Health Resources and Services Adm

Health Resources and Services Adm

U.S. Department of Health & Human SerU.S. Department of Health & Human Ser

H

RSA

HRS

HEALTH RESO

IN THISISSUE

is published by the Health Resources andServices Administration, Department of Healthand Human Services. All information containedherein is in the public domain.

Please forward comments, letters and questions to:Office of CommunicationsHIV/AIDS Bureau, HRSA5600 Fishers Lane, Room 7-46Rockville, MD 20857Phone: 301-443-6652Fax: 301-443-0791or by E-mail to: koneill@hrsa.govHRSA Care ACTION

HRSACare

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In this issue of HRSA Care Ato provide an overview of adolescents. Our objectivethe issues that every indivipeople should understand, in need of more in-depth ivariety of resources availaon the web.There are an estimated 40,tions in the U.S. annually; 10,000 infections, are belieages 13 to 21. Despite the Act providers, and organizals across the country, relainfected teens are currently Most HIV-positive adolesceunaware of their serostatutwenties, unless we becomoutreach, prevention, and care needs. Therefore, renepidemic among the natiotant.Applying what has already essential first step. More pto the problems that separinformation and health caUltimately, integration of Hcounseling, and testing intmaking primary care a noexception are crucial if we reduce the incidence of HIin the third decade of the A

HIV Disease in Adolescents and Risk forSeroconversion1. Centers for Disease Control and Prevention (1999). HIV/AIDS

Surveillance Report: U.S. HIV and AIDS cases reported throughJune 1999. 11(1).

2. Centers for Disease Control and Prevention (1998). HIV

counseling and testing in publicly funded sites: 1996 annualreport.

3. Klein JD, Slap GB, Elster AB and Cohn SE (1993). Adolescents and

access to health care.

70:219.

4. Kaiser Family Foundation (1999). Hearing their voices: a

qualitative research study on HIV testing and higher-riskteens.[On-line:

5. Kaiser Family Foundation (1999). What teens know, and don’t

(but should) about sexually transmitted diseases. [On-line:

6. Centers for Disease Control and Prevention (1998). Youth Risk

Behavior Surveillance, 1997.

47:SS-30.

7. Centers for Disease Control and Prevention (1998). Trends in

sexual risk behaviors among high school students, U.S. 1991-1997.

47:SS-30.

8. Advocates for Youth (1999). Teen pregnancy prevention initiative

statistics. [On-line:

9. Katz MH, McFarland W, Guillin V, Fenstersheib M, Shaw M, Kellog T,

Lemp G, MacKellar D, Valleroy L (1998). Continuing highprevalence of HIV and risk behaviors among young men who havesex with men: the Young Men’s Survey in the San Francisco BayArea in 1992 to 1993 and in 1994 to 1995.

19:178-

181.

10. Ryan C and Futterman D (1997). Adolescent Health Challenges:

Lesbian and Gay Youth Care and Counseling.

8(2):208-210.

11. Centers for Disease Control and Prevention (1998). Youth Risk

Behavior Surveillance, 1997.

47:SS-30.

12. Substance Abuse and Mental Health Services Administration

(1998). Preliminary results from the 1997 National Household

Survey on Drug Abuse. [On-line:

13. Schalwitz J (1992). HIV seroprevalence among incarcerated,

runaway and homeless youth in San Francisco. Conferenceabstract. International Conference on AIDS 1992. July 19-24;8(3):188(abstract number PuC 8212).

15. Pfeifer RW and Oliver J (1997). A study of HIV seroprevalence in a

group of homeless youth in Hollywood, CA.

20(5):339-342.

16. Thompson LS and Farrow JA (eds.) (date unavailable). Hard

Time, Healing Hands: Developing Primary Health Care Servicesfor Incarcerated Youth. Arlington, VA: National Center forEducation in Maternal and Child Health.

17. Widom R and Hammett TM (1996). HIV/AIDS and STDs in

juvenile facilities. U.S. Department ofJustice.[On-line:

Bulletin of the New York Academy of

Medicine

http://www.kff.org/content/1999/

1492/HearingVoices2.PDF ]http://www.kff.org/content/archive/ 1465/stds_t.pdf ]

Morbidity and Mortality Weekly

Report, Surveillance Summary

Morbidity and Mortality Weekly Report, Surveillance

Summary

http://www.advocatesfor youth.org/statisti/htm

]

Journal of Acquired

Immune Deficiency Syndromes and Human Retrovirology

Adolescent

Medicine, State of the Art Review

Morbidity and Mortality Weekly

Report, Surveillance Summary

http://www.health.org/pubs

/97hhs/httoc.htm ]

Journal of Adolescent

Health

NIJ Research in Brief.

http://www.hivinsite.ucsf.edu/topics/prisons

/2098.2fdd.html] .

14. Stricof RL, Kennedy JT, Nattell TC, Weisfuse IB, Novick LF (1991).

HIV seroprevalence in a facility for runaway and homelessadolescents. Suppl:50-3. [Online. Abstract from: Medline: PMID 2014885, UI91196832.

1. Ryan C & Futterman D. Lesbian and gay youth: Care and

counseling. NY: Columbia University Press, 1998.

2. Chabon, B, Futterman, D & Jones, C. Adolescent HIV counseling

and testing protocol. In RyanC&Futterman D. Lesbian andgay youth: Care and counseling. NY: Columbia UniversityPress, 1998.

3. Hoffman N, Futterman D & Myerson A. Treatment issues for

HIV-positive adolescents. AIDS Clinical care, 11(3):1-21, 1999

American Journal of Public Health

HIV Care for Sexual Minority Youth4. Schietinger H, Sawyer M, Futterman D, et al. Helping Adolescents

with HIV adhere to HAART. TREAT Monograph:1999. 10 Centersfor Disease Control and Prevention. Youth risk behavior

HIV DiseaServing AdInsert: CalAdolescen

References

surveillance--U.S. 1997. MMWR47(SS-3), 1998.

HIV Disease inAdolescentsIntroduction to the Novem
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SeroprevalenceHistorically, 17% of reported AIDS cases have beendiagnosed among individuals in their twenties; giventhe period from seroconversion to AIDS — ten years onaverage — it is clear that most were HIV-infected whilein their teens. This data, combined with the estimatethat one quarter of new infections occur amongindividuals under 21 years of age, can leave no doubtthat HIV disease in adolescents is a significant publichealth problem.GenderCompared with adults, females represent a muchhigher proportion of reported AIDS cases amongadolescents and young adults: 55.5 percent in individuals ages 13-19 and 40.5 percent in those ages 20-24,compared to 23 percent of cases among all adults andadolescents. There are several reasons why:

The sexual partners of young girls tend to be boyswho are older.Because of the immature cervix, adolescent girlshave heightened risk for sexually transmitteddiseases (STDs). Their occurrence increases risk forHIV infection and the need to see a provider whomay recognize the need for an HIV test.

Fewer adolescent boys than girls receive counselingand testing, although data suggest that theirseroprevalence rate is higher.

Access to Counseling and TestingAdolescents of both genders are the most medicallyunderserved of any age group. They face very highbarriers to HIV counseling and testing, including:

poor access to youth-appropriate testing facilities,cost of testing,lack of awareness of HIV, andthe belief that they are not at risk.

Results of one random-sample national telephonesurvey of 400 individuals from 15 to 17 years oldshowed that 25 percent had been tested for HIV,although 42 percent had had sexual intercourse.Adolescent males are also unlikely to be tested for HIVinfection because they are less likely than females tosee a clinician, since they do not have the reproductivehealth concerns that cause their female counterpartsto seek medical care. Thirty five percent of the fewcases diagnosed among young men in their teens havebeen among those with hemophilia or anothercoagulation disorder — in other words, among youngmen who needed to see a clinician for a non HIVrelated health problem and who demonstrated aknown risk factor (hemophilia) for HIV.

1

3

4

5

At publicly funded

sites in 1996:

The number of females 13-19 years of age whowere tested was 2.5 times greater than thenumber of males in the same age group.

Among those tested, the seropositive rate inyoung males was twice that in young females(0.4 percent and 0.2 percent, respectively).

Young men who have sex with men face additionalbarriers. Low self-esteem, the inability to have anhonest relationship with their health care provider,and the fear of being exposed as a gay or bisexual manare all major problems.

2

Predictors of RiskSexual Activity Among Adole

37 percent of 9th graders iof 12th graders have had inSixteen percent of sexuahaving had more than fouOver one million teenaannually.

Early Sexual Activity Among YYoung men who have sex wvulnerable to HIV infection. socialize, lack of accurasexuality and risk behaviortial for having partners increase their vulnerability.The Young Men’s Survey, a survey conducted in the San 1994-1995, found both a

8

Adolescents not in schoFrom 10 to 15 percent of aschool. Academic failure aschool is associated with rmental illness, addiction ational problems includinphysical illness and HIV. Vis available on sexual acttion.

10

HIV Disease in Adolescents

and Risk for Seroconversion

FACTS

AIDS Cases Diagnosed in

Individuals Aged 13-24

(Cumulative)1

Other1%

MSM42%

Heterosexual Contact19%

IDU16%

MSM/IDU7%

Hemo/Colag.5%

Unknown10%

Proportio

Total AIDS Cas

African Americans 

5040302010

0

47.7

19.9

41.7

2

Ages 13-19 Ages 20

—

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4 

Continued from Page 3 . . . HIV DISEASE IN ADOLESCENTS

Substance AbuseSubstance abuse strongly influences behaviors thatincrease risk for HIV transmission. It also decreases theprobability that HIV-positive adolescents will bereached through outreach, tested, and linked to care.

One-third of high school youth report having hadfive or more alcoholic beverages at least once in theprior month; more than 25 percent report smokingmarijuana; 16 percent report using inhalants suchas industrial solvents, paints, and nitrates.Heroin use among teens has nearly doubled since1991, and nearly 1 in 50 high school students reporthaving injected an illegal drug.

Homelessness in YouthThe rate of HIV infection is higher among homelessyouth than in the general U.S. population.

One study conducted in three adolescent clinic settingsin San Francisco (n=1254) found a sero- prevalencerate of 3.0 percent. Of these three clinics, one servedhomeless youth specifically; the seroprevalence rateamong its clients was 9.3 percent .

A New York City study (n=2667) in a facility forhomeless and runaway youth found 5.3 percent tobe HIV positive.A recent survey conducted in among homeless youthin Hollywood, CA (n=96) reported a HIVseroprevalence rate of 11.5 percent.

Youth in CorrectionsResults from seroprevalence studies among youth incorrections from the early 1990s vary widely — from 0to 4.2 percent. Few more recent data are available.In a survey of state and local juvenile justice detentioncenters, most of the 73 respondents did not haveinformation regarding the number of youth with HIVdisease in their systems, or the number who were HIVpositive upon release. STD rates were high: 2 percentfor syphilis, and 14 percent for gonorrhea. Two of thesystems had mandatory screening for HIV, and mostprovided STD, HIV and pregnancy testing on a voluntary basis, or when clinically indicated.

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Adolescent 

How do HIV-positive childrenand adolescents learn aboutthe Burgess Clinic?Dr. D'Angelo:Dr. D'Angelo:

The clinic is linke

with a variety of communitybased outreach programidentifying kids who are at riskWe also have our own outreacactivities.The problem is that manadolescents are not beinreached by these efforts. Somstumble into care when thepresent for other healtreasons. But, rarely do we sekids who have gone to practitioner in the communitwho has said to them, ‘Sayyou’re participating in behavrisk for HIV infection. I wa

While the overw

patients have acquired their inyears, a growing number wWith HAART, we are bringing previously not have survived tvery successfully.Two-thirds of the patients afemales. But, it’s important thirds of all out-patientChildren’s National Medical Clargely because young femaconcerns that make medical cthey typically enter the medthan males.Who are your patients?

.

“Most kids don’t get into we would hope — througmechanism that identifies young adults at risk, procounseling and testing, apositive individuals with system of care.”

The Adolescent Initiative was conducted from 1994 through 1996 in10 project sites across the country.These data have been assimilated from project evaluation activities. Sexual activity was reported for 1931males and 1904 females.

RYAN WHITE CARE ACT DATA BITE

Youth Reporting Unprotected Sexual Intercourse

70%60%50%40%30%20%10%

0

61%

41%

64%

45%

Males Females

EverLast 30 days

Special Projects of National Significance

Adolescent Initiative

A list of resources on adolescents and HIV disease may be found onthe web at . References for this article may befound on page 12 of this publication.

www.hrsa.gov/hab
6

There are other aspects of adolescence that influencesusceptibility to HIV. Adolescent females, for instance,are at much higher risk of acquiring a whole variety ofsexually transmitted diseases just because of the type ofcell that lines their genital tracts. This changes as theygrow older.We’ve had an opportunity recently to participate in anational study — called the REACH study — that isgoing to allow us to answer these types of questions.Remember, though, we’re answering these questions 20years into the epidemic.

me a week before her physical. I knew that 6 monthsprior she had had a baby. She’d shown up in theobstetrician’s office 81⁄2 months pregnant.Her baby was treated at birth and subsequently withAZT and is HIV negative. The young mother has becomea n

What has the Burgess Clinic experienceshown about maintaining continuity ofcare for adolescents?

What kind of social support network do your clientstypically have?How can we encourageadolescents to accept treatment?

Dr. D'Angelo:

Dr. D'Angelo:Dr. D’Angelo:

For many who have acquired the infection

during their teenage years, the disease is, unfortunately,the least of their problems. These are kids who havesuffered all kinds of deprivation: emotionaldeprivation, physical deprivation, and sexualexploitation. These are kids who have already lived fivelifetimes worth of difficult and unpleasant things by thetime they’re 15 or 16 years of age.Having said that, we find that many are remarkablyresponsive to a caring attitude and are really excellentpatients. This may be surprising because the knockagainst adolescents is that you’ll never get them to taketheir medicine. Of course, we have kids who are veryresponsible about caring for their disease and kids whoaren’t. But the same is true of adults.Ironically, there’s some benefit from poor adherence inthe past. We’ve begun to do a resistance study in ourpatients. And even though we’ve had patients who’vebeen “on medication” for 8 or 10 years, they are stillamazingly responsive to treatment. One of these kids is19 years of age. She acquired her infection perinatally,and she should have been resistant to everyantiretroviral medicine known to man. Instead she’stotally susceptible to treatment and, consequently, Idon’t think she has taken meds as prescribed until now.When she began HAART she had a viral load of fourmillion; 2 weeks later it was 17,000, This dramaticimprovement has been sustained because she’s finallyable to adhere to her treatment regimen.

The majority of the kids that we see

actually do have some sort of family network. It maynot be a family network in the way many people definefamily, but it’s family for them – whether it’s their grouphome and their group home counselor, their aunt oruncle, or their grandparent.We are actually very lucky. We’re continually told thatthe family is threatened in this community, but Districtof Columbia residents have been remarkablyresourceful in redefining their social networks in such away to provide support. Our case managers becomepart of that. Our clinicians become part of that. Ournurses and nurse practitioners become part of that aswell, and this is one of the reasons that providing careto adolescents is so labor intensive.But, some of these kids are so isolated that even ifthey’re living at home, their families don’t know abouttheir disease. Or if their families know, certainlynobody else in the neighborhood does because the entirefamily could be ostracized. There is still anextraordinary stigma attached to HIV. Is it better thanit was? Yes. Are we where we should be? Absolutely not.

I never know when the teachable moment

is going to be.I saw one of my patients the other day for a collegephysical. This is a kid who dropped out of high schooland had been living on the streets — I’d completely lostcontact with her for a 2-year period of time. She called

“Perinatally-infected children, with what inadults would be relatively robust CD4 counts,can be catastrophically ill.”

“One of our clients isn’t on HAART because

she doesn’t want anyone except her mother toknow about her HIV infection. She is afraid

that with medication bottles around the houseothers will find out.

"What we try to do is to reverse the naturaltendency to say: ‘Get lost, we don’t want tocare for you. You’re too difficult to take carefor. It’s too negative an experience for me towatch you not take your medicine'."

Serving Ad

Find

BackgroundIn 1994, $2.7 million was awthrough the Special Projects (SPNS) Program to support thtion and replication of improvcare to HIV-positive adolescenlaunching the program was needed by HIV-positive adoavailable, awareness of the adolescents was not widesprers, and the knowledge base ftation of youth-appropriate prTen heterogeneous projects we3 years, each designed to meyouth population at the locaimproved the lives of the adoilluminated program charaserving youth effectively.Collectively, the 10 SPNS Adolenrolled more than 5,400 adHIV; 654 were already HIV possignificant since many prograground zero. The 10 projecentire array of CARE Act ppeople, but their findings inelements of successful youth-c

Providers must firmly estaare going to provide. Hyouth have many diverse rarely equipped to address Collaboration between aestablishing and maintproves difficult. While thcapable of serving adolesome ci

SPNS Adolescent Initiative FProvider service mix andinteragency collaboration 

Continued from Page 5. . . ADOLESCENT CARE: A CLINICIAN'S PERSPECTIVE absolute model patient. She 

'Taking care of myself is now because who’s going to care of renaissance in this young wo
8

Respect and confidentiality are equally important.Teen clients want respect from program staff andpractitioners, and they expect it to be manifested inquality of care. Confidentiality is a paramountconcern, even to the extent that some adolescents areleery of translators. If clients do not perceive thatthey can trust their providers and that their confidentiality is protected, they will not stay in care forlong.

Basic human needs

Pressing needs such as shelter and food takeprecedence over HIV, and must be addressed by

providers before other care issues. Startlingly, oneInitiative program reported that some homelessadolescents indicated that they wanted to becomeHIV positive because they believed that they wouldthen receive health services and support.

Mental Health

Conquering psychological barriers to accepting HIVcare and heeding prevention messages is a majorproblem, and one that all providers must help theirclients address. At-risk adolescents commonlyhave a poor self image, and thus are unlikely to seethe need for either HIV testing or a modification of"risky" behaviors. Some adolescents are especiallyprone to “magical thinking,” the belief that HIVinfection can’t happen to me. Others are oftensusceptible to hopelessness and fatalism, and mayhave problems with drug and alcohol abuse.

To be effective, programs must teach youth to valuethemselves, which can be achieved through:

Establishing peer support groups to reduce stigmaand isolation of HIV positive youth;Providing or linking with substance abusetreatment programs for youth; andOffering non-judgmental support.

Adapting to Adolescent Needs

Perhaps the most fundamental finding from theAdolescent Initiative is the importance of keepingthe focus on youth. Accordingly, staff must bewilling to adapt expectations and modify tactics toconform with the level of maturity and priorities ofadolescents.HIV-positive and at-risk adolescents comprise aheterogeneous group. Programs must be adapted tothe adolescent subpopulation they serve. Forexample, street youth are often illiterate or read atno higher than a fourth grade level; this must bereflected in printed materials they receive. If theprovider serves several subpopulations, they needto provide services accordingly. This might bemanifested in individual support groups for gayand bisexual males, youth recovering fromsubstance abuse, and HIV-positive adolescentmothers.Adolescent Initiative experience indicates thatyouth generally have a high level of unmet needand that serving them is expensive.

The 10 SPNS Adolescent

Initiative Projects

Teenage Access ProjectUniversity of Alabama at BirminghamBirmingham, ALAdolescent/Young Adult Planetree ProgramWalden House, Inc.San Francisco, CABay Area Young Positives, Inc.San Francisco, CAChildrens Hospital Los AngelesLos Angeles, CAHealth Initiatives for YouthSan Francisco, CATOPS ProjectGreater Bridgeport Adolescent PregnancyProgramBridgeport, CTIndiana Youth Access ProjectIndianapolis, INBoston HAPPENS ProgramChildren’s Hospital CorporationBoston, MAUniversity of Minnesota Youth & AIDSProjectsMinneapolis, MNYouthCare ProjectSeattle, WA

Because of the

number and complexity of issues facing HIVpositive and at-risk youth, more intensive casemanagement generally is required. Youth mayneed frequent reminders of appointments andfurther support in terms of access and transportation. They often require help with housing or

Addressing immediate needs andovercoming barriers

Flexibility is crucial whclients. Programs need to and locations convenienmean performing intakeweekends, or off-site at scents.Modifying program entrimportant; providers havoften are unable to fulfilthat, for adults, might not one Initiative program foclients were anxious to reduction group, but westandard six sessions. In developed a “mini” curcovered in 2 hours.Successful programs propportunity to be involved activity. Most successful had youth on staff in posoutreach to program plan

Continued from Page 5. . . SERVING ADOLESCENTS THE FUNDAMENTALS

HIV/AIDS BureAdolescents are serinvolved in special described below.

REACH — Reachieffort of HRSA, NIis to better undermechanisms for bFive grants totalinetworks linking clinical research. care in youth-senNew Orleans, San In the context of Initiative, three afor serving adoleMiami, and Chic
Health Concerns

Adolescents and HIV: Outreach and Care

Improving Access to Information andCounseling and Testing

Sexual minority youth experience the same physicalhealth and mental health concerns as their heterosexual peers. They additionally face the tasks of managing a stigmatized identity from a very early age, oftenwithout family or peer support. Isolation—a commonreality for many gay youth—affects them cognitively,socially, and emotionally, with significant implications for health outcomes, including risk for HIVinfection.Because health prevention and promotion literaturerarely mention sexual orientation, non-heterosexualyouth may view them as irrelevant. Unlike theirheterosexual peers, gay youth lack safe places tosocialize in supervised, alcohol and drug free environments. And because many health providers stillassume that patients are heterosexual, they do not askabout sexual identity. Moreover, they provide little orno information on behaviors that increase risk forSTDs and HIV.Regardless of sexual orientation, adolescents mayengage in same-sex behavior, putting themselves at riskfor STDs, including HIV. By creating a nonjudgmentalenvironment where adolescents feel safe to disclosehealth problems and concerns, providers can addressthe needs of all adolescents, including those of nonheterosexual youth. Providers can let teens know thatthey are comfortable with any concerns the youth mayhave by including visual cues in their offices andwaiting rooms, such as posters, brochures and booksabout sexuality, substance abuse, and HIV (seeresource list for an excellent poster on issues of concernto teens).Sexually active gay and bisexual male adolescents,

especially gay youth of color,are known to be at high risk forHIV infection, yet HIV counseling and testing is still notreadily accessible as a routinepart of adolescent care.Nonetheless, HIV counselingand testing is a gateway to carefor HIV-positive youth. It alsohelps reinforce HIV preventionstrategies for uninfected youth.Although some may wrongly

believe that adolescents do not want to get tested anddo not want providers to ask personal questions, teensactually prefer having providers initiate discussionabout HIV prevention and testing.

The enormous disparity between the number of HIVinfected youth and the relatively few who are currentlyreceiving care continues to receive attention from HRSA.Services to sexual minority youth are currently available through all CARE programs. In addition, theagency is participating in special projects that willincrease understanding of HIV disease in youth, andresult in better care for this population. For example,HRSA is partnering with other agencies and organizations to financially support the replication of a youthoriented counseling and testing campaign developed bythe Adolescent AIDS Program at Montefiore MedicalCenter (a recipient of CARE Act funds). Using socialmarketing strategies and pro-active peer outreach, thecampaign: 1) helps youth associate sexual activity withthe need for HIV counseling and testing; and 2) creates anew paradigm for a continuum of care from prevenProactive testing strategies are especially important to non- heterosexual youth, particularly those who are reluctant to disclose their sexual identity. Adolescent

outreach strategies must respond to the realitythat youth who actively seek HIV counseling andtesting may be perceived to be gay. For such youth, fearof disclosure, and ensuing discrimination andharassment serve as a barrier to testing and receivingcare.

—

Resources for Sexual Minority Youth

Wildflower Resource Network

Poster for offices and waiting rooms:

sexual minority

“This is a safe place to talk about...”

Advocates for YouthGay & Lesbian Adolescent Health ResourceCenterNational Youth Advocacy CoalitionYouth Guardian Services

P.O. Box 3315Bloomington, IN 47402Information on health and HIV prevention,support and community resources.http://www.youthresource.com/

— 718-882-0322

Clearinghouse for provider training onhealth, mental health and HIV/AIDS care forsexual minority youth. Adolescent AIDSProgram, Montefiore Medical Center,adolaids@aol.com

—

202-319-7596

Referrals to support groups, supportiveservices and providers around the country.http://www.nyac@nyacyouth.org

—

703-361-6909

Online support for sexual minority youth andyouth with family membershttp://www.youth-guard.org

(prevention and care). Criticyouth oriented messages and ship and involvement in outrenity networking and outreach A primary concern for all infection, regardless of sexual to their HIV status. Access tpsychosocial care is especiagoals for primary care include1. determining the stage of HIV 

status;

2. providing ongoing health m

primary care needs;

Goals for Primary Care

10 

YOUTH HO

The Ryan White National 

HIV/AI

Over 600 youth activists will 2000 in St. Louis for the RyaConference on HIV/AIDS. Past coHIV education in the publieducation through the Arts, health, living with HIV, and con2000 conference will see treatment and skills- building with HIV. Concurrent tracks wi

Power of Prevention (peer-baOur Communities, Ourselvesubpopulations)Getting it Going (advocacy aSupporting Our Youth (trayouth).

The conference is a project of prevention organization in National Association of People the Ryan White Foundation. CDC, The National AIDS Laboratories.Youth registration (before Deceand includes conference materthe duration of the conference. Sara Leedom at NAPWA, 202-89sleedom@napwa.org.

HIV counselingand testing isstill not readilyaccessible as aroutine part ofadolescent care.

Continued from Page 1. . . HIV CARE FOR SEXUAL MINORITY YOUTH