Jean Q. Davis
In 1986 Surgeon General Koop, in a widely publicized report, called for prevention efforts targeted on the next “at risk” population-adolescents. Teens are capable of all the risky behaviors that adults do, but combine them with their cognitive, emotional, and physical developmental issues. The number of adolescents with AIDS is low, less than five percent of the total cases reported. As of June 7, 1991 there were 208 cases reported for this year. (MMWR, 1991) Of the teenagers infected 46 percent are white, 34 percent are Block, 18 percent are Hispanic. The new cases are overly represented in urban areas in minority populations.
Although the number of cases is low, they are deceptive because one fifth of persons with AIDS are in their twenties. The latency period between HIV infection and the onset of symptoms and illness can be as long as ten years. Therefore many of these AIDS patients acquired the virus in their teens. Also, a greater proportion of teens than adults with AIDS are female and members of minority groups, and have contracted the Virus heterosexually.
The profile of AIDS cases in the general population in Connecticut is different from the overall national profile. Connecticut continues to have the highest rate nationwide of AIDS in children and ranks fifteenth among states for HIV infection for women of child-bearing age. Our minority population makes up fifty-five percent of those infected, although they represent only fifteen percent of the general population. Nationwide, women are ten percent of those infected but in Connecticut women are twenty percent of the AIDS population and women are almost thirty percent of those with AIDS in New Haven. (Morris, 4/23/90) There is a clear and ominous heterosexual transmission pattern in our community.
In the midst of these gloomy statistics, there appears to be a window of opportunity for prevention. Those who have looked for HIV infection in high risk groups in New Haven have not found alarming numbers. We have an opportunity for educational interventions.
Adolescent behavioral factors that put them at risk for HIV infection are well known. Teen pregnancy, sexually transmitted diseases, drug and alcohol abuse, runaways and prostitution are all issues in the public eye that are viewed with alarm and as out-of-control.
Even with the threat of AIDS being highly publicized, today's teens continue to be sexually active. In the last ten years the percentage of sexually active teens has risen dramatically and the age that they begin has fallen. The Teen Pregnancy Coalition of Connecticut recently reported that the pregnancy rate for ten to fourteen year olds increased by 100 percent from 1980 to 1987 in this state. The rate for the fifteen to nineteen year olds rose by twenty-three percent.
Connecticut is fifth in the country in its rate of teen pregnancy and it's a problem for suburban, rural, and urban communities. Twenty percent of birth in New Haven in 1990 were to teen mothers. The New York Times Connecticut section on July 7th had a major article about the concern with the continued rise in teen pregnancy. However not one mention was made about the threat of HIV infection in this population. We compartmentalize our interventions and educational programs for risk-taking behaviors.
Conceptually, sexually transmitted diseases are similar to HIV infection for adolescent. With both of them a teen doesn’t want to believe that they will contract them and they know that their partner wouldn’t have one. The statistics for STDs are startling and little known in the school community. Teenage pregnancy is visible but sexually transmitted diseases are not. Once again it is a stigmatized topic that also connotes promiscuity. Twenty-eight percent of reported cases of gonorrhea in New Haven during the first three months of 1990 were adolescents. The statewide STD rate increased 900 percent between 1986 and 1980 for fifteen to nineteen year olds. (Spinner,1990) Clearly this is a risky behavior, sexual intercourse without barriers, that needs educational intervention.
We target AIDS as a STD particularly with teens, but drug abuse is another risk-taking behavior that is common in the adolescent population. Sharing needles is a clear transmission route for HIV infection. School surveys show that teens use drugs but unfortunately, these numbers don’t reflect the true picture because the surveys are done with a school population. There is an enormous adolescent school dropout population that abuses drugs, particularly in inner cities. This is certainly evident in New Haven where the actual dropout rate is disputed but generally acknowledged to be substantial. For ninth graders in the school year 1990-1991 the average number of days out of school was thirty-nine, almost eight weeks. Consequently, the prevalence of drug use among teens is not known nor is the number of those that inject drugs intravenously. IV drug use is the second largest transmission category for AIDS at present in the United States and a concern is that it is a bridge to the heterosexual population.
Many factors impede reaching adolescent about drug abuse. Denial, lack of awareness of personal risk, mistrust, the addictive nature of the risk-taking, lack of space in treatment programs are all major intervention problems.
