'Explosive' Data Confirm Prediction: AIDS Is Spreading Among Teenagers
By Ellen Flax
New federal statistics appear to substantiate a warning sounded often by public-health experts over the past several years: The AIDS virus is spreading rapidly among teenagers.
Between July 1988 and August 1989, the number of teenagers with AIDS jumped by 43 percent, according to the Centers for Disease Control.
As of this month, 421 cases of AIDS among 13- to 19-year-olds had been reported to the CDC That number, health officials emphasize, includes only teenagers who have actually developed the disease, not those who have been infected by the human immunodeficiency virus but show no signs of illness.
What is especially disquieting, experts with federal and private agencies agree, is the evidence that many adolescents, both boys and girls, are engaging in behavior that puts them at potentially high risk.
"The explosive spread of the virus among heterosexuals that health officials warned about is becoming a reality among adolescents," said Wanda Wigfall-Williams, director of the initiative on adolescents, AIDS, and HIV at the private Center for Population Options, which released a report on the subject last week.
James H. Williams, director of the National Education Association's health-information network, added: "I really don't think [educators] appreciate how extensive a problem this is. I don't think they see it as an epidemic."
"Unless they know of an HIV child, or a teacher, in their school," he said, "it doesn't hit home."
Andrew Humm, director of education at the Hetrick-Martin Institute for Lesbian and Gay Youth in New York City, agreed. "No sense of emergency has been created in the schools," he said.
Experts say that although teenagers account for less than 1 percent of all reported AIDS cases, their sexual behavior, including intercourse with multiple partners and infrequent use of condoms, may make them more vulnerable than many adults to HIV exposure.
Nationally, most confirmed cases of AIDS have been found in adult homosexual males, although an increasing number of patients are drug users from minority backgrounds.
The CDC estimates that between 1 million and 1.5 million people in the United States have been infected by HIV, the virus that causes AIDS, for an infection rate of from 4.3 to 6.5 per 1,000. In certain high-risk teenage groups, such as runaways and intravenous-drug users, the rate could be even higher, CDC officials say.
According to the CDC data, female adolescents are more likely than adult females to contract AIDS. The male-to-female ratio of adolescent AIDS cases is 5 to 1; among adults, that ratio is 12 to 1.
The data show that the biggest single source of exposure to the virus reported by female adolescent patients was heterosexual contact, which was cited by nearly 4 out of 10 such patients. Some 72 percent of the female teenagers with AIDS are black or Hispanic; the CDC has reported that this is probably the result of the higher intravenous-drug-use rates among minority males.
At a 1987 Congressional hearing, former U.S. Surgeon General C. Everett Koop warned of a future "explosion" in the number of teenagers infected with the AIDS virus. (See Education Week, June 24, 1987.)
'Truly Phenomenal' Rates
This prediction appears to have been disturbingly accurate, researchers tracking the spread of AIDS say. They point to the following data:
About one-fifth of the nearly 110,000 AIDS cases diagnosed to date in the United States have been found in people in their 20's. Scientists believe that the AIDS virus can have an incubation period of up to 10 years, meaning that many of these people were infected as teenagers.
Of the teenagers who applied to join the military between October 1985 and June 1988, 0.04 percent were HIV positive, according to tests required of all recruits. Among Job Corps applicants, who are also tested for exposure to the virus, 0.33 percent of the teenage applicants since 1987 have tested positive.
Of more than 1,100 homeless and runaway youths anonymously tested for HIV infection by Covenant House, a shelter for young people in New York City, 7 percent had been exposed to the virus.
In the first national survey on the prevalence of AIDS on college campuses, released last spring, 0.2 percent of the 16,861 blood samples tested showed infection with HIV. Ten of the 19 schools participating in the survey had infection rates of zero, while five had rates that were 0.4 percent or higher.
A national study of blood samples from hospitals conducted by the CDC found that 1 percent of the 15- and 16-year-olds in high-risk cities, such as New York, were infected with the virus. It also found that between two and three times as many 21-year-olds were infected as well. In lower-risk areas, 0.3 percent of 15- and 16-year-olds were infected.
The rates of teenagers who have other sexually transmitted diseases--often a sign of unprotected intercourse--is on the rise. The number of reported syphilis cases for teenagers between the ages of 15 and 19 rose from 15 per 100,000 in 1984 to 21.9 per 100,000 last year.
In 1987, gonorrhea was reported in more than 1 percent of young people ages 15 to 19. Although people between the ages of 20 and 24 had an infection rate of more than 1.5 percent, the CDC found that "when adjusting for sexual-activity rates adolescents 15-19 actually have the highest rates of gonorrhea of any age group."
H. Hunter Handsfield, director of the sexually transmitted disease-control program for the Seattle-King County Department of Health, called the gonorrhea rates "truly phenomenal," especially for black, inner-city teenage girls.
In his area, he said, if a black girl becomes sexually active at the age of 13 or 14, her risk of of getting gonorrhea is 25 percent every year. If the same girl delays her sexual activity until the age of 15, she has a 50 percent chance of getting the disease by the age of 18, he said.
Experts say a variety of emotional and physical factors make teenagers more susceptible to AIDS and other sexually transmitted diseases. Adolescents, they say, are more likely than adults to experiment and take risks--and frequently fail to weigh the potential consequences of their actions.
Such tendencies carry over into their sex lives, the experts say. As a result, sexually active teenagers are more likely than adults to have a large number of sexual partners--and are less likely to use condoms or other forms of contraception.
And teenage girls may be especially susceptible to sexually transmitted diseases, physicians say, because the cells that line their cervix--and are more vulnerable to these diseases--are more likely to extend beyond the cervix at menarche.
Role of Schools
The new report by the Center for Population Options, a Washington-based group that has strongly promoted the movement for school-based health clinics, contains much of this new data and calls on schools, parents, communities, and health-care providers to play a more active role in AIDS prevention.
A study completed earlier this year by the Alan Guttmacher Institute found that, while more than 9 out of 10 sex-education teachers discuss AIDS and other sexually transmitted diseases, such discussion appears to be inadequate.
"At least on the surface, it seems that coverage of these topics is universal, but not in great depth," said Asta M. Kenney, associate for policy development at the institute.
Others say that schools cannot be expected to play more than a limited role in preventing the spread of AIDS.
"The schools are not a public-health agency," said Louis Nayman, director of the AIDS-education project and a field director for the American Federation of Teachers. "Their primary responsibility is not to stop the transmission of disease."