Epidemic In The Making
As of November, 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 say, is the evidence that many adolescents, both boys and girls, are engaging in very high-risk behavior.
"The explosive spread of the virus among heterosexuals that health officials warned about is becoming a reality among adolescents,'' says Wanda Wigfall-Williams, director of the initiative on adolescents, AIDS, and HIV at the private Center for Population Options, which also released a report on the subject.
Adds James Williams, director of the National Education Association's health-information network: "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 teacher in their school, it doesn't hit home.''
Andrew Humm, director of education at the Hetrick-Martin Institute for Lesbian and Gay Youth in New York City, says: "No sense of emergency has been created in the schools.''
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. Five times more male adolescents than female have the disease; among adults, the male-female 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. 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.
Health officials are also concerned about the increased incidence of other sexually transmitted diseases--often a sign of unprotected intercourse. The number of reported syphilis cases in teenagers between the ages of 15 and 19, for example, rose from 15 per 100,000 in 1984 to 21.9 per 100,000 last year.
Experts say a variety of emotional and physical factors make teenagers more susceptible to AIDS and other sexually transmitted diseases. They say that because adolescents are more likely than adults to experiment and take risks, they frequently fail to weigh the potential consequences of their actions.
Such tendencies carry over into their sex lives, the experts add. 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 because the cells that line their cervix--which are more vulnerable to these diseases--are more likely to extend beyond the cervix at menarche.
Concern about the spread of AIDS has led a growing number of public officials to call for schools to play a greater role in its prevention.
A study completed last year by the Alan Guttmacher Institute found that, while more than 9 out of 10 sexeducation 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,'' says Asta Kenney, associate for policy development at the institute.
Others say that the schools cannot be expected to play more than a limited role in preventing the spread of AIDS. Says Louis Nayman, director of the AIDS Education Project and a field director for the American Federation of Teachers: "The schools are not a public-health agency. Their primary responsibility is not to stop the transmission of disease.''
--Ellen Flax, Education Week