Youth Facing Life with HIV

While the number of young people living with HIV across the country rises steadily, the Seattle area continues to have a low incidence of HIV among youth aged 13 to 24. This transmission rate has remained low in our area due in part to access to clean needles and targeted risk-reduction programs. In addition, youth-friendly community-based organizations offering free healthcare to homeless youth, recovery services for substance users, "teen feeds" and intensive case management also contribute to a healthy youth population.

In December 2000, 179 youth [ages 13 to 24] were reported as living with AIDS in King County. Between September of 1999 and December 2000, 229 additional youth tested positive for HIV, without reportable AIDS. The actual number of youth living with HIV is undoubtedly higher, partly because many young people currently infected with HIV will not test positive until later in life.

YouthCare is a service agency for homeless and at-risk youth that also provides case management to HIV-positive youth in King County. Currently, YouthCare serves about 20 young people living with HIV and AIDS. Many HIV-positive youth access medical care at the Northwest Family Center at Harborview Medical Center, where Nurse Practitioner Mary Jo O'Hara supervises the programs for young adults.

"Most of the young people that we [YouthCare and Northwest Family Center] are trying to provide services for are not identifying HIV as particularly important," O'Hara says. "They don't feel sick, they don't look sick. So other issues of food, shelter, and survival take precedence." In addition to the typical young adult concerns, many HIV-positive youth also face issues surrounding sexual orientation, homelessness, substance use, or mental illness. HIV is another factor to add into an already complicated life. Many also have a history of abuse and trauma, which can compound the stresses they face in daily life.

Nationally, youth are facing an ongoing crisis of HIV and AIDS. Every hour, two Americans under the age of 25 become infected with HIV, accounting for at least one-half of all new HIV infections. One recent study reported that 50% of sexually active high school seniors stated that they use condoms "only some of the time."

"Clearly these are people who grew up with HIV," O'Hara says. "What that tells us is, they know. But the circumstances in their lives that lead to [becoming HIV-positive] don't seem to be under their control. There are definitely groups that have gotten the [HIV prevention] message," she continues. "[Those at risk] are young people that life often happens to, as opposed to,  for. What we need to do to support those kids is bigger than saying 'HIV is an STD you need to be aware of.' It's about education and skills, and really giving a belief that there is a future. It certainly isn't about knowing about HIV."

"One of the other things that we need to address," O'Hara believes, "is that the young people who are at risk are probably young people that struggle with a variety of other mental health issues -- post-traumatic stress disorder, depression. It's cumulative life experience with bad things that will put you at risk for HIV. It's more complicated than 'use a condom every time.'"

Recently, the Seattle/King County Public Health Department began a program to provide HIV testing and counseling to youth throughout the area. In order to make the testing more "youth-friendly," oral saliva HIV tests are used. Testing takes place at agencies identified as serving youth at higher risk for contracting HIV, particularly targeting homeless and sexual minority youth. So far, 185 young people have been tested; however, no youth have tested positive yet.

In the Puget Sound area, the population of HIV-positive and at-risk young people is scattered throughout a wide geographic region, making HIV-specific outreach and care difficult to access. Great efforts continue to be made to get youth tested for HIV and to let them know the importance of being aware of their HIV status.