An article in the May issue of the Archives of Pediatrics and Adolescent Medicine discusses the barriers to HIV testing for youth and outlines opportunities for innovation and efficiency in adolescent HIV testing.
The authors state that while an increasing number of adolescents are infected with HIV, few youth are identified as seropositive and even fewer are linked to medical care and social services. If more youth were identified, transmission to sexual partners and children would be reduced and individuals could benefit from treatment.
The authors suggest that public health professionals must address barriers to prevention and testing and examine alternative strategies to current HIV-testing practices.
Benefits of Early Detection
The article starts by identifying benefits of early detection. It suggests that youth identified as HIV positive can potentially prolong the duration and quality of their lives with antiretroviral and combination drug therapies.
It goes on to say that early detection will help individuals reduce the likelihood of transmission to others. In addition, young women who are HIV positive and pregnant can take steps to reduce the risk of transmitting the virus to their infants to as low as 2 percent.
Barriers to Early Detection
The authors suggest that the current practice of requiring two clinic visits and conducting individual pre-and-post-test counseling has created barriers to identifying HIV-positive adolescents soon after their infection. They point to studies that show that approximately 40% of youth do not return to receive HIV test results when a second visit is required.
In addition, the authors note that HIV testing is often provided in STD clinics that are not typically designed for adolescents. Further, parental consent requirements for HIV testing in many states remain a significant barrier.
Alternative Strategies to HIV Testing
The authors offer a number of alternative HIV-testing practices that might better meet the needs of adolescents.
First, they suggest utilizing new technologies, including rapid tests, that do not require a laboratory analysis and allow for same-day results.
Second, the authors suggest more research with adolescents regarding home testing and client-controlled testing as additional alternatives to traditional clinic settings.
Strategies for Increasing HIV Testing
The authors argue that traditional HIV testing practices reach mostly the "worried well" and that new strategies must be used to reach those youth who frequently engage in HIV-risk behaviors.
One strategy that seems attractive to youth is presenting a videotape [about HIV testing] in clinic waiting areas. Studies show that approximately 76% of youth will choose to watch the videotape, and 41% will test for HIV following the video.
The authors also highlight national HIV-prevention social marketing campaigns. They suggest media and computer games as a potentially effective strategy since adolescents are far more familiar with them than adults.
Finally the authors suggest that the "mainstreaming of HIV" is anticipated to increase HIV testing by making it a routine procedure in health care. They caution that providers need to be trained and organizational procedures established in order to encourage testing and to safeguard individuals' rights.
The authors conclude that early detection of HIV among adolescents remains a significant challenge for policymakers, service providers, and communities. To meet this challenge, they suggest implementing new HIV technologies, identifying different procedures and settings for conducting testing, and mounting community-level social marketing programs.
For more information:
M. J. Rotherman-Borus, et al., "Promoting Early Detection of Human Immunodeficiency Virus Infection Among Adolescents," Archives of Pediatrics and Adolescent Medicine, May 2000, vol. 154, no. 5, pp. 435-39.
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