Many sexually active teens avoid HIV testing
The numbers are chilling. Young people between 13 and 24 represent about one-fourth of the nation’s new HIV cases. Even more alarming; only half of them know they are infected.
Despite the fact that medical advances have ensured that HIV and AIDS is more preventable and not a death sentence if you do contract it, it is still imperative that young people are educated about the disease, say experts.
According to the federal Centers for Disease Control and Prevention, only 22 percent of high school students who admitted in a 2013 survey to being sexually active got tested for HIV, the virus that causes AIDS.
Young adults between 18 and 24 did slightly better, with 35 percent saying in a 2010 survey that they got tested.
The American Academy of Pediatrics recommends all 16- to 18-year-olds be screened for HIV, but many balk at being tested, said Falmouth pediatrician Kira Grant Edwards, DO. She said her sexually active teen patients resist for fear their parents might find out, and for other social concerns.
“I feel like some of the other STD screenings that we do – the urine STD screenings for gonorrhea and chlamydia pretty routinely – I don’t get much pushback for that, but with HIV, think that because of a little bit of stigma there’s more pushback from teenagers,” she said.
Communities need to send the message that testing is the responsible thing to do, Dr. Grant Edwards said. “Then maybe they would feel responsible for getting a test and not that it was labeling them as having done some behavior.”
The Cape Cod numbers are less alarming than the nationwide averages. According to state Department of Public Health statistics, 653 people with HIV or AIDS lived in Barnstable County on Dec. 31, 2014, representing a prevalence rate of 7.9 per 100,000. This is lower than the state rate of 10.7 per 100,000.
Of those, none were diagnosed between the ages of 13 and 19 and only five were diagnosed between the ages of 20 and 24, according to the report. Almost seven in 10 of those diagnosed were age 50 and older.
But the numbers only reflect those who get tested.
Max Sandusky, director of preventive and screening services for the Cape Cod AIDS Support Group, offers HIV tests at clinics in Provincetown and Hyannis. The group is opening another site this year in Falmouth.
Testing is free and confidential. The organization focuses on clients 18 or older.
Sandusky said men who have sex with men and IV drug users are among the highest-risk groups. “[They] tend to be more informed than the general public about HIV, but that’s not always the case,” he said. “I’m surprised at the lack of education.”
Anecdotally, Sandusky said that 20-somethings have made up the majority of diagnoses in the last five years, prompting his organization to step up their efforts to educate young people about prevention methods, particularly “pre-exposure prophylaxis,” also called PrEP.
PrEP, known by its brand name, Truvada, combines two medicines that can cut the risk of contracting HIV through sex or IV drug use by 92 percent. Users must take the pill daily for it to be fully effective.
Health experts recommend taking the drug and using a condom to further decrease your chances of infection.
Still, too many young people aren’t practicing safe sex, especially when drugs and alcohol are involved. The CDC reported that 22 percent of sexually active students said they drank alcohol or took drugs before the last time they had intercourse.
“A lot of times, substance abuse is a contributing factor.” Sandusky said. “It’s sometimes very difficult to get a twenty something-year-old to understand that having eight or 10 cocktails a night is really not normal. That’s what they’re used to going out, and alcohol or other substances is certainly going to have an impact on the decisions they make.”
In cases of unprotected sex with an HIV positive person, there’s also treatment to help prevent an infection soon after exposure. Called Post-Exposure Prophylaxis or PEP, it involves taking antiretroviral drugs within 72 hours of exposure.
To remove the stigma around testing, Sandusky urged young people to seek out health providers with whom they can openly discuss their personal concerns. In Massachusetts, anyone 13 and older can request confidential testing without a parent’s consent, and the state offers many services to support people infected with HIV.
“Testing on a routine basis is always a good idea,” he said. “If you’re sexually active and have more than one partner, testing should be every three to six months.”
In addition to the AIDS Support Group clinics on the Cape, confidential testing for HIV and other STDs is also available at Hyannis Family Planning.
The organization offers free HIV testing to most teens, said Emily Gold, director of reproductive health services at Health Imperatives, a Brockton-based nonprofit that oversees the Hyannis clinic and eight others from Weymouth to the Cape and Islands.
Despite these affordable and confidential services, Gold said the Hyannis clinic has seen a drop over the past five years in 13- to 18-year-olds.
“It’s concerning,” she said. “We don’t think it’s because they’re not sexually active.”
Thrive!, an organization of CIGSYA (Cape & Islands Gay & Straight Youth Alliance) in Hyannis, annually serves about 1,500 people 22 and younger. Thrive! provides a nonjudgmental community for gay, bisexual, lesbian, straight, transgendered and questioning youth, while promoting health education and risk reduction, said Scott Fitzmaurice, the group’s executive director.
“The strategy is to get everybody tested, get everybody that’s positive in treatment,” he said.
Valerie Al-Hachem, director and grants administrator for Infectious Disease Clinical Services of Cape Cod and Falmouth hospitals, also praised PrEP while advocating continued use of condoms.
“It reduces chance of transmission (through sex) to nearly zero,” she said.