"I find this stunning at this stage of the epidemic," said Dr. Donna Futterman as she made a presentation to the North American Sessions of the International Association of Physicians in AIDS Care (IAPAC) in May in Chicago. Her slides declared that "AIDS is NOT over for youth."
Futterman, director of the Adolescent AIDS Program for the Albert Einstein College of Medicine in the Bronx, told the audience of doctors and other medical providers, "People talk about condom failure, but they don't talk about abstinence failure. The young people who make an abstinence pledge and fail are less likely to use a condom.
"Abstinence is important to talk about," Futterman continued, "but we can't start and end there."
Her clinic staff try to get doctors at the hospital to test for HIV when they treat sexually transmitted infections (STIs) in teens and young adults, but Futterman says that doctors ask her why they should do this. One doctor treating a teenage girl for pelvic inflammatory disease (PID) told her, "What do you mean that you think my patient did something to get HIV?" Futterman said, "It's just an STD like PID.
"The kids can be doing the same things kids are doing in Iowa, but they're more likely to run into the virus [in the Bronx]," she says. "Doctors internalize their patients and become defensive for them, but now we have to go beyond the patient in front of us to the general public and what we can do to protect against the spread of the virus."
Unfortunately, young people rely heavily on the "visual AIDS test." "I can look in his eyes and tell." "He looks fine." "I know he's okay, and plus he told me he's negative." These quotes -- which Futterman has heard many times in her 20 years of treating youth with HIV -- ran in Newsweek magazine the week of her presentation (May 11).
"As shocking as it is to think that this is the youth assessment," said Futterman, "it's more shocking that this is the provider [healthcare worker] assessment. What you did doesn't matter -- you either have HIV or not. It's what you do in the future that counts."
Her clinic created the A.C.T.S. project -- Assess, Consent, Test, Support. A "concise yet comprehensive" laminated pocket guide to testing youth for HIV is given to hospital staff. "We've made it as simple as it could be and it still is not taken up as much as it could be."
And yet, Futterman points out that, "You can't expect kids to tell you what they're doing, or adults tell you how many hamburgers they ate."
She listed "reality-based prevention" that runs on a safer sex continuum:
Everyone needs to understand that there is a link between sex, STIs and HIV, and that there's a link between prevention and testing. The counseling that comes with testing can help clear up misconceptions, and any positive test results can help keep people from transmitting the HIV they didn't realize they had. On the negative side, she acknowledges that condom use is not easy.
And sadly, research has shown that one of five teenagers infected sexually also have an HIV-positive parent. Futterman said this is due to the socioeconomic factors the families live in -- poverty, drug use, and lack of access to healthcare and information.
Her clinic works with the "Connect to Protect" national research partnership that designs posters and other materials to grab the attention of teenagers. Messages appear under headings like "Gettin' busy?" and "Doin' it?"
"The success of the gay community was in mobilization and awareness, not just individual behavior," she said.