Adolescents at High-Risk of HIV/AIDS December 2011 Meera Beharry, MD Division of Adolescent Medicine University of Rochester Medical Center ACT for Youth Center of Excellence Cornell University Bronfenbrenner Center for Translational Research Cornell University Cooperative Extension of New York City New York State Center for School Safety University of Rochester Medical Center Div. of Adolescent Medicine

Objectives  Define high-risk youth populations  Discuss the additional challenges for this population  Review strategies that work

Definition High Risk Youth  Unprotected sex (oral, anal, vaginal) with multiple partners  Survival sex  Homeless youth  Men who have sex with men  LGBT  Sharing needles  Youth in justice system  Long term survivors of peri-natal HIV infection  Survivors of sexual abuse

CDC Vital Signs Dec  1.2 million people are living with HIV  240,000 don’t know they are infected  Only 28% of people with HIV are taking HIV medicine regularly and have their virus under control. CDC Vital signs Dec. 2011

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Keys for success  Age appropriate  Developmentally appropriate  Culturally competent  Youth friendly, discrete and easily accessible location  Convenience = “one-stop” full service clinic  Partnership with New York State  Multi-disciplinary team  Community involvement Jeffrey M Birnbaum, MD,MPH SUNY Downstate Medical Center

Members of Multidisciplinary team  Adolescent Medicine Medical Providers- Physician, PA or Nurse Practitioner  Nursing  Mental Health Providers- Psychologist, Psychiatrist, Social Worker  Case Management  Outreach- Outreach Coordinators, Peer Educators  Research

Why do we need to have HIV related services specifically for adolescents and youth?

Definition High Risk Youth  Unprotected sex (oral, anal, vaginal) with multiple partners  Survival sex  Homeless youth  Men who have sex with men  LGBT  Sharing needles  Youth in justice system  Long term survivors of peri-natal HIV infection  Survivors of sexual abuse

Special Needs of Young MSM/Gay Youth with HIV  Disclosure of sexuality in general as well as how it relates to engagement in care and treatment adherence  Outreach to “ballroom” community and other venues for MSM/gay male youth  Mental health issues: increased suicide rates, social isolation, peer support  Clinical expertise in dealing with syphilis, anal STDs Jeffrey M Birnbaum, MD,MPH SUNY Downstate Medical Center

What about youth infected with HIV perinatally?

Unique Clinical Issues in Perinatally Infected vs. Behaviorally Infected Youth  Perinatally infected youth more likely to be in more advanced stages of HIV disease and immunosuppression  More likely to have history of infections with complications/disabilities (eg. blindness, O 2 dependent, chronic renal failure)  More likely to have heavy ARV exposure hx therefore more likely to have multi-drug resistant virus Jeffrey M Birnbaum, MD,MPH SUNY Downstate Medical Center

Special needs of Adolescent /Young Adult females with HIV  Sexual health related issues best dealt with on-site in clinic if possible: routine gyn exams, Pap smears, colposcopy, family planning  Expertise in dealing with teen pregnancy and teen/young adult parenthood; HAART adherence during pregnancy  Mental health issues: domestic violence, power imbalance in relationships with older men, hx of sexual abuse Jeffrey M Birnbaum, MD,MPH SUNY Downstate Medical Center

IDU

Special Needs of Transgender Youth  Issues related to consent for care  Mental health aspects of transgender care  Specific hormonal regimens  Interactions between hormonal treatments and prevention counseling specific to this population  Case management issues: gender identity on Medicaid card, legal name changing, housing, education, employment Jeffrey M Birnbaum, MD,MPH SUNY Downstate Medical Center

Risks of Hormonal Therapy NOT under a Doctor’s Care  Untreated mental illness, young person may not be a “true transgender”  Risk behaviors involved in being able to buy hormones  Street hormones  “German hormone”, “pure hormone”, “silicon”  Needle sharing/”hormone parties”- Hep B, Hep C & HIV  Bacterial infection from non-sterile technique/supplies  Liver damage; blood clotting problems, deep vein thrombosis  Prescribing doctor may not know about transgender health.  Recommend:

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Life Skills Needed for Transition to Adult Clinic  Knowing when and how to seek medical care for symptoms or emergencies  Using one’s primary care provider appropriately  Making, canceling, and rescheduling appointments  Coming to appointments on time  Calling ahead of time for urgent visits  Refilling of prescriptions on time  Maintenance of one’s health insurance  Negotiating multiple subspecialty providers Jeffrey M Birnbaum, MD,MPH SUNY Downstate Medical Center

Summary  High-risk youth need specialized care  Multi-disciplinary team  Age appropriate, developmentally appropriate and culturally competent care  Call: AIDS (English) SIDA (Español)

References  HEAT Program:  CDC:  NYS DOH AIDS Institute:  100 questions and answers about HIV/AIDS  (Español)  NYC DOH/Mental Health:

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