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U.S. Fact Sheet

Adolescents & Young Adults with HIV

January 1999

Contents:


Young People with AIDS: New Cases

Adolescents (13-19 Years Old)

  • Of the 347 new cases of AIDS reported in adolescents aged 13 to 19 from July 1997 through June 1998, 52% were in females, 48% in males.

  • Within the 181 new adolescent female cases of AIDS in the 12 months through June, 1998, 49% still did not have an exposure risk category identified, 40% were exposed through heterosexual contact, 7% were in the injecting drug use (IDU) exposure category, and 4% had received blood products.

  • Within the 166 new adolescent male cases of AIDS in the 12 months through June, 1998, 34% did not have an exposure risk category identified, 30% were in the MSM exposure category, 11% had hemophilia, 8% were exposed through heterosexual contact, 7% were in the IDU exposure category, 7% were in both IDU and MSM categories, and 4% had received blood products.

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Young People 20-24 Years

  • Of the 1676 new cases of AIDS reported in young people aged 20-24 from July 1997 through June 1998, 38% were in females and 62% in males.

  • Within the 640 new AIDS cases in females aged 20-24, in the 12 months through June, 1998, 49% were exposed through heterosexual contact, 36% did not have an exposure risk category identified, and 14% were in the IDU exposure category.

  • Within the 1,036 new AIDS cases in males aged 20-24, in the 12 months through June, 1998, 55% were in the MSM exposure category, 20% did not have an exposure risk category reported, 11% were in the IDU exposure category, 8% were exposed through heterosexual contact, 5% were in both IDU and MSM categories, and 2% were exposed through having hemophilia or other coagulation disorder.


AIDS Incidence Estimates: 13-19 Years and 20-24 Years(1)

  • The above figures on exposure categories are from actual case reports; the CDC has also reported adjusted estimates regarding AIDS incidence in young people and the exposure risk category that is thought to have caused the infection:

    1. The estimated number of new AIDS cases for the calendar year 1997 in females from 13-19 was 165, of which the majority, 64%, were in the heterosexual exposure category (and 21% in the IDU category);

    2. The estimated number of new AIDS cases for the calendar year 1997 in males 13-19 was 158, of which the majority, 51%, were in the MSM category (and 14% in the heterosexual category);

    3. The estimated number of new AIDS cases for the calendar year 1997 in females 20-24 was 647, of which the majority, 75%, were in the heterosexual exposure category (and 21% in the IDU category);

    4. The estimated number of new AIDS cases for the calendar year 1997 in males 20-24 was 964, of which the majority, 66%, were in the MSM category (and 16% in the IDU category; 11% in the heterosexual category).


Young People with AIDS: Cumulative Numbers

Adolescents (13-19 Years Old)

  • The cumulative number of AIDS cases in adolescents (13 to 19 years) reported to CDC through June 1998 is now 3,302.

  • Of the 3,302 cumulative AIDS cases in adolescents, 2,018 (61%) have been diagnosed in males and 1,284 (39%) in females.

  • The proportion of females -- 39% -- within the total number of AIDS cases in adolescents is over twice as high as the proportion of females in adults over 20 with AIDS (16% of the 653,774 cumulative AIDS cases in people 20 years of age and over have been in females) [cumulative AIDS cases, U.S.].

  • Nearly half (48%) of the cumulative adolescent cases of AIDS in the U.S. represent African American teenagers, about a third (31%) represent Caucasian teens, and a fifth (20%) represent Hispanic teens. The other 1% of cases have been in Asian/Pacific Island and American Indian/Alaska natives.

  • Of the 1,589 African American teens who have been diagnosed with AIDS since the beginning of the epidemic, 53% have been females and 47% males.

  • Of the 1,014 Caucasian teens diagnosed with AIDS, 21% have been females and 79% males.

  • Of the 647 Hispanic teens diagnosed with AIDS, 33% have been females and 67% males.

  • Of the 1,284 adolescent females diagnosed with AIDS since the beginning of the epidemic, 52% were infected through heterosexual contact, 14% were infected through injecting drug use (IDU), 7% were infected through blood products, 1% had hemophilia or coagulation disorder, and 26% did not have a risk identified.

  • Of the 2,018 adolescent males diagnosed with AIDS since the beginning of the epidemic, 36% had hemophilia or coagulation disorder, 34% were men who have sex with men (MSM), 6% were infected through IDU, 5% were in both IDU and MSM categories, 5% were through heterosexual contact, 4% were through receipt of blood products, and 11% had no risk identified.


Young People (20-24 Years Old)

  • The cumulative number of reported AIDS cases in young people aged 20 to 24 through June 30, 1998 is/was 23,729.(1)

  • Of the 23,729 cumulative AIDS cases in those aged 20-24, 17,377 (73%) were male and 6,352 (27%) were female.

  • Forty-one percent of the cumulative cases of AIDS in young Americans from 20-24 years of age represent African Americans, 36% represent Caucasians, and 21% represent Hispanic youth. The other 2% of cases have been in Asian/Pacific Island and American Indian/Alaska natives.

  • Of the 9,721 African American 20-24 year-olds who have been diagnosed with AIDS since the beginning of the epidemic, 36% have been females and 64% males.

  • Of the 8,653 Caucasian 20-24 year olds diagnosed with AIDS, 17% have been females and 83% males.

  • Of the 5,043 Hispanic 20-24 year olds diagnosed with AIDS, 26% have been females and 74% males.

  • Of the 6,352 females aged 20 to 24 diagnosed with AIDS since the beginning of the epidemic, 54% were infected through heterosexual contact, 28% were infected through injecting drug use (IDU), 2% were infected through blood products, and 16% did not have a risk identified.

  • Of the 17,377 males aged 20 to 24 diagnosed with AIDS since the beginning of the epidemic, 63% were in the MSM exposure category, 12% were infected through IDU, 10% were in both IDU and MSM categories, 4% had hemophilia or coagulation disorder, 4% were exposed through heterosexual contact, 1% were through receipt of blood products, and 6% had no risk identified.


Deaths from AIDS in young people(1)

A total of 8,250 young people aged 15 to 24 have died from AIDS in the U.S. since the beginning of the epidemic through June 1998. Of the 8,250 total young people who have died, 3,550 (43%) have been African American; 2,898 (35%) have been Caucasian; 1,730 (21%) have been Hispanic, 37 (0.5%) have been Asian/Pacific Islander; and 28 (0.3%) have been American Indian/Alaska native.


Young People with New HIV Infection* (Not AIDS)**(1)

*Note: 31 states report confidential HIV infection reports; these are not complete national numbers.

** HIV infection cases do not include people who have developed AIDS.

  • Youth in the age groups 13 through 24 years accounted for 15% of newly diagnosed cases of HIV infection reported from July 1997 through June 1998; the total number of these newly identified HIV cases in young people was 2,535.(2)

  • The incidence of new HIV infection is higher in adolescent/young women than it is in adult women as a whole: Nearly half (49%) of all persons 13 to 24 years of age newly reported with HIV infection from July 1997 to June 1998 were female, whereas women accounted for about a third (32%) of all adult new cases of HIV infection during that same time period.


Adolescents (13-19 Years Old)

  • A quarter (25%) of all current female HIV infection cases reported through June 1998 are teen and young women from 13-24; for current HIV infection cases in males, 15% are from 13 to 24 years.

  • The total number of HIV infection cases in adolescents, reported in 31 states with confidential HIV infection reporting through June 1998, is 3,851.

  • Of these 3,851 HIV infection cases reported in adolescents, 66% are in African American teens, 28% are in Caucasians, 5% are in Hispanics, and 1% represent Asian/Pacific Islanders and American Indian/Alaska natives.

  • Of the 2,530 HIV infection cases reported in African American adolescents, 60% were in females and 40% in males. Of the 1,073 HIV infection cases reported in Caucasians, 41% were in females and 59% were in males. Of the 176 HIV infection cases reported in Hispanics, 55% were in females and 45% were in males.


Young Adults (20-24 Years Old)

  • The total number of HIV infection cases in young adults ages 20-24, reported in 31 states with confidential HIV reporting through June 1998, is 13,911.

  • Of these 13,911 HIV infection cases reported in the 20-24 year old age group, 53% are in African Americans, 39% are in Caucasians, 5% are in Hispanics, and 3% represent Asian/Pacific Islanders and American Indian/Alaska natives.

  • Of the 7,324 HIV infection cases reported in African Americans young people aged 20-24, 41% were in females and 59% in males. Of the 5,482 HIV infection cases reported in Caucasians, 21% were in females and 79% were in males. Of the 663 HIV infection cases reported in Hispanics, 14% were in females and 86% were in males.


Study on HIV Infection Rates in a Group of Disadvantaged Out-of-School Youth(4)

  • A recent study with data from 1990 through 1996 on the rates of HIV infection among entrants to the U.S. Job Corps program (a federally funded job training program for disadvantaged out-of-school youth from all 50 states and U.S. territories) found that:

    1. Overall, young disadvantaged women, particularly African-American women, are being infected with HIV at younger ages and at higher rates than young disadvantaged men.

    2. In the total group of over 350,000 16- to 21-year-olds tested, more than 2 per 1,000 tested HIV positive.

    3. However, rates among young African-American women exceeded 5 per 1,000, the highest HIV infection rate of any group in the study, and by age 20, the HIV infection rate for African-American women in the study was 7 per 1,000.

    4. During the seven-year study period, HIV prevalence was 50% higher for women in the study than for men (3 per 1,000 versus 2 per 1,000) as a result of significantly higher rates of infection among young women 16-18 years of age.

    5. HIV prevalence among young African-American women was 7 times higher than for young white women, and 8 times higher than for young Hispanic women (rates were 4.9 per 1,000, 0.7 per thousand, and 0.6 per thousand, respectively.

  • Data from the above-referenced study suggest that HIV prevalence among disadvantaged young women is highest in the District of Columbia (10.3 per 1,000), Florida (9.8 per 1,000), Maryland (9.1 per 1,000), South Carolina (8.2 per 1,000), and Louisiana (5.1 per 1,000). Rates among young men were highest in the District of Columbia (7.8 per 1,000), Florida (4.2 per 1,000), Maryland (3.9 per 1,000), Connecticut (3.8 per 1,000), and Virginia (3.7 per 1,000).(3)

  • The good news from the above Job Corps study was that, from the beginning of the study period to the end, HIV prevalence among young people in the Job Corps was cut in half. HIV prevalence among women dropped from 4 per 1,000 in 1990 to 2 per 1,000 in 1996, and HIV prevalence among men dropped from 3 per 1,000 in 1990 to 1.5 per 1,000 in 1996.(3)

  • Even so, rates of HIV infection among Job Corps participants were more than 2 times higher than rates among youth seen in adolescent health clinics and more than 8 times higher than among young people of the same age applying for military service.


More Information on HIV/AIDS in Young People 13-24 Years Old

  • Young people aged 13 through 24 years accounted for 4% of new AIDS cases reported during the 12 month period from July 1997 through June 1998.(2)

  • During the period from January 1994 to June 1997, 7,200 new cases of HIV infection were reported among 13- to 24-year-olds by the 25 then-reporting states. Of the total number, 3,203 (44%) were female; 4,566 (63%) were African American and 394 (5%) were Hispanic. Of the total, at least 26% (1,886) had heterosexually acquired infections; 31% (2,270) were in men who have sex with men; and 6% (449) were in injection drug users.(3)


References

  1. HIV/AIDS Surveillance Reports, Mid-year 1998 Edition, Vol.10, No.1; Centers for Disease Control and Prevention, National Center for HIV, STD and TB Prevention Atlanta GA 30333; December 1998.

  2. CDC Fact sheet on the HIV/AIDS Epidemic in the United States, 1997-1998.

  3. Trends in the HIV and AIDS Epidemic, 1998: Trends in HIV Diagnoses in 25 States. CDC, June 1998.

  4. National Data on HIV Prevalence Among Disadvantaged Youth in the 1990's, Centers for Disease Control and Prevention, August 1998. Also published in the Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology (JAIDS), September 1998.

  5. December 1998 - Update from UNAIDS.


Treatment


Reports and Recommendations

  • Updated Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents. Panel on Clinical Practices for Treatment of HIV Infection, Department of Health and Human Services - 4/24/98. Updated 12/1/98. (Available through the HIV/AIDS Treatment Information Service (ATIS) Web site at http://hivatis.org, or call 1-800-448-0440, and from the National Prevention Information Network at http://www.cdcnpin.org.)

  • Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. MMWR April 17, 1998 / Vol. 47 / No. RR-04. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30333.


Other Resources, Reading and Links Regarding Treatment


Prevention

Reports and Recommendations

Young people around the world find themselves vulnerable to HIV for many reasons:(5)
  • They do not know about HIV or STDs.

  • They know about HIV or STDs but do not know how to avoid infection.

  • They know about avoiding infection but may be unable to get hold of condoms, or may feel unable to discuss condom use with their partner.

  • They may be unable to defend themselves against unwanted sex (in the Democratic Republic of Congo, nearly a third of young women in a large study reported that they had been forced by their partners into first sex, and similar statistics on coerced sex are reported from many parts of the world).

  • Adolescence is a time when many people experiment -- not only with different forms of sex but with drugs as well as alcohol.

  • Efforts to promote safer sexual behavior are all-important for young people, who are too often unprotected and at risk for HIV. Prevention efforts seem to have a good chance of success among younger people: for example, when following active condom promotion and education campaigns in schools and among youth groups, dramatic declines have been recorded in infection rates among teenagers in Uganda and Tanzania.

  • Two-thirds of current U.S. high-school students have had sexual intercourse, according to the CDC. One-fourth of high school seniors have had four or more sexual partners. And many kids are having unprotected sex, HIV education or not. Only half of sexually active seniors report using latex condoms consistently.

  • Based on findings of the recent U. S. study of 350,000 U.S. Job Corps entrants the CDC notes that young women must be reached early and provided with skills and information needed to protect themselves from infection. Since many of these young women are likely infected by men older than themselves, CDC recommends that "prevention programs for disadvantaged young women should include a focus on building the self-esteem and skills necessary to delay sexual intercourse and to negotiate condom use."(4)

  • In the U. S. Job Corps study, from the beginning of the study period to the end, HIV prevalence among young people in the Job Corps was cut in half. HIV prevalence among women dropped from 4 per 1,000 in 1990 to 2 per 1,000 in 1996, and HIV prevalence among men dropped from 3 per 1,000 in 1990 to 1.5 per 1,000 in 1996. Even so, rates of HIV infection among Job Corps participants were more than two times higher than rates among youth seen in adolescent health clinics and more than eight times higher than among young people of the same age applying for military service.(4)

  • Comprehensive HIV prevention efforts for young people must include programs targeted to young people who are neither in school nor workplace settings. Several community-based programs for disadvantaged inner-city young people have been found effective in reducing risk behaviors. It is critical that effective approaches are widely replicated, particularly in areas of high prevalence among young people.(4)

  • Only 27 states mandate sexuality or HIV education, and the content of these programs can too often be compromised by local politics.

  • A national CDC survey in 1994 found that 86% of health education teachers taught basic facts about HIV and its transmission, 77% taught "reasons for choosing sexual abstinence" but only 37% of health education teachers taught the correct use of condoms.

  • In New York City, where HIV education is mandated, condom demonstrations in classrooms are prohibited.


Services

  • Title IV of the Ryan White CARE Act was authorized in 1990, and reauthorized in 1996, to support the development of infrastructure to provide comprehensive care to children, youth and their families. Title IV projects facilitate linkages between comprehensive care and clinical research and support the participation of HIV infected women, children, adolescents, pregnant women and families in clinical research trials. Services are provided by 225 Title IV sites in 25 states and territories. National Pediatric and Family HIV Resource Center, Newark, NJ, Ryan White CARE Act Title IV HIV Programs for Children, Youth, Women and Families: Directory: 1997-1998.

  • Medicaid is the largest single payor of direct medical services to 50% of all persons living with AIDS and up to 90% of those persons under 18 years of age living with AIDS.

  • AIDS services in Washington DC.

  • Where to go for further information and assistance with AIDS.


For Further Reference or Assistance

  • CDC National HIV/AIDS Hotline: 1 (800) 344-AIDS (-2437); for Spanish access call 1-800-344-7432; for TTY access, call 1(800) 243-7889. Confidential information, referrals, and educational material on HIV/AIDS. Available 24 hours a day, 7 days a week

  • CDC National Prevention Information Network (NPIN) [formerly the National AIDS Clearinghouse], PO Box 6003, Rockville, MD 20849-6003; Phone 1 (800) 458-5231; from 9 to 6 M-F. Information, fax back, HIV/AIDS surveillance reports and other publications, educational materials, and resource/reference help.


Fact sheet compiled by Catherine Briggs, MD MPH

Please feel free to send comments and suggestions about our about "Adolescents and Young Adults with HIV: A Fact Sheet" to ortegaes@umdnj.edu with a subject line "Young US Fact Sheet."



  
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