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What Works in HIV Prevention for Youth

Chapter 1: Introduction and Overview


Above all, HIV prevention works: there is a wide range of proven strategies to reduce behaviors that increase the risk of transmitting or acquiring HIV.

-- Institute of Medicine, 2000

As each generation comes of age, there is a substantial increase in the rate of infection as individuals enter their late teens and early twenties, with infection rates peaking in the mid-to-late twenties. Sustained, targeted prevention for each group entering young adulthood is what will keep these waves from developing.

-- Centers for Disease Control and Prevention (CDC), 1997

Despite remarkable advances in research and clinical practice, AIDS is not over. Without a stronger commitment to HIV prevention for youth, it never will be. Even the very best treatments fall far short of a cure, and a vaccine is nowhere in sight. Young people need the tools to protect themselves from HIV infection, and we know a lot about what works. Making proven interventions available to young people is the only way to stop the spread of AIDS with this generation.

Every year, public health officials announce that at least half of new HIV infections in the U.S. are in young people under the age of 25, a statistic so often repeated that it is losing its ability to shock and alarm. As the frontline in the war on AIDS, community-based organizations (CBOs) have a special responsibility to keep Americans from growing accustomed to over 20,000 young people becoming HIV infected each year. CBOs are well-positioned to protect young people from the devastation of AIDS and the consequences of decisions made too young.

What Works in HIV Prevention for Youth offers insights from prevention science and community-based programs about strategies and approaches that can help prevent new HIV infections among America's adolescents and young people. It is a collaborative effort of AIDS Action and AIDS Alliance for Children, Youth & Families. We hope that this guide will be useful to community-based organizations wishing to begin, improve, or expand HIV prevention services targeted toward youth.

After nearly 20 years of the HIV/AIDS pandemic it can be said with confidence that:
  • Prevention works.

  • Prevention is cost effective.

  • HIV/AIDS prevention promotes better overall health.

Presidential Advisory Council on HIV/AIDS (2000)

An Intractable Problem

Noting that at least one young American under age 20 was becoming infected with HIV every hour of every day, the Office of National AIDS Policy (ONAP) in 1996 called American youth a "generation at risk." Today, this characterization is as true as it was five years ago. Although protease inhibitors and other new treatments dramatically reduced the AIDS death rate for youth -- a 35 percent decline among those 15 to 24 years of age, from 1996 to 1997 alone -- there has been no decline in the number of new HIV infections among young people. AIDS remains a brutal disease and a significant threat to America's youth.

Any young person who engages in the normal experimentation and sexual curiosity that mark adolescence as a developmental period is at some risk for HIV infection, especially in geographic regions with a high HIV prevalence. But, as it does with adults, AIDS most threatens youth who already face poverty, racism, homophobia, gender inequality and other power differentials in relationships, poor access to health care, and homelessness. These same young people may also be struggling with sexual identity, self-esteem, and discrimination or exploitation. Homeless and runaway street youth, juvenile offenders, and young people who exchange sex for drugs, money, or affection are especially at risk.


While HIV/AIDS among youth is a problem that defies easy solutions, HIV prevention science does provide some answers. We know much about what works to prevent HIV infection in youth, including programs that are frank and targeted -- employing both the languages and vocabularies of the young people and communities the programs are trying to reach, and offering risk- and harm-reduction strategies to youth who are doing things that put them at risk. Unfortunately, such programs are not available in most schools and communities (ONAP, 2000).

If preventing HIV infection among young people were simply a matter of applying research data, prevention programs across the country would feature "school-based HIV education for youth, condom availability, explicit public service messages targeted to people most at risk, and needle exchange and syringe purchase, as well as more traditional abstinence-based approaches" (FCAA, 1997, p.8). Clearly, there is an enormous gap between this ideal and what actually exists in local communities. In part, that's because HIV is contracted through sexual and drug-using behaviors that adults don't want to talk about with adolescents; they don't want to believe that teens even have sex or use drugs. In part, it reflects the triumph of politics over science. But it is never too late to do the right thing for America's youth.

Community-based organizations are uniquely able to fill the gap between what prevention science identifies as effective HIV prevention for youth and what is available locally. Indeed, a central tenet of the CDC's HIV prevention programs is that "those closest to the problem, equipped with needed information and tools, are best able to solve it" (CDC, 1998a, p.1). As families, schools, youth-serving organizations, and policy makers struggle to integrate their desire to protect adolescents from AIDS with their concerns for traditional values and community norms, CBOs are providing leadership locally. They are helping to develop a community consensus for HIV prevention and putting in place effective science-based HIV prevention interventions targeted for those most in need. This document seeks to support these efforts by offering those closest to the problem an update on what is working in HIV prevention for youth.

Overview of the Guide

Chapter Two, "Youth and HIV/AIDS Today," is a snapshot of the current epidemic among young people in the United States, including the disproportionate impact of HIV and AIDS on young men who have sex with men and young African American and Latina women. The behaviors and life circumstances that put certain groups of young people at very high risk for HIV infection are reviewed, and the need for voluntary HIV counseling and testing for youth is outlined.

Chapter Three, "What Prevention Science Research Says," summarizes findings from research on effective HIV prevention programs for youth, as well as on characteristics of effective prevention interventions across the board. The need for both individual-level and community-level interventions is stressed.

Chapter Four, "What's Working in Local Communities," provides examples of HIV prevention strategies and models that community-based organizations are putting into practice to help reduce new HIV infections among adolescents and young people. Programs from across the country using peer education and social marketing are profiled. A contact person is listed for readers who want more information about individual programs.

Chapter Five, "Summary and Resources," concludes the guide by inviting CBOs to accept the challenge of reducing the 20,000 new HIV infections each year among America's youth and advising careful adaptation of proven HIV prevention interventions to meet local needs and circumstances. It also refers CBOs who want to explore more fully the art and science of HIV prevention for youth to a variety of resources for more information, most of which is obtainable free of charge, either through the Web or through toll-free numbers.

"References" includes the references for the cites used throughout the document.

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This article was provided by AIDS Action Council.