Scope of the Problem 

The human immunodeficiency virus (HIV), which causes AIDS, ranks seventh among the leading causes of death for U.S. children 5 to 14 years of age and sixth for young people 15 to 24 years of age. Because the average period of time from HIV infection to the development of AIDS is 10 years, most young adults with AIDS were likely infected with HIV as adolescents. Almost 18 percent of all reported cases of AIDS in the United States have occurred in people between the ages of 20 and 29. 

In the United States, through June 1998, 3,282 cases of AIDS in people aged 13 through 19 had been reported to the Centers for Diseases Control and Prevention (CDC). Many other adolescents are currently infected with HIV but have not yet developed AIDS. Data from the 31 states that conduct HIV case surveillance indicate that among adolescents aged 13 through 19: 

46 percent were male

54 percent were female

28 percent were white, not Hispanic

66 percent were black, not Hispanic

5 percent were Hispanic

less than 1 percent were Asian/Pacific Islander or American Indian/Alaskan Native 

Transmission 

Most adolescents recently infected with HIV are exposed to the virus through sexual intercourse or injection drug use. Through June 1998, HIV surveillance data suggest that nearly half of all HIV-infected adolescent males are infected through sex with men. A small percentage of males appear to be exposed by injection drug use and/or heterosexual contact. The same data suggest that almost half of all adolescent females who are infected with HIV were exposed through heterosexual contact and a small percentage through injection drug use. 

The studies conducted every two years in high schools (grades nine through 12) consistently indicate that approximately 60 percent of the students have had sexual intercourse by the twelfth grade; half report use of a latex condom during last sexual intercourse, and about one-fifth have had more than four lifetime sex partners. 

Approximately two-thirds of the 12 million cases of sexually transmitted diseases (STDs) that are reported in the United States each year are in individuals under the age of 25 and one-quarter are among teenagers. This is particularly significant because if either partner is infected with another STD, the risk of HIV transmission increases substantially. If one of the partners is infected with an STD that causes the discharge of pus and mucus, such as gonorrhea or chlamydia, the risk of HIV transmission is three to five times greater. If one of the partners is infected with an STD that causes ulcers, such as syphilis or genital herpes, the risk of HIV transmission is nine times greater. 

Treatment 

Adolescents tend to think they are invincible, and therefore, to deny any risk. This belief may cause them to engage in risky behavior, to delay HIV-testing, and if they test positive, to delay or refuse treatment. Doctors report that many young people, when they learn they are HIV-positive, take several months to accept their diagnosis and return for treatment. Health care professionals may be able to help these adolescents by explaining the information slowly and carefully, eliciting questions from them, and emphasizing the success of newly available treatments. 

Clinical Trials 

The National Institute of Allergy and Infectious Diseases (NIAID) supports clinical trials at many clinics and medical centers throughout the United States. These studies help evaluate promising therapies to fight HIV infections, prevent and treat the opportunistic infections and cancers associated with AIDS, and reconstitute HIV-damaged immune systems. 

Recruiting adolescents into clinical trials is important to ensure that research results will be applicable to therapy for that age group. Most clinical trials are open to adolescents, but in reality very few enroll. Of the 53,000 participants in studies conducted in the NIAID-supported AIDS Clinical Trials Groups, for pediatric and adult HIV-infected people, 812 (1.5 percent) were adolescents. To encourage participation by more teenagers, the Pediatric AIDS Clinical Trials Group (also funded by the National Institute of Child Health and Human Development (NICHD)) has developed a study specifically designed to appeal to adolescents. 

The National Cancer Institute (NCI) is conducting clinical research trials for children and adolescents on the NIH Campus in Bethesda, Md. Thirty percent of the patients enrolled in these NCI intramural studies are adolescents. The NCI also has a major initiative to identify, provide access to and enroll adolescents with sexually acquired HIV infection into clinical research trials through a community-based clinic at the Hospital for Sick Children in Washington, D.C. The clinic, named NE Place ("any place") by the teens, provides comprehensive adolescent services, including outreach, education and comprehensive care. Adolescents must report to NCI for enrollment, but then receive follow-up care at the NE Place clinic. Physicians who are interested in referring patients for evaluation in any NCI programs should contact the Referral Coordinator: