# Presentation: 315208

## 

Can We Become More Effective in
Preventing HIV Infection among Young People?

**Can We Become More Effective in**
**Preventing HIV Infection among Young People?**

**Presidential Advisory Council on HIV/AIDS****Washington, DC****August 7, 2003**

## Sexual Intercourse 1970s-80s

- 1971-1979 - 15-19 year old females living in metropolitan areas
- 1982-1988 - 15-19 year old females in the US

## Estimated number of HIV diagnoses*, by age-group and year of diagnosis – 25 states,+ 1994-2001

***Adjusted for reporting delays.**
**+ ****Alabama, Arkansas, Arizona, Colorado, Idaho, Indiana, Louisiana, Michigan,  Minnesota, Mississippi, Missouri, New Jersey, Nevada, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. **

## Teens/Young Adults Are at High Risk for STDs

**Gonorrhea****	**	516/100K 15-19 year-olds
**Chlamydia**		1,373/100K 15-19 year-olds
**Herpes**		  6%   12-19 year-olds				17%   20-29 year-olds
**HPV**			Some studies 28%-46% women < 25

## Birth Rates Among 15-19 Year Olds, 1990s

| Country | Rate  | Rank |
| --- | --- | --- |
| South Korea | 3.1 |    1 |
| Sweden | 7.3 |   10 |
| Zimbabwe | 11.0 |   20 |
| Trinidad and Tobago | 15.0 |   30 |
| Jordan | 17.9 |   40 |
| Montenegro | 20.1 |   50 |
| Dominica | 24.2 |   60 |
| Morocco | 27.6 |   70 |
| Rwanda | 32.2 |   80 |
| Philippines | 39.2 |   90 |
| Egypt | 44.1 | 100 |
| Uruguay | 49.3 | 110 |
| Bahamas | 53.8 | 120 |
| United States | 58.6 | 128 |

## Three Epidemics Among Young People

- Half the estimated new 40,000 HIV infections each year are among those _<_ 25 year-olds
- Three million other new STD infections each year
- Nearly one million pregnancies each year

## Reduce Sexual Risk Behaviors Among Youth

- Never had intercourse **55%**

- Condom at last intercourse
**19%**

- No condom at last intercourse**14%**

- Ever had intercourse

**45%**

**Reduce Sexual Risk Behaviors Among Youth**

- By the year 2010, increase to 95% the proportion of adolescents who abstain from sexual intercourse or use condoms if currently sexually active (NHO 25-11, LHI5)

**YRBS 2001**

## Social Institutions that Most Influence Young People

- Parents & families
- Schools
- Media
- Health care providers
- Faith-based organizations
- CBOs that serve youth
- Colleges/universities
- Employers
- Government agencies

## HIV Prevention Strategic Plan Through 2005

**Goal 1**
- 	By 2005, **decrease by at least 50% the number of persons in the United States at high risk for acquiring or transmitting HIV infection** by delivering targeted, sustained and evidence-based HIV prevention interventions.
**Objective 3**
- 	**Among adolescents**, increase the proportion who consistently engage in behaviors that reduce risk for HIV acquisition or transmission.

## HIV Prevention Strategic Plan Through 2005

**	****Strategy 1**
**	**Research, develop, implement and evaluate evidence-based, **community-based HIV/STD prevention programs that help adolescents abstain from intercourse, delay intercourse and develop safer sexual practices - particularly for adolescents in high-risk situations**, especially out-of-school youth, gay/lesbian/ bisexual/transgender and questioning youth, immigrant youth and youth with limited English proficiency, those who have been sexually abused, youth in detention and foster care, run-away youth, youth engaged in sex work and youth of color.** **
**	**

## Community-Based Strategies

- Surveillance:	HIV/AIDS, serosurvey, spectra of 	 disease
- Intervention:	State/territorial, 6 city health departments 	Nongovernmental–national, regional, 	community-based
- Research:	Young men’s/women’s surveys, 		Project AIM, Family/adolescent risk 	behavior & communication, many others
- Support: 	AIDS Hotline, NPIN, AFY, BRTA/LRTA

**Notes:**
One slide, usually spend longer, see handout 
YRBS: Establish and monitor risk behaviors, ntl, state/large city, next data collection       Spring 2001
SHPPS 2000 data pub’d Spring 2001?]
SHEP [What to say?]
Health Passages [What to say?]
Li Yan Wang articles]
CSHP States Eval Workshop]
New Branch
New Administration

## HIV Prevention Strategic Plan Through 2005

**	****Strategy 2**
- 	Research, develop, implement and evaluate evidence-based **comprehensive school-based HIV/STD prevention programs** that help all adolescents abstain from intercourse, delay intercourse and develop safer sexual practices, particularly youth of color and gay/lesbian/bisexual/ transgender and questioning youth.

## School-Based Strategies

- Monitor progress:		YRBSS, SHPPS
- Enable constituents:		SEAs/SHDs, Large LEAs/ 								LHDs, NGOs, FAs
- Apply research:			Guidelines, Tools
- Evaluate results: 		Interventions, 								State/Local Programs

**Notes:**
One slide, usually spend longer, see handout 
YRBS: Establish and monitor risk behaviors, ntl, state/large city, next data collection       Spring 2001
SHPPS 2000 data pub’d Spring 2001?]
SHEP [What to say?]
Health Passages [What to say?]
Li Yan Wang articles]
CSHP States Eval Workshop]
New Branch
New Administration

## Trends Among Youth

## High School Students Who Ever Had Sexual Intercourse, 2001

**45**

**34**

**41**

**52**

**61**

**43**

**61**

**48**

**0**

**20**

**40**

**60**

**80**

**100**

**Overall**

**9th**

**10th**

**11th**

**12th**

**White**

**Black**

**Hispanic**

**Percent**

## Trends Among Black High School Students, YRBSS

- * Intercourse during the last 3 months
- **  Among currently sexually active students

## Trends Among Youth

## Gay, Lesbian, And Bisexual Youth Heterosexual Peers

- Missed school because did not feel safe (20% vs. 5%)
- Attempted suicide (36% vs. 9%)
- Pregnant twice or more (24% vs. 10%)

- Sources:  MA, VT YRBS; MN Adolescent Health Survey; ADD Health

**Notes:**
Gay, lesbian, and bisexual youth are at greater risk than their heterosexual peers for a variety of health risk behaviors.
Massachusetts YRBS data shows that 20% of GLB students missed one or more days of school because of fear for their safety as compared with 5% of heterosexual students.
36% of GLB students in Massachusetts attempted suicide in the past year as compared with 9% of heterosexual students.  Data from ADD Health indicates that, nation-wide, GLB students are twice as likely as their heterosexual peers to have attempted suicide.
Among male students in Massachusetts, 34% of students with only opposite-sex sexual partners did not use a condom at last intercourse, 39% of males with same-sex sexual partners did not use a condom, and 68% of males with both male and female sexual partners did not use a condom.
The Minnesota Adolescent Health Survey found that 24% of lesbian or bisexual female students reported 2 or more pregnancies as compared with 10% of heterosexual female students.
Massachusetts and Vermont YRBS data showed that over 40% of students with both males and female sexual partners used cocaine in their lifetime as compared with less than 20% of students with only opposite-sex partners.
Massachusetts and Vermont YRBS data showed that a quarter of Vermont students and 37% of Massachusetts students with both male and female partners vomited or used laxatives to control their weight as compared with less than 10% of students who had only opposite-sex partners.

## Youth in High-Risk Situations

- Who sell or barter sex
- In juvenile justice facilities
- In runaway & homeless shelters
- In STD clinics
- In mental health facilities
- In alcohol or drug abuse treatment
- In gangs
- Migrant and immigrant

## Integrate Efforts to Prevent HIV Infection, Other STDs, & Unintended Pregnancies

- (1)	Young people should know how to prevent other STDs and pregnancy
- (2)	Efficiency of approach
- (3)	Collaboration among those concerned
- (4)	Related issues (e.g., comparative effectiveness of condoms, condoms vs. OCs)
**(5)****	****Potential to increase effectiveness**

## IntegrateSEA Supplement to Prevent Sexual Risk Behaviors among School-Age Youth

- Work with interested SHD Directors of:
- Abstinence Programs, HIV Prevention, STD Prevention, Adolescent Pregnancy Prevention
- Purpose: Increase appropriateness, efficiency, & impact of efforts to reduce sexual risk behaviors among school age youth
- By improving communication, coordination, and/or collaboration among interested organizations in the state implementing such efforts

## Sex in the Media

- What adverse impacts, if any, does sex in the media have on sexual risk behaviors of young people?
- What options might be available for various social institutions to reduce any defined adverse impact (e.g., parents & families, media themselves, health care providers)

## Advancing HIV Prevention:New Strategies for a Changing Epidemic

- _Strategy 1_Make voluntary testing a routine part of medical care
- _Strategy 2_Implement new models for diagnosing HIV infections
- _Strategy 3_Prevent new infections by working with persons diagnosed with HIV
- _Strategy 4_Further decrease perinatal HIV transmission

## Parents Are Important

- Adolescents want information about sex from their parents
- Parents who talk about sexual topics can help reduce their adolescents’ sexual risk behavior
- Communication skills are important for parents to talk about sex

- Sources:  Kaiser Family Foundation; Parents Matter!; Add Health; Dittus, Jaccard, & Gordon (1999)

**Notes:**
Although 56% of parents with 10-12 year olds have not talked to their children about relationships and becoming sexually active and 62% have not talked about avoiding pregnancy and sexually transmitted diseases, these are the topics kids most want information on – from their parents.  50% of kids want guidance regarding when to have sex and information about how to protect themselves from AIDS and STDs; 38% want information on preventing pregnancy.
Adolescents who report discussions with their parents about  the social, emotional,  moral,  pregnancy and parental consequences of engaging in sex are half as likely to initiate sex  than adolescents who do not report such discussions.  Adolescents who have accurate perceptions of their parents’ attitudes towards them engaging in sex are also substantially less likely to initiate sex.
Parents who possess a greater number of general and sexual communication skills, including being able to talk openly about sex, and being comfortable and skilled enough to talk, are 10 times more likely to talk with their children about a number of sex topics including abstinence, puberty, and reproduction.
Few effective programs for parents exist.  DASH is currently working with Columbia University to develop  and evaluate a cost-effective program for parents that capitalizes on school-community partnerships in reaching parents in neighborhoods where adolescents are at greatest risk.  Linking Lives is aimed at increasing parents’ skills in communicating about sex and at improving parents’ relationships with their children.  

## Integrate Risk Reduction & Youth Development Efforts

**Causes of Death Ages 10-24 ****& Risk Behaviors**

**Unintentional/intentional injuries**
-    32%	Rode with a drinking driver
-      8%	Attempted suicide
**Alcohol/drug use**
-    28%	Episodic heavy drinking
-    27%	Used marijuana
**Sexual behaviors**
-    52% 	Ever had sexual intercourse
-    19%	Ever had _>_4 sex partners

**Competence**
**Confidence**
**Caring**
**Connections**
**Contributions**
**Character**

**Youth Development**

## Building Blocks of Hope

**Address by Mrs. Janet K. Museveni**
**First Lady of the Republic of Uganda**
**Institute for Youth Development**
**Washington, DC**
**May 13, 2003**

**	****A young son disappeared mysteriously from his family . . .**

## 

Can We Become More Effective in
Preventing HIV Infection among Young People?

**Can We Become More Effective in**
**Preventing HIV Infection among Young People?**

**Presidential Advisory Council on HIV/AIDS****Washington, DC****August 7, 2003**