denial or fear of their HIV infection, misinformation, distrust of doctors and parents, lack of belief that the drugs will help, low-self esteem, unstructured and chaotic lifestyles, and lack of family and social support. To help adolescents, treatment regimens must balance the goal of prescribing a maximimally potent regimen with a realistic assessment of existing and potential support systems to faciliate adherence. Consider a non-protease regimen to avoid protease resistance.

Advocates suggest doctors work closely with affected youths, their families, and other care providers to devise treatment plans that are integrated into school and daily activities.