1. Adolescents and HIV: Rates, Risk and Intervention Opportunities
Katrina Kubicek, MA, PhDc
Presentation to the Black AIDS Institute and UCLA HIV Science Academy
August 28, 2013

3. This is a developmental stage of development
What is Adolescence?
This is a developmental stage of development
Age range varies, but generally thought to begin with the pubescent years around the age of ten and continues up until physical maturation is reached around the end of the teenage years.
For the duration of this time, significant developments happen with regard to sexual and physical development as well as cognitive changes
The World Health Organization (WHO) defines ‘‘adolescents’’ as individuals 10–19 years of age, and ‘‘youth’’ as 15–24 years of age

4. Emerging Adulthood
Developmental period distinct from adolescence – typically defined as years 18-25
Important distinction from adolescence in that this is often the first time youth live on their own and form more lasting intimate relationships
Research indicates that this period may have increased risk for substance use and sexual risk behaviors

5. HIV among Adolescents
CDC estimates that youth aged account for 39% of all new HIV infections in the United States;
15-29 year olds comprise 21% of the US population
Although overall rates of HIV diagnoses remained stable from 2006 to 2009, HIV diagnosis rates increased for youth aged 15–19 and 20–24 years over the same period
Approximately 68,600 young people aged 13–24 years were living with HIV infection at the end of 2008; of those, nearly 60% did not know they were infected.
Some youth are more affected than others
Young men who have sex with men – especially young men of color
Adolescent minorities

6. HIV among Adolescents

7. HIV Risk among Adolescents
47% have had sexual intercourse at least once.
40% of currently sexually active students did not use a condom the last time they had sex.
15% have had four or more sex partners.
6% had sexual intercourse for the first time before age 13.
2% have injected illegal drugs at least once.
Sexually transmitted infection rates are highest among adolescents

8. HIV Testing in Adolescence
The 2011 Youth Risk Behavior Survey found that 13% of 9th–12th grade students had ever tested for HIV
46% of high school students have had sexual intercourse
HIV testing varies by factors such as:
Sexual experience
Race/ethnicity
Among sexually active students who did not use a condom the last time they had sex, 30% had ever been tested for HIV
HIV testing is recommended by CDC as a routine part of health care for adolescents and adults aged 13–64 years for reducing the spread of HIV

9. Risk Factors for Adolescents
Substance use – club drugs (e.g., methamphetamines, cocaine, ecstasy) other drugs and alcohol linked to unprotected sex
Dating violence – link to HIV risk behaviors among adults and adolescents involved in partner violence
Impulsivity - sensation seeking, rises dramatically during adolescence and increases risks to healthy development
Peer influences – perceptions of what peers do often more important than actual behaviors of peers
Education and awareness - Research has shown that a large proportion of young people are not concerned about becoming infected with HIV
24% of high school students had 5 or more drinks in one day in the past 30 days and 21% had smoked marijuana in past 30 days

10. Special Populations Homeless Youth
Young men who have sex with men (YMSM)
African American YMSM
Ballroom community
African American female adolescents
African American male adolescents

11. Homeless Youth
Rates vary between 5% - 17%; even lowest of this range is about twice that of the prevalence rates of non-homeless youth
High levels of “substance use disorders” among homeless youth
Homeless youth may be involved in higher risk activities such as injection drug use and sex exchange
Many homeless youth have experienced abuse – particularly sexual abuse
Strategies that may decrease risk include the elimination of need to rely on illicit activities for income, provision of basic needs, increased outreach efforts, and early identification of and protection from childhood sexual abuse

12. Young Men Who Have Sex with Men (YMSM)
HIV rates among YMSM continue to rise, particularly among young men of color
Among adolescent males ages 13-19, about 91% of all diagnosed HIV infections are from male-to-male sexual contact

13. Specific Risks for YMSM
Strong relationship between drug use and HIV transmission
Experiences of harassment, violence and victimization can lead to poorer mental health and HIV risk-related behaviors
Societal and familial homophobia contribute to mental health and well-being of YMSM
Limited resources such as sexual education and outreach for HIV prevention efforts
Additional stressors can increase risk for involvement in risky behaviors
Social media and mobile phone apps may present additional risk

14. HIV Among YMSM by Race/Ethnicity

15. African American Young Men Who Have Sex with Men
Higher HIV rates among African American YMSM but sexual risk and substance use rates are similar or lower than their White counterparts
Racism and homophobia affect HIV risk
Less “safe spaces”
African American YMSM tend to have sexual partners of same racial/ethnic group – affects the HIV reservoir

16. House and Ball Communities
Derived from Harlem Balls of the 1920s, underground celebrations and competitions
House and Ball communities work in tandem to develop and support a community involving primarily African American and Latino individuals of diverse sexual and gender identities
Houses are different groups of individuals that compete against each other during Balls
Balls are underground events involving competitions focused around dance, athletics, and gender expression.
Houses are identified as having a sense of family, friendship, and support and have a Mother and/or Father
The limited research with these communities suggests HIV is a major public health concern

17. African American Female Adolescents
One in four girls (14-19) has an STI; and nearly half (48%) of the African-American girls had at least one STI
Despite reporting greater frequency of condom use than their White and Hispanic counterparts, African American female adolescents experience disproportionately high rates of HIV/STIs
Younger female adolescents are more susceptible to STIs due to biological factors (e.g., cervical ectopy, maturing immune system)
Issues related to higher rates include:
Limited partner communication
Sex refusal self-efficacy
Condom use self-efficacy
STI knowledge
Research has found that parent–adolescent communication about sex is protective for young African-American females

18. African American Male Adolescents
Of the approximate 19,000 adolescent and young adult males living with a diagnosis of HIV infection, 64% are African American
Chlamydia rate among African American males was 12 times higher than that among White males; syphilis rate is 22 times higher
14% of adolescents have had sexual intercourse with four + persons, yet 39% of African American males reported more than 4 partners
Among adolescent males, a traditional conception of manhood is associated with engagement in sexual risk behaviors
While some cultural or psychosocial factors may affect risk, again, we see that African Americans are exposed to STIs and HIV at higher rates than other groups

19. The Cascade of HIV Prevention: Linkage to Care
Adolescents may experience unique challenges in this arena:
Insurance and confidentiality
Sense of “invincibility”
Maintaining relationships with providers
Medication adherence

20. Promising or Best Practices : Behavioral Interventions
Multifaceted approach to HIV prevention, (e.g. individual, peer, familial, school, church, and community programs) is necessary to reduce the incidence of HIV in young people
Biomedical Prevention Efforts
Examples of Effective Behavioral Interventions
Focus on Youth
Mpowerment
Project AIM
SIHLE
Street Smart

21. Summary Adolescents remain a high risk population
Young MSM, minority youth and homeless populations represents unique challenges for prevention work
Challenge in engaging them in the cascade of HIV prevention
Affordable Care Act provides new opportunities to engage youth and young adults
Working with parents or other social support systems is important
Schools should be integrated into public health efforts
Churches and other community centers may also offer important prevention opportunities.

22. Resources
National Resource Center for HIV/AIDS Prevention among Adolescents -
The Center For Strengthening Youth Prevention Paradigms
Society for Adolescent Medicine -

23. Contact Information
Katrina Kubicek Program Manager – Community, Health Outcomes and Intervention Research Program Children’s Hospital Los Angeles