The materials found on this page of the site were compiled in a briefing book that was produced for a conference for youth and providers that explored issues related to the HIV epidemic among young people in the United States. This conference was called "Gettin' Busy: Youth and HIV" and was held on October 24, 2000 in New York City.

Gettin’ Busy:Youth and HIV Executive Summary Every provider of adolescent health and social services— in schools, clinics, public and private agencies and other settings—can play a decisive role in helping young people address the continuing health emergency of HIV/AIDS. This resource book is designed to give service providers tools to assist young people in finding quality HIV prevention, testing and health care services. The HIV/AIDS epidemic poses increasingly complex challenges to providers and to young people themselves. HIV infection rates con-tinue unabated and many populations of young people are at grow-ing risk of infection. Youth express a great deal of concern about AIDS , but high levels of risky behavior persist. New therapies for HIV present more reasons to promote testing and treatment, but may also make some young people less vigilant about self-protection. Making the health system work for young people remains a daunt-ing, and crucial, task. As the recently released White House report: Youth and HIV/AIDS 2000: A New American Agenda noted, “Most young people who are already HIV-infected don’t know it. The vast majority of HIV-infected youth do not receive adequate medical care.”1 The report concludes that, “The multiple systems and serv-ices that touch the lives of young people should integrate science-based HIV prevention into their ongoing activities...voluntary HIV counseling and testing should become a routine component of ado-lescent health care.” Young People At Continued Risk Nearly 20 years into the epidemic, AIDS remains a significant health risk for young people. Approximately half of new HIV infections (or about 20,000 infections per year) are among people under age 25. As many as one quarter of these infections are among people under 22. 2 Of the people living with HIV disease in the US today, a fourth (25%) became infected during their teen years.3 By the end of 1999, 3,725 cases of AIDS had been reported among 13- to 19-year-olds, and 25,904 cases among 20- to 24-year-olds. (Because of the delay in onset of symptoms, most of those receiving an AIDS diagnosis in their 20s were infected in their teens.) Young women and people of color represent an increasing share of the youth epidemic. Young men who have sex with men (MSMs) contin-ue to account for a substantial percentage of HIV disease in youth. Among young people more than any other group, HIV is spread through sexual activity. In 20- to 24-year-old men, 78% of AIDS cases (for which risk factors were reported) in 1999 were due to sexual risk, as were 80% among young women in this age group.4 MSMs account for the vast majority of sexual exposures in male youth, and incidence rates remain high in this population. A study published this year 5 of young msm s living in US urban areas found that 7.2% of 15- to 22-year-olds were hiv positive. Young African-American, Latino, and mixed race MSMs were found to be at elevated risk. The Perception And Reality Of Risk Young people express deep worries about the AIDS epidemic. One recent survey found that both teenagers and parents ranked HIV and STDs as their top issue of concern.6 In another survey, over half of all teens (56%) said they were “personally concerned” about becoming HIV infected, with African-American and Latino teens expressing significantly higher rates of worry.7 Yet even with these anxieties, many teens do not identify themselves as personally at risk of infection because they “trust” their partners or use condoms “most of the time.”8 A combination of behavioral, biologic and socioeconomic factors increase adolescent vulnerability to HIV infection. Condom usage rates among adolescents are increasing but are still too low. In a study of high school age youth 9 58% of sexually active students nationwide reported using a condom during their last sexual encounter. Reported condom usage rates were higher for young men: 66% of young men, compared with 51% of young women, reported condom use. As young people mature, condom usage rates fall: among 9th graders, 67% reported condom use, compared with 48% of 12th graders. The importance of teaching consistent condom use is emphasized by the fact that sexual activity is the norm for many teens. A little over one third (36%) of all high school students define themselves as sexually active, with 51% of 12th graders reporting current sexual activity. One fifth (21%) of 12th graders report having had four or more sexual partners during their lives.10 Young people at particularly high risk for HIV infection include young MSMs, bisexuals, transgenders, homeless youth, runaways, injection drug users, victims of sexual abuse, mentally ill youth, and young people in the penal or foster care systems.11 One quarter (25%) of STDs in the US occur in teenagers, and the presence of these infections elevates risk for acquisition and transmission of hiv infection.12 Also of concern are several recent studies suggesting that awareness of the success of powerful combination therapies for HIV disease has lead to increased risky behavior.13 Reasons for Early Testing and Treatment The advent of Highly Active Anti-Retroviral Therapy (HAART) provides new reasons for young people to get tested and into treatment early in the course of infection. Yet prevention interventions for teens very often focus on safer sex behavior and neglect to emphasize the importance of testing and accessing care.14 Only a quarter (25%) of sexually experienced 15- to 17-year-olds say they have ever been tested for HIV.15 And one national survey found that 69% of 15- to 17-year-olds do not know where to get tested for HIV.16 Many young people fail to receive early care for hiv disease, and most youth enter care with significant immune dysfunction.17,18 This missed opportunity for care is especially troublesome because teens may be particularly well-suited to benefit from AIDS treat-ments. A study released in April 2000 reported that the “robust immune systems” of HIV-infected adolescents means that they “may be the best candidates to benefit from aggressive drugs such as (HAART).” 19 Helping Young People Get What They Need Health care workers are an important—and largely untap-ped— prevention resource for young people. One study found that most adolescents would like their doctors to ask them questions about their hiv risk behaviors, and would prefer that doctors initiate these discussions.20 Many adolescents say they prefer to discuss HIV testing with their doctors and friends, rather than their teachers or family members. Many health and social service providers have the perception that appropriate counseling and hiv testing of young people requires specialized skills. But with attention to some basic guidelines, providers can incorporate HIV counseling and testing into routine health care and other services. (See “Providing Testing and Counseling Services for Young People”21 in the “Tools for Providers” section.) In order to reach young people effectively, hiv testing programs must be accessible and “teen friendly.” Testing programs should be available in primary care settings, mobile units, school-based health clinics, drug treatment facilities and family planning programs. There are several elements to a “teen friendly” health care site,22 including:      • Respect for teens who are sexually active,      • Free (or low cost) testing,      • Availability of a broad range of health and mental health         services,      • Confidentiality,      • Convenient access to public transportation. Many young people are modest about their bodies, and a high level of privacy is essential in providing services to this population. Like all people, some adolescents may be particularly apprehensive about receiving their HIV test results. Providers and their young clients should work together to determine the best timing for testing. They should also make plans for coping with bad news, ensuring adult and peer support, and accessing emergency mental health services if necessary. Providers should understand New York’s new hiv reporting and partner notification law and discuss the implications of this law with clients. (See New York Testing Laws in “Prevention and Testing” section.) HIV testing gives health care providers an opportunity to offer HIV and STD prevention services, such as educating teens about condom use and safer sex, and assessing needs for other services including substance abuse treatment or family planning.23 Community outreach can also help young people get tested and into care. “Live With It. Get Tested,” is a social marketing campaign that speaks in the language young people use for having sex and promotes testing and care services at New York agencies. The campaign is taking place in four additional cities, including Baltimore, Los Angeles, Miami and Washington, D.C. (See “. Live With It. Get Tested. Campaign” in the “Resources for Young People & Providers” Section.) The HIV/AIDS epidemic challenges health care providers in all settings to reach out to young people with HIV prevention, testing and care. With new treatments to improve and prolong the lives of people with HIV disease, these contacts between providers and young people are now potentially more meaningful then ever before in the epidemic. References: 1 Office of National aids Policy, "Youth and HIV/2000: A New American Agenda," ONAP, The White House, September 2000 2 Centers for Disease Control and Prevention, "Young People at Risk: HIV/ Among America's Youth," August 1999; Rosenberg P et al, "Declining Age at HIV Infection in the United States," letter in New England Journal of Medicine, March 17, 1994, vol. 330, p. 789 3 Kirby, D, "The AIDS Knowledge Base: HIV Prevention Among Adolescents," November 1997 on the web at http://hivinsite.ucsf.edu/akb/current/09adol/ 4 Centers for Disease Control and Prevention, "/Surveillance Report," vol. 11, no. 2, June 2000. These figures represent AIDS cases for which a risk factor was reported 5 Valleroy, LA, et al, "Prevalence and Associated Risks in Young Men Who Have Sex with Men," JAMA, vol. 284, no. 2, July 12, 2000 6 "Teens Today: A Survey of Parents and Teens of Today's Teenage Behaviors and Concerns," Liberty Mutual Group, Boston, and Students Against Destructive Decisions/Students Against Drunk Driving, September 2000 7 Kaiser Family Foundation, Menlo Park, CA, "Preliminary Findings from a New National Survey of Teens on HIV/AIDS," kff , 2000 8 Kaiser Family Foundation, Menlo Park, CA, "Hearing Their Voices," prepared by Michaels Opinion Research for kff , June 1999 9 Centers for Disease Control and Prevention, "Youth Risk Behavior Surveillance-United States, 1999," Morbidity and Mortality Weekly Report, CDC, vol. 49, no. SS-5, June 9, 2000 10 CDC, June 9, 2000 11 Futterman, D, Chabon B, Hoffman N, "HIV and AIDS in Adolescents," Pediatric Clinics of North America, vol. 47, no. 1, February 2000 12 Futterman, 2000 13 Lehman, S, et al, "Are At-Risk Populations Less Concerned about HIV Infection in the HAAR Era?" abstract presented at 7th Conferenceon Retroviruses and Opportunistic Infections, January 2000 14 Rotheram-Borus, MJ , Futterman, D, "Promoting Early Detection of Human Immunodeficiency Virus Infection Among Adolescents," Archives of Pediatrics and Adolescent Medicine, vol. 154, no.5, p. 435-439, May 2000 15 Kaiser Family Foundation/mtv /Teen People, "What Teens Know and Don't (But Should) About Sexually Transmitted Diseases: A National Survey of 15 to 17 Year-olds," kff , March 18, 1999 16 kff , 2000 17 Futterman, 2000 18 In the survey of urban MSMs noted above (Reference 5), 65% said they had been tested for HIV infection, yet only 18% of the HIV-positive men knew they were infected before the study, 15% were receiving HIV-related medical care, and 8% were receiving drug therapy for HIVdisease; the fact that 41% of these young men reported unprotected anal sex during the last six months highlights the need for increase prevention and testing efforts 19 Douglas, SD, et al., "T-Lymphocyte Subsets in HIV-Infected and High-Risk HIV-Uninfected Adolescents: Retention of Naive T-Lymphocytes in hiv -Infected Adolescents," Archives of Pediatrics and Adolescent Medicine, vol. 154, no. 4, p. 375-380, April 2000 20 Rawitscher, LA, "Adolescent's Preferences Regarding Human Immunodeficiency Virus ()-Related Physician Counseling and Testing,"Pediatrics, vol. 96, no. 52, 1995 21 Ryan, C, Futterman, D, Lesbian and Gay Youth, Columbia University Press, 1998 22 kff , 1999 23 Futterman, 2000 The HIV. Live With It. Get Tested! Program is funded by the National Institutes of Health (NIH), HIV/AIDS Bureau of the Health Resources and Services Administration (HRSA), and the Congressional Black Caucus. life beat, the music industry fights aids , is a national partner. Meaningful support has been provided by Trojan Brand Condoms and the Levi Strauss Foundation.

PROVIDER CONFERENCE
Briefing Book Contents

Youth & The HIV/AIDS Epidemic

Young People at Risk: HIV/AIDS Among America's Youth
CDC, August 1999
http://www.cdc.gov/hiv/pubs/facts/youth.htm

HIV/AIDS Surveillance Report
U.S. Department of Health and Human Services - CDC,
Vol. 11, No. 2,
1999 Year-End Edition
http://www.cdc.gov/hiv/stats/hasr1102.htm

Need for Sustained HIV Prevention Among Men Who
Have Sex With Men
CDC, August 1999
http://www.cdc.gov/hiv/pubs/facts/msm.htm

Fact Sheet - HIV/AIDS and People of Color
Sexuality Information and Education Council of the United States (SIECUS)
http://www.siecus.org/pubs/fact/fact0015.html

National Data on HIV Prevalence Among Disadvantaged
Youth in the 1990s
CDC Update, September 1998
http://www.cdc.gov/

Fact Sheet - The HIV/AIDS Epidemic in the U.S.
Kaiser Family Foundation, June 1999
http://www.kff.org/content/archive/1497/HIV epidemicfs.PDF

HIV and AIDS in Adolescents
Pediatric Clinics of North America, Vol. 47, No. 1 February 2000

High HIV Prevalence and Associated Risks in Young Men Who Have Sex With Men
JAMA, July 12, 2000, Vol. 284, No. 2
http://jama.ama-assn.org/issues/v284n2/abs/joc00112.html

Dangerous Inhibitions: How America Is Letting AIDS
Become An Epidemic of the Young
(Monograph Series)
Harvard AIDS Institute, Chris Collins, February 1997
http://www.hsph.harvard.edu/Organizations/hai/lead_initiatives/marketing
_health/dangerous.html

Fact Sheet - Teen Sexual Activity
Kaiser Family Foundation, August 2000
http://www.kff.org/content/2000/3048/TeenSexualActivity.PDF

Youth Risk Behavior Surveillance - US, 1999
CDC Surveillance Summaries, Morbidity and Mortality Weekly Report (MMWR), Vol. 49,
No. SS-5, June 9, 2000
http://www.cdc.gov/

Kaiser Family Foundation Preliminary Findings From a New National Survey of Teens on HIV/AIDS, 2000
http://www.kff.org/content/2000/3092/Teensurveyonhiv.pdf

Hearing Their Voices - A Qualitative Research Study on HIV Testing and Higher-Risk Teens
Prepared by Michaels Opinion Research for the Kaiser Family Foundation, June 1999

Teens on Sex: What They Say About The Media
As An Information Source
Kaiser Family Foundation
http://www.kff.org/content/archive/1160/teenfct2.html

Teen Survey Executive Summary 2000
Liberty Mutual
http://www.libertymutual.com/personal/teen/2000_landing.html

Teaching Teenagers a Subject Many Know All Too Well
The New York Times, Science/Health Section, October 10, 2000
http://nytimes.com/

The STD-HIV Connection

The Role of STD Detection And Treatment In HIV Prevention
CDC, July 1889
http://www.cdc.gov/nchstp/dstd/Fact_Sheets/facts_std_testing
_and_treatment.htm

Fact Sheet - Sexually Transmitted Diseases in the United States
SIECUS
http://www.siecus.org/pubs/fact/fact0008.html

From Epidemiological Synergy to Public Health Policy and Practice: The Contribution of Other Sexually Transmitted Diseases to Sexual Transmissions of HIV Infection
Sex. Transm. Inf., 1999, 75:3-17

Excerpts From Policy Reports

Youth and HIV/AIDS 2000: A New American Agenda
Office of National AIDS Policy - The White House
http://www.whitehouse.gov/ONAP/index.html

No Time to Lose: Getting More from HIV Prevention
Committee of HIV Prevention Strategies in the United States, Division of Health Promotion and Disease Prevention, Institute of Medicine, National Academy Press, Washington, DC
http://www.nap.edu/books/0309071372/html/index.html

Prevention Science

What Are Adolescent's HIV Prevention Needs?
UCSF, Updated April, 1999
http://www.caps.ucsf.edu/capsweb/adolrev.html

What Are Young Gay Men's HIV Prevention Needs?
UCSF
http://www.caps.ucsf.edu/YGMtext.html

Comprehensive HIV Prevention Messages for Young People
CDC Update, January 1997
http://www.cdc.gov/nchstp/od/news/compyout.htm

Promoting Early Detection of Human Immunodeficiency Virus Infection Among Adolescents
Arch. Pediatr. Adolesc. Med., Vol. 154, May 2000
http://archpedi.ama-assn.org/issues/v154n5/abs/pco90229.html

Abstract 239: Repeat HIV Testing, Subsequent Risk Behaviors, and HIV Seroconversion Among Young Men Who Have Sex With Men: Implications for HIV Prevention Counseling
1999 National HIV Prevention Conference

Reducing HIV Sexual Risk Behaviors Among Runaway Adolescents
JAMA, September 4, 1991, Vol. 266, No. 9
http://jama.ama-assn.org/

Structural Interventions to Encourage Primary HIV Prevention Among People Living With HIV
AIDS 2000, 14 (suppl 1):S00-S00

Condoms

Fact Sheet - The Truth About Latex Condoms
SIECUS
http://www.siecus.org/pubs/fact/fact0011.html

Condom Availability in New York City Public High Schools: Relationships to Condom Use and Sexual Behavior
American Journal of Public Health, September 1997,
Vol. 87, No. 9

Sex Education

Does Sex Education Work?
UCSF
http://www.caps.ucsf.edu/sexedtext.html

Should We Teach Only Abstinence in Sexuality Education?
UCSF
http://www.caps.ucsf.edu/capsweb/abstinence.html

Fact Sheet - Adolescence and Abstinence
SIECUS
http://www.siecus.org/pubs/fact/fact0001.html

Abstinence and Safer Sex: HIV Risk-Reduction Interventions for African American Adolescents
JAMA, Vol. 279, pp. 1529-1536, May 20, 1998
http://jama.ama-assn.org/issues/v279n19/abs/joc80091.html

No Easy Answers: Research Findings on Programs to Reduce Teen Pregnancy
The National Campaign to Prevent Teen Pregnancy/Task Force on Effective Programs & Research Washington, DC, March 1997
http://www.teenpregnancy.org/fmnoeasy.htm

Parental Roles

How Do Parents and Children Talk About HIV?
UCSF
http://www.caps.ucsf.edu/parent-child.html

Patterns of Condom Use Among Adolescents: The Impact of Mother-Adolescent Communication
American Journal of Public Health, October 1, 1998
CDC Update, October 1, 1998
http://www.cdc.gov/nchstp/dstd/Condom_Use_Among_Adolescents.htm

Voluntary HIV Testing & Counseling

What Is Testing's Role in HIV Prevention?
UCSF
http://www.caps.ucsf.edu/testtext.html

Fact Sheet - HIV Testing
Kaiser Family Foundation, June 1999
http://www.kff.org/content/1999/1492/HIV_Testing.PDF

Promoting Early HIV Diagnosis and Entry Into Care
AIDS 1999, 13:2317-2330

Product Information: OraSure HIV-1 Oral Specimen Collection Device
Epitope
http://www.epitope.com/products/default.asp?
sec=2&subx=2&cid=2&prd=133

Product Information: How Does OraSure Work?
Epitope
http://www.epitope.com/products/prodsubarea.asp?
cid=5&pid=133&sec=2&subsec=2

Product Information: Commonly Asked Questions About OraSure HIV-1, HIV, and AIDS
Epitope
http://www.epitope.com/products/prodsubfaq.asp?
pid=133&sec=2&subsec=2

Product Information: Glossary of Terms
Epitope
http://www.epitope.com/products/prodsubarea.asp?
cid=1&pid=133&sec=2&subsec=2

The Calypte Urine Based Testing Solution
http://www.calypte.com

Calypte Info Center Resources: FAQS
http://www.calypte.com/Inf/InfHme.html

New York State HIV Testing Laws

HIV, Teens, and Health Laws
Adolescent AIDS Program, Montefiore Medical Center
http://www.adolescentaids.org/

HIV Reporting CD4 and Viral Load Tests: The Facts for People Living With HIV or AIDS
State of New York Department of Health, June, 2000
http://www.health.state.ny.us/home.html

HIV Testing: Significant Changes in What Happens When You Take an HIV-Related Test, Effective June 1, 2000
GMHC
http://www.gmhc.org/basics/testing.html

Providing Testing and Counseling Service to Young People

Montefiore Medical Center Risk Evaluation Program (Form)

TA Call Report: Serving HIV Positive Youth
Health Resources and Services Administration, September, 2000
http://www.hrsa.dhhs.gov/

Fact Sheet - Gay, Lesbian, and Bisexual Adolescents
SIECUS
http://www.siecus.org/pubs/fact/fact0013.html

Communication Between Adolescents and Physicians About Sexual Behavior and Risk Prevention
Arch. Pediatr. Adoles. Med./Vol. 150, September, 1996

Overview: HIV Infection in Adolescents, Including Lesbians and Gay Males
Excerpted from: Lesbian and Gay Youth: Care and Counseling, Columbia University Press, 1998

HIV Counseling, Testing, and Prevention
Excerpted from: Lesbian and Gay Youth: Care and Counseling, Columbia University Press, 1998

Guidelines for Use of HIV Drug Therapies

Antiretroviral Therapy in Adults
JAMA, January 19, 2000, Vol. 283, No. 3
http://jama.ama-assn.org/

Youth Publications

Teen Summit AIDS… A Crisis Among African American Youth
BET/Kaiser Family Foundation
http://www.kff.org/content/archive/20/bet_teensummit.html

Reality: A Zine About Youth and HIV
Health Initiatives for Youth, Summer/Fall 2000

Oral Sex: What Are The Risks?
Health Initiatives for Youth
http://www.hify.com/oral_sex.htm

Get It Right or Get Out of the Way: A reaction to the Foo Fighter's Statements on HIV/AIDS
Health Initiatives for Youth
http://www.hify.com/foo_reaction.htm

Are You Listed? HIV Names Reporting and Youth
Health Initiatives for Youth
http://www.hify.com/namesreporting.htm

Talking About Disclosure
Health Initiatives for Youth
www.hify.com

What You Need to Know About Homophobia
Health Information Pamphlet
Health Initiatives for Youth
www.hify.com

What You Need to Know About Substance Use
Health Information Pamphlet
Health Initiatives for Youth
www.hify.com

Peer Power
Adolescent AIDS Program, Montefiore Medical Center,
June, 2000
http://www.adolescentaids.org/

"HIV. Live With It. Get Tested!" Campaign

Program Focuses on HIV Among the Young
The Washington Post, November 30, 1999
http://www.washingtonpost.com/

The New Face of HIV Is Young, Black; Despite The Risks, Unsafe Behavior Goes On, Doctors Find
The Washington Post, July 16, 2000
www.washingtonpost.com/artical