Epidemiology of acquired immunodeficiency syndrome and human immunodeficiency virus infection in adolescents

The epidemiology of acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus infection (HIV) in adolescents is important for purposes of prevention and car, since sexual and drug behavior is formed during this period. For 1990 the Centers for Disease Control reports .4% of AIDS cases are among adolescents 13-19 years old; this figure has steadily risen since 1982. 53% of the reported AIDS cases were from New York, Florida, California, Texas, Puerto Rico, and New Jersey, and has remained stable since 1984. 72% were from metropolitan areas of 1 million population, with a small decreasing trend between 1986-88. 75% of reported cases occurred between 17-19 years, and usually among males (80%) and ethnic minorities (36% African Americans and 18% Hispanics). The sex ratio dropped from 4:1 to 3:1 in 1988. Modes of transmission; indicator diseases and mortality; HIV seroprevalence data; risk of HIV transmission in adolescents; knowledge, attitudes, beliefs, and behavior; research needs; and prevention are discussed. From the studies available, it is reported that adolescents are aware that sexual intercourse and sharing IV drug needles are the main modes of HIV transmission. HIV transmission is more likely to be associated with homosexual contact. Misconceptions are that one could tell if a person were infected with HIV. Knowledge does not always translate to appropriate behavior. Perceived risk does decrease risky behavior, i.e., through abstinence or condom use. More information was desired. Research needs were identified as lagging behind present knowledge of children and adults, and necessary in clinical, epidemiologic, behavioral, and prevention aspects. The natural history of infection is limited to studies of hemophilia, where infected adolescents may have a lower rate of progression to AIDS or a longer incubation period or higher tolerance to severe immunodeficiency. Questions arise concerning the unique factors, such as hormonal changes, that influence the clinical course of the infection. Health care models need to be assessed. Identification of subpopulations that are at the highest risk is needed, i.e., the influence of the crack cocaine epidemic on HIV transmission. Prevention is seen in terms of new creative approaches, comprehensive school and nonschool health education, and behavioral techniques to avoid risky behavior throughout the health community.