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Among adolescents aged 13-21, older adolescents, males, and members of racial minorities have the highest infection rates.(1) Among new cases of HIV infection reported among 13- to 24-year-old men in the United States in 2001, 48% were among men who have sex with men, 3% were among men who injected drugs, another 3% were among men who both had sex with men and injected drugs, and only 6% were among men who were exposed through heterosexual contact.(2) Among new cases of HIV reported among young women aged 13-24 years, the exposure category with the largest number of cases was heterosexual contact (33%).
These high-risk groups are somewhat bounded by social networks, but this may change.
This chapter presents data on adolescent sexual risk-taking behavior, reviews the studies measuring the impact of adolescent prevention programs, and identifies common characteristics of programs that have been effective in reducing sexual risk-taking behavior.
It recommends a) that these effective school and community programs be implemented more broadly, b) that promising clinic programs and comprehensive community-wide campaigns be replicated and evaluated, and c) that additional programs focusing on high-risk youth be implemented and evaluated.
Adolescents, in general, are at risk of contracting HIV through sexual transmission, because a large majority engage in sexual intercourse, have multiple partners over a period of time, and fail to consistently use a condom during every act of intercourse.
In addition, many young people also become infected with other STDs that facilitate the transmission of HIV.
Among sexually experienced people, adolescents aged 15 to 19 years have some of the highest reported rates of STDs.
In addition, particular groups of adolescents (eg, males who have sex with males, injection drug users, and teens who have sex for drugs) engage in even greater risk-taking behavior.
Among sexually active students in grades 9-12 in 2001, 58% reported using a condom the last time they had intercourse.(3) This percentage is two to three times higher than those reported in the 1970s before AIDS became a public issue.(5) This increase over time suggests that the emergence of AIDS and public campaigns to prevent AIDS through increased condom use have actually increased condom use.
However, condom use varies with urban area, age, ethnicity, gender, and involvement in other risk-taking behaviors, and this national average obscures wide variations in different groups.
On the other hand, in the United States, most of these adolescents are actually at relatively low risk, because they rarely, if ever, have sex with people who are HIV infected.
In contrast, adolescents in countries where HIV infection is widespread are at much higher risk of contracting HIV through sexual intercourse, as are adolescents in low-prevalence countries who have unprotected intercourse with members of very high-risk groups (eg, males who have sex with other males or injection drug users).
About half of all new HIV infections worldwide, or approximately 6,000 per day, occur among young people.(14) The United Nations General Assembly Special Session on HIV/AIDS (UNGASS) established the goal of reducing HIV prevalence among young men and women aged 15 to 24 by 25% in the most affected countries by 2005, and by 25% globally by 2010.(15) Because many HIV-infected adolescents and young adults have not been tested for HIV and their HIV status is not known, and also because of the typically long latency period before development of clinical AIDS, many cases of HIV/AIDS that are identified among people in their 20s or even early 30s may have been acquired during their teen years or in their early 20s.