HIV-INFECTION AND AIDS IN ADOLESCENTS - A POSITION PAPER OF THE SOCIETY FOR ADOLESCENT MEDICINE

Although adolescents represent less than 0.4% of the reported cases of AIDS in this country, there is growing concern that HIV infection may be spreading in this age group despite current efforts at education, prevention, and care. The Society for Adolescent Medicine believes that preventing and treating HIV infection in adolescents and young adults should be a major concern for health care providers and public health authorities. In order to accomplish this, the following priorities must be addressed: 1. Documentation of the extent of the problem of HIV infection in teenagers. This must be accomplished by continuing and expanding the surveillance of HIV infection in selected adolescent populations and by augmenting epidemiologic data with information concerning the natural history of HIV infection in adolescents and young adults. 2. Development of adolescent-specific systems of care (organized on a regional basis) for those infected or at high risk of infection. This care must include diagnostic and therapeutic services for conditions that are common to adolescents as well as those that are specifically associated with HIV infection. It should also include psychological and social support services and be coordinated through an appropriate primary care provider. Ideally, this care will be available and regionally organized through the cooperation of care providers as well as federal, state, and local health agencies. 3. Development of a rational approach to counseling and testing of adolescents. There should be no mandatory of testing of adolescents. Confidential testing should be readily available to adolescents and every effort should be made to ensure the rights of privacy of the patient. Anonymous testing should also be available for those who so choose. Programs and the clients they serve should be made aware of the positive and negative features of each approach to testing. Counseling should be developmentally and culturally sensitive and always identify risks as well as benefits of testing. Both counseling and testing should take place in settings in which adolescents feel comfortable and where care and support services can be made readily available. Appropriate parental or other adult support should be incorporated into the process whenever possible. 4. The needs of ''special populations'' of adolescents, including gay and bisexual youth, homeless and runaway youth, incarcerated and detained youth, youth in foster care, youth using alcohol or other drugs, and youth with hemophilia should be addressed by care providers as well as federal, state, and local health and social service agencies. Particular emphasis should be placed on removing financial and institutional barriers to care for these adolescents. 5. Prevention should be reaffirmed as the best means of interrupting the pandemic of HIV infection and implemented in an adolescent-specific manner. Efforts should target youth at greatest risk of HIV infection and focus on repeated contact, aggressive follow-up, and the integration of prevention education with practical life skills. All prevention programs should have well identified and easily accessible links to counseling and testing as well as care and treatment services. Mass prevention efforts should begin by age nine years and provide specific and explicit messages. HIV infected youth should receive special interventions as a means of secondary prevention. Adolescents should be considered appropriate candidates for medical prevention efforts, including vaccines, should these become available. 6. Efforts to make changes in the aforementioned areas should be validated by appropriate research studies. Funding for such adolescent-specific research must continue to be provided by federal, state, and local agencies and private foundations. Particular attention should be directed toward documenting the natural history of HIV infection in adolescents, determining what makes for a successful secondary prevention program, determining the effects of counseling and testing on adolescent behaviors, and finding appropriate ways to validate prevention intervention studies. The Society for Adolescent Medicine has long been on the forefront of this epidemic and efforts to stem its spread to teenagers. The Society, in conjunction and cooperation with its members, private foundations, and federal agencies, will work to see that its specific recommendations to advance these six identified areas of need are carried forward in as timely a fashion as possible.