More than 30 years after the beginning of the AIDS epidemic, young people are again taking dangerous risks with their lives, according to a new report from the Centers for Disease Control and Prevention.
Each month about 1,000 young people ages 13 to 24 are newly infected with HIV, the virus that causes AIDS, according to new data.
About 60 percent of HIV-positive young people have no idea that they’re infected, according to the report released last week.
Young people 13 to 24 account for more than a quarter of the 50,000 new HIV infections each year, the CDC says. About 1.2 million Americans have HIV or AIDS.
“This is our future generation,” says CDC director Thomas Frieden. “That so many young people become infected with HIV each year is a preventable tragedy.”
Both the financial and human costs of these new infections are staggering, Frieden says. The lifetime cost of treating someone with HIV is about $400,000. That means these new infections add $4 million in new health-care costs each month.
And while new HIV infections have leveled off among most groups, they are rising among young people, says Kevin Fenton, who leads the CDC’s office on AIDS. Most of that increase is being driven by new HIV infections in young black men who have sex with men, he says.
The finding adds to the evidence that doctors need to routinely screen all patients for HIV, says Kenneth Mayer, medical research director of Boston’s Fenway Health, a community health organization that provides AIDS services.
In November, the U.S. Preventive Services Task Force endorsed routine HIV testing for everyone 15 to 65. The CDC and American Academy of Pediatrics also call for routine screening, beginning in the teen years.
Yet only 13 percent of high school students have been tested for HIV, the report says. Frieden says doctors need to get the message that screening is essential. While the number of people who refuse an HIV test is very small, he says the number of doctors who fail to offer the test is great.
“They key here is to make it routine screening, just like we have cholesterol screening,” Frieden says. “If someone refuses, that is their right, but we should say this is what we do.”
Getting tested is the first step to treatment, which can dramatically improve patients’ health and also prevent them from spreading the infection, Mayer says. People who know they’re HIV-positive are less likely to engage in risky behaviors, such as sharing needles or having unprotected sex, studies show.
And people whose virus is under control, reduced to undetectable levels, are virtually incapable of spreading the infection to others, a finding that has led doctors to talk of “treatment as prevention.” Only 30 percent of those with HIV have their virus under control, however, because of a “cascade” of obstacles to care, including lack of insurance, poverty and other issues, Frieden says.
By getting more patients on treatment, Frieden says, the nation can reduce the total amount of AIDS virus in circulation, which would dramatically reduce the number of new infections, even if people didn’t change their behavior. He said the country needs to do a better job of educating young people about AIDS and the need to change their behavior.
“It is astonishing the level of ignorance of basic physiology that many high school and middle school students have,” Frieden says. “There is not going to be an easy, quick, simple solution.”
Overall, 20 percent of all patients with HIV are unaware of their status, according to the CDC, and about one-third are diagnosed late in their infection, after having had HIV for perhaps a decade. A number of socioeconomic factors keep people from getting tested, including the stigma of AIDS, poverty and lack of access to care.
Young gay and bisexual men, along with African-Americans, are disproportionately affected. About 72 percent of new HIV infections in this age group occur in men who have sex with men, and 57 percent occur among African-Americans, the CDC says.
Mayer notes that there are really two AIDS epidemics in the U.S. The first wave of HIV patients is aging and in care, and many have their disease under control. A second wave of newly infected young people – who weren’t even born when AIDS burst into the national consciousness three decades ago – now often acts as if they’re unaware of the tremendous risks they’re taking, Mayer says.
According to the new CDC report, which interviewed high school students, young men who have sex with men are more likely than others to have had four or more sex partners and to have injected drugs. Among sexually active students, young gay or bisexual men were more likely to have used alcohol or drugs before their last sexual experience and were less likely to have used a condom. Young gay and bisexual men were less likely, however, to report being taught about AIDS or HIV in school, according to the CDC.
“The AIDS epidemic seems very remote to young people,” Mayer says. “There is no equivalent of a young Magic Johnson. If you are young, this seems like a disease of old people.”