Lj. Dangelo et al., HIV-INFECTION AND AIDS IN ADOLESCENTS - A POSITION PAPER OF THE SOCIETY FOR ADOLESCENT MEDICINE, Journal of adolescent health, 15(5), 1994, pp. 427-434
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 tha
t preventing and treating HIV infection in adolescents and young adult
s should be a major concern for health care providers and public healt
h authorities. In order to accomplish this, the following priorities m
ust be addressed: 1. Documentation of the extent of the problem of HIV
infection in teenagers. This must be accomplished by continuing and e
xpanding the surveillance of HIV infection in selected adolescent popu
lations and by augmenting epidemiologic data with information concerni
ng the natural history of HIV infection in adolescents and young adult
s. 2. Development of adolescent-specific systems of care (organized on
a regional basis) for those infected or at high risk of infection. Th
is care must include diagnostic and therapeutic services for condition
s that are common to adolescents as well as those that are specificall
y 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 region
ally organized through the cooperation of care providers as well as fe
deral, 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 re
adily available to adolescents and every effort should be made to ensu
re the rights of privacy of the patient. Anonymous testing should also
be available for those who so choose. Programs and the clients they s
erve should be made aware of the positive and negative features of eac
h approach to testing. Counseling should be developmentally and cultur
ally sensitive and always identify risks as well as benefits of testin
g. Both counseling and testing should take place in settings in which
adolescents feel comfortable and where care and support services can b
e made readily available. Appropriate parental or other adult support
should be incorporated into the process whenever possible. 4. The need
s of ''special populations'' of adolescents, including gay and bisexua
l youth, homeless and runaway youth, incarcerated and detained youth,
youth in foster care, youth using alcohol or other drugs, and youth wi
th hemophilia should be addressed by care providers as well as federal
, state, and local health and social service agencies. Particular emph
asis 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 imple
mented in an adolescent-specific manner. Efforts should target youth a
t greatest risk of HIV infection and focus on repeated contact, aggres
sive follow-up, and the integration of prevention education with pract
ical 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 ni
ne years and provide specific and explicit messages. HIV infected yout
h should receive special interventions as a means of secondary prevent
ion. Adolescents should be considered appropriate candidates for medic
al prevention efforts, including vaccines, should these become availab
le. 6. Efforts to make changes in the aforementioned areas should be v
alidated 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 a
dolescents, determining what makes for a successful secondary preventi
on program, determining the effects of counseling and testing on adole
scent behaviors, and finding appropriate ways to validate prevention i
ntervention studies. The Society for Adolescent Medicine has long been
on the forefront of this epidemic and efforts to stem its spread to t
eenagers. 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 nee
d are carried forward in as timely a fashion as possible.