The American Academy of Pediatrics now recommends that all teens 16 to 18 years old receive regular, routine HIV tests if they live in an area where the prevalence of HIV is greater than 0.1% of the population.
The AAP also advises that adolescents of any age who are tested for other sexually transmitted infections also be tested for HIV.
Previous guidelines recommended HIV testing only for teens who admitted to being sexually active. The new recommendations were outlined in a position paper released Monday that also advocates that the routine screening be done using a rapid response test that gives a diagnosis about 20 minutes after the test is conducted.
“We’re finding that when targeted testing is offered to sexually active youth… we’re not getting those youth to actually test and we have not decreased the number of new infections in [that] population,” says Dr. Jaime Martinez, an adolescent medicine specialist with Stroger Hospital of Cook County in Chicago. He deals with HIV-infected youth daily and is one of the authors of the AAP paper.
In 2006, there were more than 1.1 million HIV-positive people living in the United States. Of that population, the CDC says 5% were adolescents and young adults, ages 13 to 24 years old. That may seem like a small overall percentage but consider this: Upwards of 70% of new HIV infections are caused by people of all ages who are unaware of their HIV-positive status. Roughly one of every two HIV-infected adolescents don’t know they’re positive.
“I can’t think of a downside [to testing],” says Martinez. “We find that youth who test and become aware of whether they’re affected… become more conscious about engaging in safer sex practices.”
Data also show that adolescents who engage in routine HIV screening are ultimately less likely to transmit the virus. The sooner a teenager is made aware of his or her status, the sooner he or she can begin treatment, prevent future transmissions of the virus, and, doctors hope, delay the development of AIDS. Yet, despite the AAP’s arguments, it’s questionable whether health care professionals, particularly pediatricians, will adopt this new recommendation.
“Physicians in general are afraid of the issue of HIV,” says Martinez. “Many pediatricians have a skewed view of their patients. They also feel they don’t have time to test.”
“Unless pediatricians approach young people about the importance of getting tested for HIV, it’s not going to happen.”
But the need for testing goes beyond pediatricians’ offices. The AAP also advocates routine testing be adopted in emergency departments and urgent care clinics in areas with an infected population greater than 0.1%. The argument is that many at-risk adolescents may not have access to a primary care provider and instead receive most of their medical care from an emergency room. Plus, the recent economic downturn has caused families to lose their insurance and thus, access to their regular physician.
“It’s been on our watch that these young people have continued to become infected,” says Martinez.
“By promoting testing and offering counseling, we can probably have some impact on reducing the number of young people becoming infected with HIV in this country.”
October 31, 2011
HIV Testing at 16