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Preventing HIV Transmission With Youth Infected at Birth

By Gary Bell

November 13, 2012

As we reach a certain age, many of us long for the vitality of youth without, of course, the consequences for our youthful indiscretions. It is a time of learning and discovery. For many, it is also a time for sexual exploration. Adolescents in 2012 have lived their entire lives with the HIV epidemic. They may have learned about it in health class, read about it on the Internet, or perhaps learned that someone close to them has been infected. Now, imagine that at age 15 or 16 you are told that you are HIV positive, not because you became infected through risky behavior, but because you have had it all of your life. More troubling: what if you have been sexually active before you found out?

There are three primary ways for newborns to become infected with HIV: while growing in the uterus, during delivery or during breastfeeding. Antiretroviral treatment of pregnant mothers has been shown to reduce mother-to-child infection rates to about 4%, significantly reducing the number of children being born with HIV worldwide. Yet, according to the Centers for Disease Control (CDC), there are approximately 10,000 people in the United States who are living with HIV acquired at or before birth.

A new study of adolescents infected with HIV from birth found that 20% were unaware that they were HIV positive until after their first sexual encounters. The study of 330 HIV-positive 10- to 18-year-olds was conducted at clinical sites nationwide as part of the Pediatric HIV/AIDS Cohort Study, which is funded by the NICHD and several other NIH institutes and offices. On average, participants who had initiated sexual activity reported having their first sexual experience at age 14. Most of the sexually active youth in the study reported some incidents of sexual activity without condom use (62%). Only one-third of these said they had disclosed their HIV status to their first partner. Another troubling statistic was that young people who did not take anti-HIV medication regularly were more likely to initiate sexual activity than were those who were more consistent.

There are many lessons to be learned through this research, but one obvious point: "kids are kids." In other words, the adolescents in this study simply behaved like most adolescents who are experimenting with their sexuality do. Therefore, it is imperative that they be made aware of their HIV status before they become sexually active and of the importance of adhering to their antiretroviral medication. While I can understand caregivers wanting to delay disclosing HIV status to a young person until they are mature enough to handle it, delaying that disclosure risks them exposing other young people to possible infection. They should also receive robust risk-reduction education -- especially geared toward disclosing their status to their sexual partners -- and the proper use of condoms.

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