More Young Americans Are Contracting HIV
On eve of World AIDS Day, U.S. experts wonder what has gone wrong
FRIDAY, Nov. 30, 2007 (HealthDay News) -- In the 26 years since scientists first spotted AIDS in America, millions of dollars have been poured into outreach efforts aimed at keeping young people clear of HIV, the virus that causes the disease.
But on the eve of World AIDS Day, a disturbing statistical fact has emerged in this country: The number of newly infected teens and young adults is suddenly on the rise.
And the question is, why?
According to data from the U.S. Centers for Disease Control and Prevention for 2001 to 2005 (the latest years available), the number of new cases of HIV infection diagnosed among 15-to-19-year-olds in the United States rose from 1,010 in 2001, held steady for the next three years, then jumped 20 percent in 2005, to 1,213 cases.
For young people aged 20 to 24, cases of new infection have climbed steadily, from 3,184 in 2001 to 3,876 in 2005.
Newer infection numbers set to be released soon by the CDC may be even higher, the Washington Post reported Saturday. According to the Post, sources close to scientists preparing the new statistics have confirmed that rates of new infection in the United States may be 50 percent higher than previously believed -- a jump from 40,000 new infections per year to up to 60,000. The increase is based on new blood testing methods, the Post said, and whether it signifies a growth in actual cases remains to be seen.
Experts say a number of factors may be at play, including the fact that many HIV-infected patients are now being kept healthy with powerful drugs -- making AIDS seem like less of a threat to young people than it did in the past.
"Certainly the 'scare factor' isn't there anymore," said Rowena Johnston, vice president of research at the Foundation for AIDS Research (amfAR) in New York City.
In the 1980s and early 1990s, the ravages of AIDS were apparent to most Americans -- either on their TV screens as high-profile celebrities succumbed to the disease, or as individuals lost friends or family members to HIV.
"To see people looking gaunt, skinny and skeletal, and to know that they were going to be dead soon," Johnston said. "It had a sobering effect."
The advent of antiretroviral drugs in the mid-1990s changed all that, however. "These days, for the most part, you can look at a person and not know that they even have AIDS," Johnston said.
That's making HIV seem like less of a threat to young people, said Martha Chono-Helsley. She's executive director of REACH LA, a Los Angeles-based nonprofit that helps disadvantaged youth understand and defend against threats like poverty, drug abuse and HIV.
"They're in this age group that feels they are invincible -- that it's never going to happen to them," she said. "Yes, they're getting all these messages from public schools on HIV and AIDS, but they've never actually seen what HIV has done, up close and personal."
Chris Blades, one of REACH LA's young, black "peer educators," said he's seen a kind of nonchalance towards HIV among the gay or bisexual men of color that he counsels.
"On a daily basis, they don't see their friends suffering from it, so it's not a major threat to them," said Blades, 21. "They're in that whole mindset of 'Oh, it can't happen to me, it will never happen to me.'"
But there has been a recent, troubling spike in new infections among gay men, young and old alike. According to the CDC, the rate of new cases of HIV infection linked to male-male sex held steady at around 16,000 cases between 2001-2004, then suddenly jumped to 18,296 in 2005.
Johnston and Chono-Helsley both point to advertisements for HIV-suppressing medicines as one possible contributing factor.
"In gay magazines, you now see [ads with] buff, handsome men climbing mountains, with some kind of quote about how 'I'm not letting HIV get in my way,'" Johnston said. "It sends the message that you, too, can be hot, buff and handsome, even with HIV."
Chono-Helsley agreed. "It's always these bright, healthy vibrant young men in these ads," she said. That could spur young gay men to relax their guard and take more risks, thinking that if they do contract HIV, "I only have to take a pill," she said.
The reality of living with HIV in America is much different, however, even when medication is working. According to Johnston, the side effects of powerful HIV-suppressing drug cocktails include fat redistribution (including unsightly "humps"), insulin resistance, higher cholesterol, increased risks for heart disease, and dangerous liver toxicities.
There's also the fear that, someday, HIV will develop mutations that render these drugs useless, triggering the re-emergence of AIDS, she said.
HIV continues to cut a wide swath through young men and women in the black community, too. According to the CDC, the number of new infections actually dipped slightly for black Americans between 2001 (20,868 cases) and 2005 (18,121 cases). However, black men are still six times more likely than white men to contract HIV, and black women are 20 times more likely to acquire the virus compared to white women.
The answers to that disparity lie mainly in economics, experts say.
"The young men that we work with are predominantly African-American, and HIV is not their No. 1 priority," said Chono-Helsley. "Often survival is their main priority -- where they are going to sleep tonight. They're kicked out of the house; they have substance abuse issues, they're in recovery."
Young black women can easily get caught up in similar problems, or are coerced into unsafe sex by their partners, she added.
Another trend -- soaring rates of methamphetamine use over the past five years -- may also be fueling HIV infection rates for both blacks and young gay men, the experts noted.
Too often, marginalized young people develop "a 'whatever' attitude -- whatever happens, happens," Chono-Helsey said.
Outreach aimed at HIV prevention remains important, of course. But one expert believes too much state and federal money is being funneled away from community outreach programs and toward "HIV Stops With Me" campaigns that focus on individuals already living with the virus.
"The message there is that, if I don't have HIV right now, then all I have got to do is avoid those people who have got it," said Carrie Davis, director of adult services at the Lesbian, Gay, Bisexual and Transgendered Community Center in New York City.
She believes those types of messages allow uninfected people to shift the burden of responsibility from themselves to the HIV-positive, or to people they deem at high risk, such as gay men or drug abusers.
"I think it affects straight people, too, in that they absorb this 'magical thinking' -- that this is someone else's problem," Davis said.
So what doeswork to change attitudes and behaviors? That's a tough question, Chono-Helsley said, and the answer usually depends on particular contexts and communities.
"You really have to evaluate what methods you're using and think about the person as a whole, not just the infection," she said. "Because they've all heard 'use a condom, use a condom.'"
The right approach is key, Blades added. "If you deliver the message to them in a way that's not preachy or looking down on them, I think that's more effective," he said. "That's what we try to do - deliver HIV information in a way that will click in with them, so that they'll take home something that they didn't know the night before."
"One thing is for sure, we can't just shake our finger at young people and say, 'You're bad,'" Chono-Helsley said. "We have to be supportive. They're young, we've all been there, remember. You can save some, but you can't save them all."
There's more on HIV and AIDS at amfAR.
SOURCES: Martha Chono-Helsley, executive director, and Chris Blades, outreach coordinator and peer educator, REACH LA, Los Angeles; Rowena Johnston, Ph.D., vice president, research, Foundation for AIDS Research, New York City; Carrie Davis, MSW, director, adult services, Lesbian, Gay, Bisexual and Transgendered Community Center, New York City; U.S. Centers for Disease Control and Prevention, Cases of HIV Infection and AIDS in the United States and Dependent Areas, 2005, online; Washington Post