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3 AIDS and Adolescents
Pages 147-252

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From page 147...
... By the end of the teenage years, the majority of young persons in America report having begun sexual intercourse, and one-half report some experience with illicit drugs.) Evidence from HIV seroprevalence studies conducted among patients admitted to 37 metropolitan hospitals during 1988-1989 suggests that the HIV prevalence rate is vanishingly small among 11-year-olds but begins rising at age 12 and continues to rise throughout the teenage years.2 These behavioral and epidemiological facts suggest that HIV prevention efforts should begin at least by early adolescence3 and that they l See, for example, Tables 3-7 and 3-11.
From page 148...
... Subsequently, it reviews what is known about the distribution of nsk-associated behaviors in the adolescent population, as well as the prevalence of sexual intercourse, condom use, and drug use and the confluence of these high-nsk behaviors. Finally, the committee considers what should be done to prevent further spread of HIV infection in this population.
From page 149...
... Indeed, some teens may progress from infection to disease more quickly than others. According to case reports, teens who acquired HIV infection through drug use or sexual behavior have progressed more rapidly than adults from infection to AIDS (K.
From page 150...
... The largest samples that provide information on adolescents are derived from the routine HIV screening of applicants for military service and the Job Corps. These data cannot be generalized with knowable margins of error to other populations, but they can provide some insight into segments of the teenage population in which the infection may be established.
From page 151...
... As noted above, the small percentage of AIDS cases diagnosed in the adolescent population does not imply that AIDS and HTV are not a problem for teenagers. Indeed, as Verrnund and colleagues (1989)
From page 152...
... Cases Percentage < 1 785 0.7 1-12 1,210 1.0 13-19 461 0.4 2~24 5,090 4.3 25-29 18,966 16.1 3~39 54,334 46.1 40~9 24,951 21.2 50t 11,984 10.2 Total 117,781 1OO.Oa Percentages may not sum to 100.0 because of rounding. SOURCE: Special tabulation provided by the Statistics and Data Processing Branch of the AIDS Program, Centers for Disease Control.
From page 153...
... The crude prevalence rate for 17- to 19-year-old applicants screened between October 15, 1985 and March 31, 1989 was 0.34 per 1,000 (Burke et al., 1990~. HIV prevalence rates among military applicantsli from October 1985 to March 1986 increased directly and linearly with age from 0.25 per thousand among 18-year-olds to 4.9 per thousand among 27-year-olds (Burke et al., 1987:132~.12 Among active-duty personnel during the period October 1985 to July 1989, prevalence rates were found to have a similar distribution by age.
From page 154...
... 3 Q LLJ Cal A LL G 1 > I o 17-19 20-24 25-29 4 30-34 35-39 40 ~ AGE FIGURE 3-2B Prevalence of HIV (rate per 1,000 persons) , by age, among active duty military personnel [N = 1,752,191]
From page 155...
... rates found among the youngest groups of applicants for military service, which may reflect differences in the populations represented in applications to these two organizations. HIV Seroprevalence in Childbearing Women.
From page 156...
... Table 3-2 summarizes selected results of this and other small-scale seroprevalence studies among teenagers and young adults. Although the observed prevalence of HIV infection varies from population to population and from study to study, one finding is clear: the AIDS virus is substantially seeded in some segments of the adolescent population.
From page 157...
... Just as more AIDS cases are seen among adult males than among adult females, so too are there more cases of AIDS among teenage boys than among teenage girIs.~4 Of all AIDS cases reported as of December 31, 1989, males outnumbered females by a 9:1 ratio.is As the first row of Table 3-3 shows, however, the ratio of male to female cases is much lower among teenagers than among adults in the United States. Thus, it can be seen that the male-to-female ratio, which is roughly 1:1 among cases diagnosed in infants (younger than 1 year)
From page 158...
... 158 Cal .
From page 159...
... from the New York City area yield male-to-female ratios of roughly 1.4:1 (Brundage et al., 1988; Horton, Alexander, and Brundage, 19891. Among Job Corps applicants, the male-to-female ratio nationally is approximately 1:1 among 16- to 18-year-olds, but for applicants between the ages of 19 and 21, the ratio climbs to approximately 4:1 (St.
From page 160...
... nonprobability sample of persons visiting clinics at 17 colleges, the vast majority of HIV infections (87 percent) were found among males (Gayle et al., 1989~.~9 Variation by Race/Ethnicity in AIDS anti HIV Prevalence.
From page 161...
... Among male applicants, the relative excess of cases among blacks is greatest for those men from the Northeast and north central regions of the country (Sharp et al., 1989~. Among Job Corps applicants, the rate of infection among blacks was approximately five times higher than that for whites (0.7 versus 0.14 percent)
From page 163...
... population lives in the New York metropolitan area, but 11 percent of teenage AIDS cases were from New York. The AIDS case data indicating a concentration of adolescent AIDS cases in urban areas, especially New York City, are paralleled by screening data on infection rates among applicants for military service.25 Figure 3-4 shows the distribution of the prevalence of infection among individuals who applied to enter the military between October 1985 and September 1989.
From page 164...
... 164 - o ~ cs~ ~ M ;\ ~ oo - ~ {~N c~ .
From page 165...
... The limited HIV seroprevalence data available suggest that runaway youth appear to be particularly at risk. A survey of more than 1,300 homeless youth seeking medical services in New York City, for example, found that 6.37 percent were infected with HIV (New York State Department of Health, 19891.
From page 166...
... For example, the committee notes with great concern that almost 1 percent of black teenage mothers who delivered babies in New York City in 1988 were infected with HIV. Even though the available evidence is sufficient to conclude that HIV is present in the adolescent population, there are relatively few data available for accurately monitoring the spread of HIV in this group.
From page 167...
... The adolescent population contains pockets of teenagers whose behavior puts them at relatively high risk of acquiring HIV infection. Sexually active teens and those who share injection equipment are especially vulnerable if the virus is present within the population from which Heir sexual and drug use partners are selected.
From page 168...
... Sexual Behavior Data Sources Previous research on unintended adolescent pregnancy has provided valuable data on adolescent sexual behavior. Three national surveys using probability samples of adolescents offer estimates of several important aspects of adolescent sexual behavior: (1)
From page 169...
... . Although the selection bias that has resulted from differential sample attrition does not appear to account for the lower level of sexual activity reported in this survey versus the level reported in others, the use of the same interviewers from wave to wave may affect a respondent's likelihood of being candid about reporting sensitive behaviors (Kahn, Kalsbek, and Hofferth, 1988)
From page 170...
... The racial differences found in the proportions of sexually active 36For an overview of the sexual behavior of adolescents and unintended pregnancy, see C
From page 171...
... . TABLE 3-7b Percentage of Never Married Teenage Females Who Report Engaging in Sexual Intercourse, by Age and by Race/Ethnicity Females, born 1964 1972 Age Alla White Black Hispanic Before 14 4.1% 2.8% 8.0% b Before 15 10.3 8.2 17.4 b Before 16 20.9 18.9 31.2 b Before 17 35.2 33.0 50.4 b Before 18 49.7 48.8 65.8 b Before 19 62.7 62.0 80.7 b Before 20 68.2 66.5 87.7 b NC 727 326 317 gab NOTE: Estimates are the percentage of females who reported first intercourse before a given age among all females born 1964~1972 who had reached that age at the time of the interview.
From page 172...
... teens and age at first intercourse appear real but remain largely unexplained.39 Multivariate analysis of the predicted probability of having premarital sexual intercourse at specific ages indicates that even controll~ng for a number of possibly confounding factors (e.g., age at menarche, mother's education, religious affiliation, family stability during adolescence) does not eliminate racial differences (Hofferth, Kahn, and Baldwin, 19871.
From page 173...
... Patterns of Heterosexual Behavior The age of initiation of heterosexual intercourse among adolescents indicates the beginning of the period of risk for HIV infection. Information on patterns of sexual intercourse, including frequency, number of sexual 4lRacial differences in virginity persist even in analyses that control for the effect of socioeconomic factors.
From page 174...
... Data from the 1982 National Survey of Family Growth indicate that a substantial subset of sexually active adolescents have intercourse frequently. Among 15- to 19-year-old unmarried sexually experienced females, 25 percent reported intercourse two to three times per month, 20.9 percent reported intercourse once a week, and 16.3
From page 175...
... Moreover, once women initiate sexual intercourse, they usually continue sexual activity. In surveys of approximately 1,800 nevermarried women conducted in 1976, Zelnik and Kantner (1977)
From page 176...
... Ku; and 1988 National Survey of Family Growth, unpublished tabulation provided by A Campbell (National Institute of Child Health and Human Development)
From page 177...
... Condoms have been shown to provide protection against AIDS and other sexually transmitted diseases (Wigersma and Oud, 1987; Feldblum and Fortney, 1988; Darrow, 1989; Periman et al., 19901.43 However, the fact that a significant number of adolescents report a history of STDs indicates that many sexually active teens are not using condoms or are not using them properly (Bell and Hein, 1984~. The prevalence of STDs among adolescents is especially worrisome given that rates of HIV transmission are thought to increase when genital lesions are present (Nahmias et al., 1989; Teizak et al., 1989; Zewdie et al., 19891.
From page 178...
... reported condom use at first intercourse. After first intercourse, when it appears that sex is more likely to be planned, teenagers are considerably less likely to use condoms and more likely to use birth control pilIs.46 Only 12.2 percent of white sexually active 15- to 19-yearold female adolescents reported current use of condoms during the 1982 wave of the National Survey of Family Growth (Pratt et al., 1984~.
From page 179...
... Preliminary analyses of the 1988 wave of the National Survey of Family Growth, however, indicate a parallel trend for a greater proportion of sexually active teenage girls to report using condoms. Among sexually experienced 15- to 19-year-old females, 19.7 percent reported currently using condoms, compared with ~ I.4 percent in 1982.49 Other analyses5° of the methods used at first and last intercourse evidence a similar rise in the rates of reported condom use.
From page 180...
... Given the potential risk for HIV infection associated with this practice, the committee believes that surveys of adolescent sexual activity should gather data on this behavior. Same-Gender Sexual Behavior Among Adolescents For some young people, sexual experimentation will include same-gender sexual behavior.
From page 181...
... Sexually Transmitted Diseases Different state requirements for reporting STDs and differential reporting by public versus private health care delivery systems make it difficult to estimate national STD incidence and prevalence rates. Moreover, rates that present the number of cases per 100,000 10- to 19-year-olds will underestimate the size of the problem because not all teens are sexually active.54 There are data available, however, indicating that STDs are a public health problem for teenagers in this country.
From page 182...
... Furthermore, continued risk taking does not appear to be related to a lack of awareness of the threat posed by unprotected sexual contacts.55 It is clear that as Tong as the sexual behaviors that transmit 55CDC-assisted surveys conducted in 1988 found that the majority of students between the ages of 13 and 18 were well aware that sexual intercourse is a risk factor for HIV transmission (CDC, 1988a)
From page 183...
... Indeed, Fullilove aIld colleagues (1990) found that 41 percent of teenage crack users in their sample reported a history of an STD, and only 26 percent of boys and 18 percent of girls reported condom use dunng their last episode of sexual intercourse.
From page 184...
... 58The 1987 National Adolescent Student Health Survey included students from randomly selected classrooms chosen from a national probability sample of 217 schools in 20 states. 59The National Household Survey on Drug Abuse is an ongoing survey of individuals aged 12 and older who live in households in the United States.
From page 185...
... Comparisons of drug-related data from the 1984 waves of the National Longitudinal Survey of Youth with data from Monitoring the Future and the National Household Survey on Drug Abuse suggest that there is underreporting of illicit drug use (other than marijuana) in the National Longitudinal Survey.
From page 186...
... . Injection Practices Among Adolescents The sharing of injection equipment to administer illicit drugs is one of the major modes of transmission of HIV in the United States and Europe.
From page 187...
... The impact of AIDS on the number of drug users who inject, the frequency of injection, and the use of shared injection equipment is also unknown. Of cause for concern, however, are reports such as the anecdotal information supplied by Mata and Jorquez (19881.
From page 188...
... AIDS-related studies of adults also indicate that alcohol use is associated with unsafe sexual behavior (Stall et al., 1986~; however, much less is known about adolescent risk taking under the influence of alcohol. According to adolescent surveys, marijuana is the most popular illicit drug for this population.64 In 1985, nearly one-quarter (23.6 percent)
From page 189...
... CIncludes stimulants, sedatives, tranquilizers, and illicit use of analgesics or painkillers that are generally available only by prescnption. SOURCE: NIDA National Household Survey on Drug Abuse (1988:Tables 6 and 10)
From page 190...
... Drug use is generally higher among teenage boys; girls, however, are more likely to smoke cigarettes and to use stimulants. The magnitude and direction of racial and ethnic differences in drug use present a complex and sometimes contradictory picture.66 Unlike surveys of sexual behavior, almost all national drug use surveys report that illicit drug use is lower among black youths than among whites, with Hispanics falling in between (Bachman, Johnston, and O'Malley, 1981; NIDA, 1988; Handel and Davies, in press)
From page 191...
... An analysis of two waves of the National Longitudinal Survey of the Labor Market Expenence of Youth found that blacks were more likely than whites to provide internally discrepant responses to questions on illicit drug use. Among those who admitted using illicit drugs in the past year in a self-administered form in the 1980 survey, blacks were more likely than whites to deny in a subsequent interviewer-administered survey that they had ever used illicit substances (Mensch and Kandel, 198Sb)
From page 192...
... Age appears to play an important role in the initiation of use of most drugs.68 Surveys have shown that, for most substances, drug initiation rates peak in the late teens (Kandel, 19801. Analyses based on complete drug history data for the 1980 wave of a longitudinal study of a probability sample of tenth and eleventh grade New York State students in 1971 (a total of 1,325 students)
From page 193...
... . Among white males in the 1984 National Longitudinal Survey of Youth who used marijuana, other illicit drugs, and cocaine (N = 926)
From page 194...
... Clustering of Risk Behaviors Research on adolescents has provided compelling evidence of covar~ation among sexual activity, alcohol use, drug use, and delinquency (Miller and Simon, 1974; Hayes, 19871. The early onset of sexual intercourse does not appear to be an isolated behavior, nor does drug use.
From page 195...
... Similarly, males who had used marijuana at least once were ten times more likely to be sexually active than those who had not used it, and females who had used marijuana were seven times more likely to report initiation of sexual intercourse than girls who were not involved with .
From page 196...
... analysis of retrospective data from the National Longitudinal Survey of Labor Market Experience of Your. Their work indicated that, at a given age, teenagers who use alcohol or marijuana at least once a month are more likely than nonusers to begin sexual intercourse in the following year.
From page 197...
... Although the committee recognizes the need for further research, it would reiterate that there is already sufficient information to conclude that early initiation of sexual behaviors or drug use carries the risk of HIV transmission for some fraction of American youth. This finding motivates the committee's call for AIDS interventions that target teenagers before they begin practicing risky sexual and drug-using behaviors.
From page 198...
... Loose packets of condoms, bleach kits and comic books about AIDS prevention, clutter the front seat .
From page 199...
... Smaller surveys of institutionalized adolescents provide insight into the problems of youths who reside in such settings, although the findings may not be generalizable. For example, interviews with 378 female adolescents aged 12 to 1778 residing in detention centers in the Bronx in the late 1970s found that the average age of initiation of sexual intercourse in this sample was 12 years.
From page 200...
... Moreover, although the precise number of homeless youths who use drugs is not known, small surveys of this population have consistently found that the majority report drug use (Shaffer and Caton, 1984; Rothman and David, 1985; Yates et al., 1988~. Most street youths who have participated in studies also report that they are sexually active, but few report the regular use of condoms (Shaffer and Caton, 1984; Yates et al., 1988; Hudson et al., 1989; Rotheram-Borus et al., 1989~.
From page 201...
... of different intervention strategies. It is the committee's fimn opinion that this strategy~oupling AIDS prevention programs with rigorous research efforts to determine the effects of those programs~ffers the best hope of producing effective behavioral interventions for the diverse subgroups that constitute the adolescent population.
From page 202...
... This section considers in turn, the controversy concerning the general goals of AIDS prevention programs for teenagers and specific goals for three segments of the teenage population. General Goals With regard to the use of drugs that are associated with HIV transmission, there is a consensus both within our committee and in the nation as a whole that such drug use is, in itself, physiologically destructive and psychologically debilitating.
From page 203...
... Consequently, the committee believes that AIDS prevention programs should encourage these drug users to seek treatment; they should also ensure that these young people are made aware of all effective methods for reducing their risk of contracting or transmitting HIV. The committee wishes to emphasize that the goals of prevention and risk reduction are not contradictory.
From page 204...
... In 1987, for example, the U.S. Senate voted 94 to 2 in support of an amendment to the Department of Health and Human Services appropnations bill that requiem all AIDS educational matenals and activities for young adults and school-aged children to emphasize "abstinence from sexual activity outside of a monogamous ma~Tiage."85 The impact of such legislation can be seen in the constraints that have been incorporated in AIDS prevention programs mounted by the Public Heals Service.
From page 205...
... Indeed, more than 1 million teenagers become pregnant each year,86 and more than 400,000 of these pregnancies occurred in young women 15 to 17 years of age (Hayes, 1987:5~55 2611. In the context of a deadly, sexually transmitted epidemic, the committee believes that AIDS prevention programs must heed the data on nsk-associated behaviors reported by the adolescents themselves and not be sidetracked by wishful thinking about patterns of behavior some might hope teenagers would follow.
From page 206...
... The ultimate goal of AIDS prevention is to block HIV transmission, and programs should accommodate the range of challenges young people will face and the variety of choices they may make. Abstinence, delay of intercourse until marriage, and other traditional behavioral patterns are effective ways of eliminating the risk of sexually transmitted HIV infection if in fact these patterns are enacted.
From page 207...
... As noted earlier in this chapter, estimates denved from a probability sample of Amencan men in 1970 (Fay et al., 1989189 suggest that a minimum of 20 percent of Amencan males have male-male sexual contact to orgasm at some point in their lives and that most of these men have their first such experiences during adolescence.90 Program Goals for Adolescents Who Are Engaging in Sexual Intercourse but Who Are Not Using Illicit Drugs. Intervention programs for these young people should educate them about the dangers of drug use and seek to facilitate protective changes in their sexual behaviors.
From page 208...
... The difficulties manifested by this last group of teens present the greatest challenges to AIDS prevention and arise from some of the nation's most severe social problems. They also highlight the lack of success previous efforts have had in dealing with these problems prior to the onset of the AIDS epidemic.
From page 209...
... indicate that approximately 90 percent of these teens knew that the AIDS virus could be transmitted by sexual intercourse or by Shannon needles (see Table 3151. Similarly, results of a 1988 survey of a probability sample of 16- to 19-year-olds in Massachusetts (Table 3-16)
From page 210...
... 210 oo l oo ._ C)
From page 211...
... Other studies have found racial differences with respect to beliefs about the benefits afforded 93 For example, a survey of 1,869 students from a community college located in the South Bronx, an epicenter of the epidemic, found that only 69 percent recognized that sexual intercourse without a condom increased risk for HIV infection, and slightly more than half (55 percent) were aware of the risk of vertical transmission if a pregnant woman reported sexual contact with an IV drug user within the past five years (Lesniek and Pace, 1990)
From page 212...
... 212 of ~ := Cry 5 2, Cal ~ C)
From page 213...
... More important, these efforts should collect behavioral data. Finally, given the evidence reviewed in earlier sections of this chapter, all intervention programs should seek to motivate teenagers to avoid the use of drugs and to protect themselves against the risks of sexually transmitted HIV .
From page 214...
... of the message and of prophylaxis programs foils any attempt to draw conclusions as to what factor or factors d~d or did not work in reducing syphilis in this population. Like the military STD prevention programs, early drug prevention programs for adolescents and young adults were largely aimed at providing information and evoking fear (Polich et al., 19841.
From page 215...
... In that vein, the committee notes that a recent community demonstration project in Dallas, Texas, coupled fear-arousing messages concerning HIV transmission with specific instructions on how individuals can reduce their vulnerability. This project developed a series of AIDS prevention posters for young adults that depicted images related to death: a tombstone, a hearse containing a casket, a body on a stretcher covered by a shroud.
From page 216...
... AIDS prevention programs should take advantage of multiple venues and formats of communication to deliver clear, consistent messages about behaviors that risk HIV transmission and the ways in which those risks may be reduced or eliminated. Furthermore, the committee would point out that the long-term odds of mounting successful 98Empirical examination of the relationships among knowledge, attitudes, beliefs, and behavior relevant to HIV/AIDS has provided mixed evidence.
From page 217...
... The number of school-based sex education programs that have included skills training in their cumculum is small, however, and students generally graduate from these programs with little change in their ability to use contraceptives effectively or to resist pressure to have unprotected sex (Flora and Thoresen, 19881. The available data indicate that, for the most part, drug use is learned and practiced in the context of friendship group s.~°° The social nature of early drug use points to the need for broad-scale interventions that take into account the social network of the adolescent and peer influences that may support the initiation and continuation of drug use.
From page 218...
... in this group. Identifying the social factors that support behavioral change among adolescent social groups could lead to the development of important components of AIDS prevention programs.
From page 219...
... If, for example, new norms specified the use of condoms for sexual intercourse, individuals might anticipate that their partners would expect them to behave accordingly. For adolescents who have reported difficulties discussing AIDS prevention measures with their sexual partners (Fisher, 1988)
From page 220...
... Because these programs have not been evaluated, however, it is not possible to determine whether they have been effective in achieving their goals. Encouraging teen participation as counselors and program leaders may also be beneficial in that it includes adolescents in the development and execution of prevention programs and makes them part of the solution to a problem rather than mere targets of interventions.~03 A program at the University of Illinois at Chicago, for example, seeks to promote adolescent health behavior and to increase teenagers' involvement in the community by training inner-city high school students as peer counselors.
From page 221...
... These findings also suggest that it would be a mistake to rely exclusively on parents as the source of AIDS education for teenagers. Venues for Program Delivery There are many venues through which AIDS prevention programs for adolescents can be delivered.
From page 222...
... , and television thus represents an efficient medium for reaching teens, perhaps before r~skassociated behaviors begin. Several media-based activities have been initiated for the adolescent population, including AIDS education and public service announcements.
From page 223...
... find that poor reading skills compromise the use of written AIDS prevention information (as well as questionnaires for evaluation activities)
From page 224...
... CDC has developed and funded a multimillion-doliar project for prevention programs in schools and other organizations that serve youth.~°8 With input from a wide range of governmental and pnvate-sector organizations, the agency has also recommended guidelines for AIDS education (CDC, l98Sd) to help school personnel set the scope and content of their programs.
From page 225...
... recommend providing the following information on HIV transmission: "The AIDS virus can be transmitted by sexual contact with an infected person; by using needles and other injection equipment that an infected person has used; and from an infected mother to her infant before or during birth" (CDC, l98Sd:6~. The committee notes that no information is offered on protective measures that can be taken to reduce the risks of HIV transmission.
From page 226...
... have pointed to the limited amounts of time and resources dedicated to them, the lack of consensus on program content and degree of explicitness of teaching materials, disagreements over the age at which AIDS education should begin, undue emphasis on lectures rather than skills training, and inadequate coordination with community organizations. At present, the effectiveness of school-based programs is unknown, but the committee applauds CDC's efforts to mount systematic evaluations of these activities (Kolbe et al., 1988~.
From page 227...
... The organization Hispanos Unidos Contra e] SIDA/AIDS has taken responsibility for training trainers in the Hispanic community and is developing AIDS education curncula for outreach workers and educators who work with Hispanics in churches and teen and community centers in New Haven, Connecticut.
From page 228...
... Furthermore, because many drug prevention programs work through local social systems, they may miss youths who are at greatest risk for injecting drugs because this MacProject STAR (Students Taught Awareness and Resistance) is a comprehensive, com~nunity-based drug and alcohol abuse prevention program that has been implemented in 15 contiguous communities that together constitute Kansas City.
From page 229...
... and paid them to participate in a four-session AIDS intervention program. Onehalf of the subjects were randomly assigned to an intervention that taught skills needed to refuse offers of injectable drugs, negotiate safer sex, and negotiate entry into drug abuse treatment.
From page 230...
... Some have hoped that the fear of contracting AIDS would serve as a "natural" intervention tool, preventing would-be injectors from progressing to more hazardous patterns of behavior. (The hope for such a spontaneous event underlies much of the opposition to such controversial AIDS prevention programs as synnge exchanges, which are misperceived as encouraging Mug injection.)
From page 231...
... Such services include family planning clinics, drug use and prevention programs, teenage pregnancy programs, STD clinics, and comprehensive service programs that target a variety of social and physical problems of adolescents. The current demands on these programs, most of which involve non-HIV-related problems, are considerable; the feasibility of adding responsibility for HIV-related prevention strategies, testing, counseling, and follow-up services for atrisk teens, their partners, and families is not known.
From page 232...
... This lack of consensus, in tum, presents substantial baITiers to AIDS prevention activities. The committee recognizes the difficulties posed for some individuals by frank discussions of sensitive issues such as sexual behavior, contraceptive use, and prevention of STDs.
From page 233...
... For some adolescents, effective intervention may be provided by AIDS prevention programs in 1l7The U.S. Bureau of the Census estimates that in 1980 there were 37,174,000 individuals between the ages of 10 and 19 years residing in the United States (U.S.
From page 234...
... Most important, the committee notes that there is a small segment of the teen population that at this moment is at relatively high risk for HIV infection.~9 This segment includes runaway and "throwaway" children, teens who exchange sex for survival needs, and out-of-home and homeless youths. The committee believes that AIDS prevention programs should focus attention on these youths in a manner commensurate with the elevated risks they face.
From page 235...
... (1984) Adolescent sexual behavior and friendship choice.
From page 236...
... . Center for AIDS Prevention Studies, University of California at San Prancisco, January.
From page 237...
... (1990) Evaluating AIDS Prevention Programs, Expanded Edition.
From page 238...
... (1989) Prevention of human immunodeficiency virus infection among adolescents: The interplay of health education and public policy in the development and implementation of school-based AIDS education programs.
From page 239...
... Presented at the National Institute for Drug Abuse Technical Review on Drug Abuse and Adolescent Sexual Activity, Pregnancy and Parenthood, March. Ernst, J
From page 240...
... American Journal of Drug and Alcohol Abuse 6:1-23. Gilchrist, L
From page 241...
... (1987) Factors affecting initiation of sexual intercourse.
From page 242...
... (1987) A coupon program: AIDS education and drug treatment.
From page 243...
... (1988) National estimates of teenage sexual activity: Evaluating the comparability of three national surveys.
From page 244...
... (1988) School health education to prevent the spread of AIDS: Overview of a national program.
From page 245...
... (1988) Mexican-A:nencan intravenous drug users' and needle-sharing practices: Implications for AIDS prevention.
From page 246...
... (1983) Adolescent sexual behavior and popularity.
From page 247...
... (1988) Human immunodeficiency v~rus infection among patients attending clinics for sexually transmitted diseases.
From page 248...
... (1989) Issues in AIDS prevention among juvenile offenders.
From page 249...
... (1989) AIDS prevention in junior high school students in an AIDS epicenter: Results of a baseline survey.
From page 250...
... (1990) Risk reduction among intravenous drug users in Amsterdam under the influence of AIDS.
From page 251...
... K., (1987) Preventing human immunodeficiency virus contagion among intravenous drug users: The impact of street-based education on risk behavior.
From page 252...
... (1989) Knowledge of HIV transmissions and adolescent sexual behavior.


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