The Young and the Restless

by Charles E. Clifton

We are all familiar with the numbers, but they need repeating every so often.

According to the Centers for Disease Control and Prevention, approximately 40,000 new HIV infections occur each year in the United States, about a 70% rate among men and 30% rate among women.

Of all these newly infected people, half are younger than 25 years of age. Half.

The HIV epidemic has taken a dangerous upturn among teens and young adults from coast to coast. In New York City, the highest rates of infection seem to occur among young, gay African American men, between 15 and 22 years of age, according to new health department data. The HIV seroprevalence among the 541 men who have sex with men (MSM) surveyed was 12.1%, the researchers determined. Visiting gay bars, video clubs, dance clubs and other well-known social centers of the gay community between December 1997 and September 1998, the researchers offered participants HIV testing, counseling and treatment (if necessary). They found that HIV seroprevalence among African-Americans was 18.4%, among men of mixed race it was 16.7%, among Latinos it was 8.8% and among whites, 3.1%. Nearly half (46.1%) of the men reported engaging in unprotected anal sex during the previous six months and 16.3% reported ever having had a sexually transmitted disease (STD).

In 1999, Houston Mayor Lee Brown declared an AIDS state of emergency after more than 2,500 new HIV cases were reported. Sixty-one percent of those cases were among African Americans, and 78 percent of the cases among 13-19 year olds were in African American females.

These rates of infection among young people are staggering. Again we find ourselves at risk of losing yet another generation of leaders to AIDS. What are we doing wrong?

"The first time I ran away I was 13 years old, because my stepfather had beaten me. I left for good when I was fifteen...a friend dropped me at the [Chicago] Cook County emergency room one night because he thought I was dying...that's when I found out I had the HIV...that was about three years ago."
—22 year old Matthew

Since an amendment to the Welfare Reform Act of 1996 increased federal funding for promoting chastity, the number of groups that are encouraging abstinence until marriage to combat the growing number of HIV/STD infections has grown. The new act also prohibits funded programs from promoting the use of condoms or contraception. But, are abstinence-based programs effective at curbing HIV/STD infections?

Statistics indicate that a growing number of teenagers and young adults, many of who declare themselves “virgins,” are engaging in oral and anal sex. A belief that anal and oral sex “is not really sex” and “a form of abstinence” and birth control is actually placing youth at risk for sexually transmitted diseases, which can be contracted through these acts.

These results indicate that parents and program developers need to take a broader view of sexual activity when talking about sex with young people. The view that sex is vaginal intercourse and abstinence is nothing more than holding hands is a discourse leading to disaster. Organizations and programs should be encouraged to and funded for providing a safe environment where teens and young adults can openly communicate about a whole range of sexual behaviors and issues.

In the Detroit neighborhood of Chene, at Neighborhood Service Organization, the Keepin’ It Real program targets African American youth, ages 12-19, at high risk for HIV/AIDS/STDs. With these kids, the peer educators discuss a gambit of health related and social issues—from HIV/AIDS, sexually transmitted diseases, substance abuse and alcoholism, to developing positive relationships, communication and negotiation skills, and self respect. The program activities include one-on-one risk reduction education, street outreach, workshops, and support groups.

The topics discussed are “a great tool when it comes to the youth, [who are] dealing with issues that other programs don’t necessarily want to talk about.” Peer education group leader Dimetrez Griffin continues, “peer education is not a job where you just come to work for the money, you have to really want to be a part of the community” to effectively connect with the kids.

The goals of Keepin’ It Real are twofold: first, to increase knowledge and education of HIV/AIDS/STD and substance abuse prevention in African American teenagers; and secondly, to increase social networks to enable and reinforce health enhancing behavior change through peer support. “It’s still very difficult to get [our message] into the public school system,” in Detroit, says program coordinator Janice Cross. To get around roadblocks, outreach workers go to where the kids need the interventions most, outside of schools—on the streets, at clinics, community health fairs, and after school programs, or a counselor might call for a speaker to address a group that needs HIV and health education.

“We recognize the fact that a lot of times kids are listening to other kids…rather than adults. We train our peers [kids],” said Katherine Howard, an outreach worker at NSO. “We make sure that they have the correct information … and have them deliver it in a language that’s common among their peers.”

Keepin’ It Real, is currently funded by the Substance Abuse and Mental Health Services Administration (SAMSHA); a demonstration grant providing first time joint substance abuse and HIV funding, under an initiative of the Congressional Black Caucus.

What makes the program successful is a commitment to peer-to-peer education, self-empowerment, and the dedication of the outreach staff. “We develop a rapport with the kids, we are there, they know us, they see us, and have this open atmosphere, so we’re able to interact with them…and give them information…We’re not there standing up like we’re teachers…we sit down and talk with them on a consistent basis and they know us and know about us,” Keyona Marsh, a nine-year HIV/AIDS advocate.

The reality is, however, that more youth than not across the U.S. are struggling with sex, sexuality and substance use without a peer support network. Case in point is Jason Karella.

Karella was 10-years-old when he figured out he was gay. At 17 he told his mother. She told him to get out. Jason struck out for San Francisco, in search of a gay community. Karella, now 24, an HIV positive drug user living in a shelter, is just one of many street kids who run to San Francisco every year in search of the elusive “gay community,” but instead discover homelessness and AIDS. In a CNN report, Karella said, “I ran to San Francisco because people told me this was the gay mecca. I came under false pretenses. People said they would help me, and they didn’t.”

"I've been on and off the streets since I was 16…I was living with a mate and the drugs just became a way of life…they make me forget…"
—19-year old HIV positive female

Homelessness is a major risk factor observed in many youth living with HIV. The National Gay and Lesbian Task Force estimates that 26% of gay teens are forced from their homes because of conflicts surrounding their sexual orientation. Most kids who find themselves in situations like Karella’s at one point or another try to go home. However, after short-lived reconcilement with families fail, many teens end up hustling to survive on the streets. Once on the streets, they are subjected to physical violence (including rape), drug and alcohol abuse, and prostitution in exchange for food, clothing and shelter.

Forty percent of homeless youth accessing the Larkin Street Youth Center’s LARK-Inn in San Francisco identify as gay, lesbian or transgender, and approximately 10 percent are HIV positive, mostly from drug use. The Larkin shelter serves about 3,000 street kids a year.

Located in the North Side Lakeview “Boystown” neighborhood of Chicago, Teen Living Programs (TLP) has offered several programs, including housing, counseling and job assistance, to Chicago’s homeless and abused young people for more than 20 years. Since 1999, TLP has provided services to over 7,000 street kids through its outreach, counseling, shelter, independent living, education assistance and prevention programs and a 24-hour hotline (773-883-0025).

Lyndon Stallings and Angela Burnett are TLP’s two outreach workers. They work long hours in Lakeview and Uptown, hitting streets, stores, games room, hospitals and parks—“where street kids hang out”—to find out what’s going on and to give young people information about how to be safe, find shelter and other assistance.

In the South Side neighborhood Grand Boulevard “it’s totally different,” says Stallings. “The kids bounce from house to house…so there’s usually somewhere for them to lay their heads [a friend’s house]. But on the North Side it’s different…you know the kids who are homeless…standing around, shaking a can, begging for money and sleeping on doorsteps.” When homeless youth are encountered on the streets, TLP is prepared to offer peer-led education and prevention counseling, anonymous HIV testing and treatment referrals.

Burnett and Stalling also coordinate “Beat the Heat” (summer) and “Kill the Chill” (winter). Burnett says that these two programs “allow the street kids [an opportunity] to eat, take showers, get clothing and referrals, and go into housing if they want.” The hope is that by getting a youth off the street, if only for a couple of hours, it will provide a chance for conversation, a few referrals, and build a layer of trust with the hope of eventually getting them off the streets permanently.

While important parts of an HIV prevention and treatment system for youth are available in some areas a great deal still needs to be done. Sandra Thurman, director of the Office of National AIDS Policy, released the “Youth and HIV/AIDS 2000: A New American Agenda” during the United States Conference on AIDS, held in Atlanta last October. This report highlights the growing HIV epidemic in youth and the difficulty in providing appropriate services to young people. The reality of the situation is that far too many gay, lesbian, bisexual and transgender teens are living with HIV on the streets of America.

Listen up. Peer-to-peer HIV education and prevention programs work.

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