It’s estimated that almost half of U.S. adolescents may be sexually active and many of them aren’t using condoms. Despite this, a new CDC report finds that teens still aren’t getting tested for HIV. Why is this, and what can we do about it?
The research, which was led by CDC scientist Michelle Van Handel, used national health data from 2005-2013 to look at high school students as well as surveys of young adults (aged 18 to 24). What they found was that fewer than one out of every four high school students who are sexually active report ever being tested for HIV. In total, only about 22 percent of high school students who have had sex say they have had an HIV test, and that figure only slightly improves in the 18 to 24 category, with about 33 percent of that demographic saying they’ve had an HIV test.
The researchers found that testing among young adult males was holding steady at about 27 percent, but that there has been a decline in testing among young adult women, with screening going from 42 percent to 40 percent overall. It’s worth noting that white-identifying women are still far less likely to get tested (34 percent) than young black women (60 percent).
Sadly, when taken as a whole, these figures aren’t actually that surprising.
Based on figures compiled by the CDC in 2010, it’s estimated that adolescents and young adults make up about 17 percent of the U.S. population. However in 2010 they also accounted for more than a quarter of all new HIV diagnoses. We could rush to blame sexual minorities, noting that HIV rates among men who have sex with men have always been high. However, the CDC notes that while gay and bisexual-identifying young men are most likely to get infected, around 27 percent of new diagnoses are being given to young women and young heterosexual men. That’s a significant proportion and it tells us that while unique pressures do still mean that MSM aren’t getting tested, there is something going on among the wider adolescent and young adult population that means they aren’t accessing the sexual health care they should be.
“We haven’t made the dent that we would like to have made,” author Michelle Van Handel is quoted as saying.
But why are testing rates still only a fraction of what they should be? There is concern that health care professionals aren’t actually aware the CDC recommends testing for those between 13 to 64, and in particular for high risk groups, for example MSM and trans-identifying women to name just a few. Research demonstrates that young people are more likely to get tested if their physician recommends it, so ensuring that our doctors and nursing staff are properly informed is one way we might be able to tackle this issue.
There are other stress factors that may be contributing too, but these are ones that are less easy to solve. Adolescents and many young adults are likely to still live with their parents. They may therefore decide against getting tested because they are worried their parents will find out, particularly if they think they will need to go through their health insurer.
Educating young people that confidential HIV testing is available is important. In addition, making them aware that at-home HIV tests can be purchased online, for example Home Access HIV-1 Test System and the OraQuick In-home HIV tests which have been approved by the FDA, could help. These tests allow for anonymous testing and follow-up testing if a positive result is seen, and also can help with counseling services and follow up referrals if necessary. These products aren’t necessarily cheap, and they aren’t foolproof, but making young people aware of them and, again, that they can be purchased online may help to remove that barrier.
Other possible interventions include offering testing in dental practices (which has been successful in some trials) as well as in schools and other areas where people often meet up. School HIV tests may face opposition however, given that anything related to sexual health and young people is still problematic, particularly in states that refuse to acknowledge sexual health issues and favor the failed but still popular “abstinence only” approach. Breaking down that barrier and ensuring that age appropriate but frank HIV prevention advice is given to young people will also be a necessary step.
One other area where researchers believe we may be able to help adolescents in particular is ensuring that parents talk about sexual health screenings with their children and make it clear that these should be a part of every sexually active person’s self-directed health care. By making this topic less taboo, it is hoped that it may encourage young people to pro-actively seek out the testing that they may need. HIV screening also gives the opportunity to encourage young people to take precautionary measures like using condoms and could help to make them aware of things like PrEP if they are among a demographic that would benefit, so funding greater HIV screening initiatives for young people is definitely worth the investment.
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