A recent examination by the Chicago Tribune reported disparities between the 2006 recommendation by the U.S. Centers for Disease Control and Prevention (CDC) urging all health care providers to routinely offer HIV testing to patients ages 13–64 and current practices. This critical recommendation is being disregarded for many teenage patients. The Tribune focused on patients and the impact made by testing availability and doctors’ discomfort with talking about sexuality with teens, and also looked at the practices at major hospitals in Chicago as well as trends throughout the United States.[1]

 

By the end of 2006, approximately 46,000 young people ages 13–24 in the United States were living with HIV, comprising roughly 16 percent of all HIV infections in the nation. Unfortunately, there are likely even more cases that are undiagnosed due to lack of testing and prevention education; some analysts estimate that infections among youth may be closer to 30 percent of the total cases. Health disparities are also rampant among young people infected with HIV. African Americans and Latinos accounted for 72 percent of new infections among those ages 13–19 in 2007, although they only comprise approximately 17 percent of the population.[2] “Adolescents with HIV often become seriously ill before they are diagnosed,” said Dr. Jaime Martinez, associate professor of pediatrics at the University of Illinois at Chicago, “and those unaware of their infections are less likely to practice safe sex and more likely to transmit the infection.”[3]

 

To counteract these rising percentages, known and unknown, the CDC released the Revised Recommendations for HIV Testing of Adults, Adolescents and Pregnant Women in Health-Care Settings in 2006 for all health care providers. Detailed within the report is that voluntary screening for HIV infection, undertaken only with the patient’s consent, should be performed routinely for all patients ages 13–64 years. Both spoken and written information is to be given to the patient at the testing, but patients are given the option to “opt out” by declining to be tested. As justification for the testing of all ages and risk groups, the CDC declared that as this reliable and noninvasive test can give infected patients years of life with early treatment due to early knowledge of infection, and the cost of the screening are very reasonable when compared to the benefits gained.[4]

 

As detailed by the Chicago Tribune, youth are frequently not receiving this important testing, with many doctors citing a lack of time or no knowledge of the recommendation as major obstacles. Doctors report that time limitations on pediatric visits are often very difficult as they need not only time to explain the test and receive consent but also because it takes 20 minutes to get test results, at times taking away from other important medical issues that need to be addressed. Physicians’ lack of comfort with discussing sexual issues with adolescents often comes into play as another factor impeding successful implementation of testing. According to a survey of 700 pediatricians in 2005, 66 percent felt uncomfortable discussing sexual issues with adolescents and more than 50 percent felt they did not have sufficient training for addressing the topic with patients.[5]

 

Consent rules within some states are also changing and allowing testing to become more prevalent: Illinois, in particular, recently waived its written consent form, which was regarded as a stumbling block for testing. After the removal of the consent form, 87 percent of youth patients at Chicago’s Stroger Hospital accepted the testing, rising from 62 percent when the written consent was in place. Dr. Daniel Johnson, an infectious disease specialist at the University of Chicago said that “the overwhelming majority—90-plus percent—say ‘Fine, go ahead and do it.’”[6] With stories like those of Dr. Johnson and the teens profiled in the Chicago Tribune, it appears that many youth wish to be informed about their sexual health and are concerned and interested in being tested.

 

“The importance of HIV testing among youth is paramount,” comments Jen Heitel Yakush, director of public policy at the Sexuality Information and Education Council of the United States. “It is imperative that the CDC’s testing recommendations become common practice among doctors and health care providers. HIV prevention and sex at home, in school, and in the public health setting can teach youth the importance of knowing their HIV status and to stand up for their own right to be tested.”

 

 

---