AIDS and Behavior

, Volume 16, Issue 1, pp 36–43

Trends in HIV Diagnoses and Testing Among U.S. Adolescents and Young Adults

Authors

    • Division of HIV/AIDS PreventionNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
  • Frances Walker
    • Division of HIV/AIDS PreventionNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
  • Daxa Shah
    • Northrop–Grumman Corporation
  • Eboni Belle
    • Division of HIV/AIDS PreventionNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
Original Paper

DOI: 10.1007/s10461-011-9944-8

Cite this article as:
Hall, H.I., Walker, F., Shah, D. et al. AIDS Behav (2012) 16: 36. doi:10.1007/s10461-011-9944-8
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Abstract

The Centers for Disease Control and Prevention recommends routine HIV screening in health care settings. Using national surveillance data, we assessed trends in HIV diagnoses and testing frequency in youth aged 13–24 diagnosed with HIV in 2005–2008. Diagnosis rates increased among black (17.0% per year), Hispanic (13.5%), and white males (8.8%), with increases driven by men who have sex with men (MSM). A higher percentage of white males and MSM had previously been tested than their counterparts. No increases in diagnoses or differences in testing were observed among females. Intensified interventions are needed to reduce HIV infections and racial/ethnic disparities.

Keywords

HIVSurveillanceYouth

Resumen

Los Centros para el Control y la Prevención de Enfermedades recomiendan que las pruebas de detección del VIH sean parte de la rutina del cuidado médico. Usando datos de vigilancia nacional, evaluamos la tendencia en los diagnósticos y la frecuencia de las pruebas del VIH en jóvenes entre las edades de 13–24 años diagnosticados con el VIH entre 2005 y 2008. La tasa de diagnóstico aumentó en los hombres afroamericanos (17.0% por año), Hispanos (13.5%), y blancos (8.8%), con incrementos principalmente en los hombres que tienen relaciones sexuales con hombres (HSH). Comparado con sus homólogos, un mayor porcentaje de hombres blancos y HSH se hicieron pruebas del VIH antes del diagnostico. No se observaron incrementos en los diagnósticos ni diferencias en las pruebas entre las mujeres. Es necesario intensificar las intervenciones para reducir las infecciones por el VIH y las disparidades raciales y étnicas.

Palabras claves

VIHVigilanciaJóvenes

Introduction

While overall sexual activity and unprotected sexual intercourse has declined among U.S. youth [1], in 2007 about 16% of persons diagnosed with HIV were aged 13–24 [2] and increases in HIV diagnoses have been observed among young men and young men who have sex with men (MSM) since the late 1990s [3]. Understanding the epidemiologic profile of these young men in terms of factors that put them at risk as well as others can help inform efforts for HIV prevention to slow and eventually reverse these trends.

Disparities in HIV diagnoses and prevalence among blacks/African Americans and Hispanics/Latinos compared with whites and among MSM have been documented for all ages [2, 3], and recent investigations in response to increasing HIV diagnosis rates among young black MSM confirm high prevalence of sexual risk behavior [4]. The Centers for Disease Control and Prevention (CDC) recommends persons at risk for HIV infection should test annually for HIV infection to access care early and to modify their behaviors to prevent the spread of the disease [5]. Testing among high school students is generally low overall (13%) and only about 11% of males and 15% of females in that age group who have ever had sexual intercourse have tested for HIV [6]. However, not all of these students are at high risk for HIV infection and few investigations have provided information on testing frequency among adolescents at high risk for HIV infection.

It has been suggested that men who have sex with men and women (MSMW) put females at increased risk for HIV, often with non-disclosure of sexual orientation, preventing females from recognizing their partner’s HIV risk. Generally, this unique risk group has not been well characterized although they may play a central role in HIV transmission dynamics [7]. One study found MSMW were more likely to be young and to differ by demographic and risk taking behavior [7]; however, this study did not include adolescents. Finally, young men who have had contact with the correctional system may have additional risk factors that put them at risk for HIV infection. In general, HIV prevalence is higher among incarcerated persons than the general population [8].

Using data from national HIV surveillance, we determined recent trends in HIV diagnoses among young males and females by demographic and risk characteristics, including men who have sex with men and women and incarceration at time of HIV diagnosis. We also examined testing frequency among youth infected with HIV. These data are useful to identify the drivers of the epidemic among youth, and to tailor public health goals and planning for prevention and treatment services for young people, including implementation of testing policies.

Methods

Diagnoses of HIV Infection

We used national HIV surveillance data for persons aged 13–24 years diagnosed with HIV infection in 2005 through 2008 and reported to CDC through June 2009 from 37 states that had reported HIV diagnoses to CDC for at least 4 years to allow for statistical adjustments. All cases are reported to CDC without identifying information. Assessments of duplicate cases occur both on the state and national level (potential duplicates are identified based on selected demographic characteristics and soundex code, a phonetic algorithm for indexing names by sound, as pronounced in English), and data for those cases are merged. Cases of HIV infection are counted by earliest known HIV diagnosis, regardless of stage of disease at diagnosis.

We determined the distribution in HIV diagnoses by diagnosis year, sex, age (13–15, 16–19, 20–24 years at diagnosis), race/ethnicity, and transmission category. Transmission category is the term for the classification of cases that summarizes a person’s possible HIV risk factors; the summary classification results from selecting, from the presumed hierarchical order of probability, the one risk factor most likely to have been responsible for transmission. For surveillance purposes, a diagnosis of HIV infection is counted only once in the hierarchy of transmission categories. Persons with more than one reported risk factor for HIV infection are classified in the transmission category listed first in the hierarchy. The exception is men who report sexual contact with other men and injection drug use; this group makes up a separate transmission category.

Persons whose transmission category is classified as male-to-male sexual contact include men who report sexual contact with other men (i.e., homosexual contact) and men who report sexual contact with both men and women (i.e., bisexual contact). Persons whose transmission category is classified as heterosexual contact are persons who report specific heterosexual contact with a person known to have, or to be at high risk for, HIV infection (e.g., an injection drug user). Few persons had other HIV risk factors (e.g., hemophilia, blood transfusion) and these were grouped into an “other” category. We also analyzed the data using a non-hierarchical risk factor classification to determine the number and percentage of young males for whom sexual contact with both men and women was reported. Further, we determined the number and percentage of adolescents and young adults diagnosed while incarcerated and the number of persons living with HIV infection at the end of 2007, allowing for 18 months of follow-up for the reporting of deaths.

Rates per 100,000 population were calculated with population denominators based on official postcensus estimates from the U.S. Census Bureau (Census) [2]. Population denominators were not available to determine rates by transmission category.

To explore trends in diagnoses over time for demographic and risk groups, we estimated the annual percent change (EAPC) with Poisson regression. Changes in trends in HIV diagnosis rates may be due to changes in HIV incidence or testing. Therefore, we conducted additional trend analyses stratified by states that had laws or regulations compatible with CDC testing guidelines published in 2006 [5]. To assess disparities in diagnosis rates between racial/ethnic groups, we calculated the relative percent difference using whites, who had the lowest HIV diagnosis rate, as the comparison group [9]. All analyses were adjusted for reporting delays and missing risk factor information for analyses on transmission category [2].

HIV Testing

As part of national HIV incidence surveillance, information is collected on HIV testing among persons newly diagnosed with HIV. Using data reported for young HIV-infected persons with testing history information from 24 states for 2006–2008, we estimated testing frequency by sex, race/ethnicity, age, and transmission category. Differences in testing were assessed with chi-square statistics.

Results

Diagnoses of HIV Infection

A total of 7,328 adolescents and young adults aged 13–24 years were diagnosed with HIV in 2008; 5,723 (78.1%) were male. The majority of 13–24 year old males diagnosed with HIV in 2008 were black/African Americans (63.7%), followed by whites (17.7%) and Hispanics/Latinos (16.5%) (Table 1). The major transmission category was male-to-male contact (87.9%) for all males and the percentage attributed to MSM was similar for black/African American, Hispanic/Latino, and white males. Among females, the majority of new diagnoses were also among blacks/African Americans (68.1%). Overall, 19.9% of males were reported to have had sex with men and women (MSMW); 20.6% among males aged 13–15 years, 21.2% among males aged 16–19, and 19.5% of males aged 20–24 years having had MSMW contact (data not shown).
Table 1

Estimated numbers and rates (per 100,000 population) of adolescent and young adults aged 13–24 years diagnosed with HIV infection, by year and selected characteristics, 2005 and 2008, 37 U.S. States

 

Males

Females

Year of diagnosis

EAPCa

95% CI

Year of diagnosis

EAPCa

95% CI

2005

2008

2005

2008

No.

Rate

No.

Rate

No.

Rate

No.

Rate

Age at diagnosis

 13–15 years

34

0.8

34

0.8

3.4

−18.3,

30.7

51

1.2

41

1.0

0.8

−16.3,

21.4

 16–19 years

804

13.6

1325

21.6

17.2

11.9,

22.9

419

7.5

501

8.6

4.1

−2.8,

11.4

 20–24 years

2911

38.9

4364

58.1

14.2

10.8,

17.7

1148

16.3

1063

15.0

−2.2

−6.6,

2.4

Race/ethnicity

 American Indian/Alaska native

15

7.7

24

12.2

15.2

−13.3,

53.1

11

5.6

7

3.7

−2.3

−30.7,

37.7

 Asian

24

5.3

42

9.1

18.3

−7.6,

51.5

10

2.3

13

3.1

6.3

−25.8,

52.4

 Black/African American

2224

76.9

3648

123.5

17.0

13.3,

20.9

1088

38.3

1092

37.8

−0.1

−4.6,

4.7

 Hispanic/Latino

646

24.4

945

34.1

13.5

7.4,

19.9

217

9.2

208

8.2

−3.1

−11.9,

6.6

 Native Hawaiian/other Pacific Islander

4

31.4

3

24.0

    

0.0

 

0.0

   

 White

779

6.8

1012

8.9

8.8

3.5,

14.5

268

2.4

270

2.5

0.1

−8.2,

9.2

 Multiple races

58

22.2

50

17.0

−7.9

−24.8,

12.9

25

9.6

14

4.8

−17.9

−38.1,

8.9

Transmission category

 Male-to-male sexual contact

3110

 

5032

 

17.5

14.6,

20.5

       

  Black/African American

1841

 

3188

 

20.0

16.2,

23.9

       

  Hispanic/Latino

520

 

820

 

18.1

11.1,

25.6

       

  White

663

 

917

 

10.7

5.1,

16.5

       

 Injection drug use

158

 

157

 

0.1

−17.9,

22.0

171

 

161

 

−3.3

−19.5,

16.2

 Male-to-male sexual contact and injection drug use

197

 

181

 

−3.0

−17.4,

13.8

       

 Heterosexual contact

281

 

351

 

7.7

−4.7,

21.7

1441

 

1442

 

0.4

−3.6,

4.6

 Other

3

 

2

 

 

 

 

4

 

2

 

 

 

 

aEstimated Annual Percentage of Change (EAPC) with 95% Confidence Interval (CI). EAPC not presented for groups with small numbers

EAPC for rate (age and race/ethnicity) and for numbers (transmission category)

Analyses are adjusted for reporting delay and for missing transmission category

The number and rates of new HIV diagnoses increased from 2005 to 2008 among 16–24 year old males but not among 13–15 year olds (Table 1). Increases in diagnosis rates occurred among black/African American (EAPC 17.0, 95% CI 13.3, 20.9), Hispanics/Latino (EAPC 13.5, 95% CI 7.4, 19.9), and white males (EAPC 8.8, 95% CI 3.5, 14.5). These increases were driven by increases among MSM, with increases observed among black/African American, Hispanic/Latino, and white young MSM. Compared to white males, the relative percentage difference in HIV diagnosis rates was very high for blacks/African Americans (2008, 1287.6%), followed by Hispanics/Latinos (283.1%), and Hawaiians/Other Pacific Islanders (169.7) (Fig. 1). The disparity between black/African American and white males increased between 2005 and 2008 (absolute difference, 257%). No significant changes in HIV diagnosis rates were observed among females (Table 1). Compared to white females, females of other races/ethnicities also had disproportionate HIV diagnosis rates but no increases in disparities were observed from 2005 to 2008 (Fig. 1). Increases in diagnosis rates were similar in states with laws or regulations compatible with CDC testing guidelines (EAPC 11.2, 95% CI 8.3, 14.2) and those without (EAPC 9.2, 95% CI 4, 14.7).
https://static-content.springer.com/image/art%3A10.1007%2Fs10461-011-9944-8/MediaObjects/10461_2011_9944_Fig1_HTML.gif
Fig. 1

Relative percentage difference in HIV diagnosis rates among 13–24 year old males and females, by race/ethnicity compared to whites, 37 U.S. States, 2005 and 2008

A total of 1105 (4.4%) of the adolescents and young adults diagnosed with HIV in 2005–2008 were incarcerated at the time of HIV diagnosis; with 5.0% of males and 2.9% of females incarcerated at time of diagnosis. Similar percentages of black/African American, Hispanic, and whites were diagnosed while incarcerated; numbers were low among other race/ethnicity groups and are not presented (Table 2). However, among males a higher percentage of injection-drug users and those exposed heterosexually were diagnosed while incarcerated compared with MSM. Among females, the percentage of injection drug users diagnosed while incarcerated was higher than those exposed heterosexually. Increases in HIV diagnoses were similar in states with laws for testing in correctional facilities (EAPC 11.4, 95% CI 8.4, 14.6) and those without (EAPC 9.8, 95% CI 5.8, 13.9).
Table 2

Estimated numbers and percentages of adolescent and young adults aged 13–24 years diagnosed with HIV infection, by incarceration status at diagnosis and selected characteristics, 2005–2008, 37 U.S. States

 

Incarcerated at Diagnosis

Total

Yes

No

No.

%

No.

%

No.

%

Race

 Black/African American

746

5

14,954

95

15,700

100

 Hispanic/Latino

144

4

3,923

96

4,067

100

 White

197

4

4,463

96

4,661

100

 Multiple races/Other

18

3

563

97

581

100

Transmission category

 Male

  MSM

554

3

15,406

97

15,960

100

  IDU

139

22

491

78

630

100

  MSM/IDU

93

13

631

87

724

100

  Heterosexual contact

130

11

1,103

89

1,233

100

  Other

3

15

15

85

17

100

 Female

  IDU

56

8

648

92

704

100

  Heterosexual contact

131

2

5,597

98

5,728

100

  Other

 

 

11

100

11

100

Among adolescents aged 13–15 years living with HIV at the end of 2007, the majority was black/African American and infected perinatally (Table 3). In the older age groups, the majority was also black/African American but male-to-male sexual contact for males and heterosexual contact for females were the predominant exposure modes.
Table 3

Estimated numbers, percentages, and rates (per 100,000 population) of adolescents and young adults aged 13–24 years living with HIV at the end of 2007, by selected characteristics, 37 U.S. States

 

13–15 years

16–19 years

20–24 years

Total

%

Rate

N

%

Rate

N

%

Rate

N

%

Rate

Race/ethnicity

            

 American Indian/Alaska native

6

0.3

6.4

19

0.4

14.3

83

0.5

52.1

108

0.4

27.8

 Asian

8

0.4

3.8

20

0.4

7.0

94

0.5

24.9

122

0.5

13.8

 Black/African American

1329

67.7

89.2

3334

68.0

165.0

11152

63.8

481.7

15815

64.9

271.5

 Hispanic/Latino

357

18.2

26.4

850

17.3

50.1

2865

16.4

133.6

4072

16.7

78.5

 Native Hawaiian/other Pacific Islander

0

0

 

0

0

 

15

0.1

133.1

15

0.1

56.5

 White

239

12.2

4.4

643

13.1

8.5

3086

17.7

33.1

3968

16.3

17.8

 Multiple races

24

1.2

14.2

43

0.9

22.2

187

1.1

92.5

253

1

45.1

 Unknown races

1

0.1

 

0

0

 

4

0

 

5

0

 

Transmission categorya

 Male

            

  Male-to-male sexual contact

25

2.7

 

1405

51.8

 

9406

80.9

 

10836

71.0

 

  Injection drug use

2

0.2

 

51

1.9

 

402

3.5

 

454

3.0

 

  Male-to-male sexual contact and injection drug use

2

0.2

 

46

1.7

 

482

4.1

 

529

3.5

 

  Heterosexual contact

3

0.3

 

88

3.2

 

773

6.6

 

863

5.7

 

  Other

53

5.7

 

109

4.0

 

92

0.8

 

254

1.7

 

  Perinatal

839

90.9

 

1014

37.4

 

478

4.1

 

2332

15.3

 

 Female

            

  Injection drug use

8

0.8

 

94

4.3

 

612

10.5

 

714

7.8

 

Heterosexual contact

58

5.5

 

863

39.3

 

4622

79.0

 

5542

61.0

 

Other

57

5.4

 

84

3.8

 

88

1.5

 

228

2.5

 

Perinatal

919

88.3

 

1156

52.6

 

532

9.1

 

2607

28.7

 

aDenominator data not available

Analyses are adjusted for reporting delay and for missing transmission category

Testing Frequency

Among the estimated 17,528 persons aged 13–24 diagnosed with HIV during 2006 through 2008 in 24 states, information on testing history was available from 48.1%. Among these, 54.0% of those aged 13–19 years and over two thirds of those aged 20–24 years had been tested at least once before their HIV diagnosis (Table 4). Among males aged 20–24 years, the percentage of white males who had been previously tested was higher (74.1%) compared to blacks/African Americans and Hispanic/Latinos (66.1%, Chi-square = 21.6, P < .0001 and 66.5%, Chi-square = 13.2, P = .0003). The proportion of MSM aged 20–24 who were repeat testers was higher than among males exposed heterosexually (Chi-square = 36.3, P < .0001) or otherwise (Chi-square = 17.5, P < .0001). No differences in testing by race/ethnicity were observed among males aged 13–19 years. Among females, 70.0% of those aged 20–24 tested previously and 52.9% of those aged 13–19 years. Among females aged 20–24, black/African Americans were as likely to be repeat testers (70.5%) as whites and Hispanics (69.4%, Chi-square = 0.1, P = .74 and 66.4%, Chi-square = 0.4, P = .52, respectively).
Table 4

Previous HIV testing among adolescents and young adults aged 13–24 years diagnosed with HIV, by selected characteristics, 2006–2008, 24 U.S. states

 

13–19 years

20–24 years

Total

Repeat tester

Tested in the past 12 monthsa

Total

Repeat tester

Tested in the past 12 monthsa

N

N

%

N

%

N

N

%

N

%a

Male

1603

873

54.5

534

68.1

4790

3254

67.9

1640

56.4

Race/ethnicity

          

 American Indian/Alaska Native

3

2

66.4

1

50.4

18

13

73.9

9

68.8

 Asian

2

1

47.7

0

 

28

18

65.2

8

45.2

 Black/African American

1170

616

52.7

383

69.5

2811

1857

66.1

898

54.7

 Hispanic/Latino

219

130

59.5

82

69.6

904

601

66.5

320

59.1

 Native Hawaiian/Other Pacific Islander

0

    

9

7

75.5

3

75.2

 White

192

111

57.7

64

62.3

974

722

74.1

383

58.4

 Multiple races

15

12

77.7

4

36.1

46

36

77.8

19

57.3

Transmission category

          

 Male-to-male sexual contact

1450

806

55.6

501

69.1

4225

2943

69.7

1508

57.3

Injection drug use

24

8

31.9

3

46.5

115

53

46.0

21

41.1

Male-to-male sexual contact and injection drug use

51

26

50.9

12

51.4

147

97

66.0

54

61.2

Heterosexual contact

74

33

45.1

18

61.4

301

160

53.0

56

41.1

 Female

646

342

52.9

162

52.7

1394

975

70.0

395

44.8

  Race/ethnicity

          

  American Indian/Alaska Native

1

1

100.0

1

100.0

5

4

79.0

3

75.7

 Asian

1

1

100.0

1

100.0

9

7

74.8

3

49.2

 Black/African American

460

238

51.8

109

50.8

965

680

70.5

269

43.8

 Hispanic/Latino

96

54

56.7

31

60.5

186

123

66.4

61

52.0

 Native Hawaiian/Other Pacific Islander

0

    

0

    

 White

84

46

54.9

19

48.5

212

147

69.4

55

43.0

 Multiple races

5

1

26.6

1

100.0

17

13

80.5

3

30.6

Transmission category

          

 Injection drug use

63

37

59.3

18

51.2

147

99

67.4

42

44.7

 Heterosexual contact

583

305

52.2

144

52.9

1243

874

70.3

354

45.0

Total

2249

1215

54.0

696

63.7

6184

4229

68.4

2035

53.7

Analyses are adjusted for reporting delay and for missing transmission category

aAmong those with information available on date of last test, males 13–19 years N = 784, 20–24 years N = 2906; females 13–19 years N = 308, 20–24 years N = 882

Information on the date of last test was available for about 90% of those who had had a previous test. Among these repeat testers, the majority of males (58.9%), 56.4% of those aged 20–24 years and 68.1% of those 13–19 years, were tested within 12 months of the last test (Table 4). However, only 52.7% of repeat testers among females 13–19 indicated having been re-tested within 12 months, and 44.8% among those aged 20–24.

Discussion

Between 2005 and 2008, diagnoses of HIV infection increased among adolescent and young black/African American, Hispanic/Latino, and white males, driven by increases in diagnoses among MSM in these groups. In addition, we found that disparities in HIV diagnosis rates increased among American Indian/Alaska Native, Asian, black/African American, and Hispanic/Latino males compared with white males. No changes were observed in diagnoses among females and, except for Asians, disparities in HIV diagnosis rates have narrowed somewhat. These results confirm the need to focus HIV prevention interventions on young men and on reducing disparities.

Behavioral studies indicate that disparities in HIV infection rates among racial/ethnic MSM are not attributable to higher risk behaviors among those disproportionately affected by HIV [10]; however, higher prevalence rates among subpopulations may influence infection rates when there is little mixing between groups. While cohorts of youth maturing to sexual initiation should start relatively free of HIV disease, higher HIV prevalence among blacks/African Americans and Hispanics/Latinos can put those at increased risk who initiate sexual activity if there is more mixing with older age groups.

Our results indicate that at least one fifth of adolescent and young adult males with HIV are bisexual. This is within the range of earlier findings using surveillance data of 16% to 26% MSMW among males with HIV or AIDS [11]. However, Wheeler [11] has shown that the true percentage is likely to be higher, and may be as high as 39% and possibly higher among 13–19 year olds than older men. In a study of young men diagnosed with HIV in North Carolina, 15% were reported to be MSMW and these men had more sex partners than other men and occupied central positions in network analyses [7]. Because these men can serve as a bridge of HIV transmission from MSM, a group with high HIV prevalence, to females, and their risk characteristics might differ from MSM [7], prevention interventions need to address risk behaviors specifically among MSMW.

Generally, the prevalence of HIV and STD is high among correctional populations and a disproportionate number of minorities are represented among them [8]. Our results reflect the disproportionate impact of HIV among minorities, overall and also among the incarcerated. These youth are in need of comprehensive sexual and mental health services as drug use is high among incarcerated populations with HIV.

CDC HIV testing guidelines [5] call for persons at high risk for HIV infection to test annually. Only 3 of 37 states included in the analyses did not have laws or regulations in place that were compatible with CDC’s testing recommendations published in 2006. Diagnosed rates increased similarly in both groups of states which may reflect increasing incidence or increasing testing outreach. Our results indicate that additional outreach is needed to assure repeat testing among high risk youth and to reduce racial/ethnic disparities in repeat testing. Special considerations may apply for testing adolescents, where parental involvement may be desirable but not required depending on state law. Testing was found to be higher among high school students if they were taught at school about AIDS or HIV (13.2 vs. 9.7%) [6]. As part of primary care, information about HIV should be provided to all adolescents and HIV screening discussed and offered to those who are sexually active [5].

Our results are subject to several limitations. Data are presented from 37 states that had reported information to CDC from confidential, name-based HIV surveillance for at least 4 years. Therefore, these results may not be representative of the entire United States. Information on testing history represents a convenience sample of young persons diagnosed with HIV and may therefore also not be representative all young persons diagnosed with HIV. Information on incarceration status at diagnosis may be underreported and therefore our results may be underestimates. Finally, adjustment for reporting delays and missing risk factor information may introduce uncertainties in the estimates.

While generally persons diagnosed with HIV may include those with recent as well as long-standing infections, HIV diagnoses among youth reflect fairly recent infection and our results indicate intensified interventions are needed to reverse the increasing trends and eliminate racial/ethnic disparities. Routine and repeat testing of MSM should target young males of all races/ethnicities. About 86% of high school students report that they had been taught about AIDS [6] and effective prevention interventions for adolescent and young adult males and females are available [12]. However, interventions are needed that promote a family and community environment that is supportive and free of stigma for gay and bisexual youth to complement individual behavioral interventions. Treatment and prevention services are also needed for youth who come of age with perinatal infection.

In summary, culturally sensitive messages for at risk youth, especially black/African Americans, are needed. Such messages should address traditional risk factors, such as a history of sexually transmitted diseases, number of sex partners, and drug use, as well as non-traditional risk factors such as age sorting. In addition, interventions are needed that address stigma and access to health care and prevention services to reduce disparities and reverse the trends in HIV infections among youth.

Acknowledgements

The Centers for Disease Control and Prevention (CDC) funds all states and the District of Columbia to conduct HIV surveillance and selected areas to perform HIV incidence surveillance and provides technical assistance to all funded areas. All participating investigators and contributors are CDC employees or contractors.

Copyright information

© Springer Science+Business Media, LLC (outside the USA)  2011