Confronting Teen HIV
by
Vicki Burkitt
When Martha Diaz’s uncle
died of HIV in 1991, her parents knew that she would ask questions.
Yet, to her, there were more questions than answers. One thing
was clear—there was a growing need to help people, especially
those her age (she was 17). What began as community outreach
with HIV positive adults at the South Bronx Ecumenical AIDS
Ministry at All Saint’s Lutheran Parish, has taken Diaz
down the path to teenagers with HIV. It’s a decision
she is glad to have taken. “Doing this helped me choose
what I want to do for the rest of my life,” she says.
“HIV touches everyone’s lives. Just being at risk
makes you affected by it.”
These days you will find Diaz
at the Adolescent AIDS Program (AAP) at Montefiore Medical
Center in Bronx, New York City, where she is peer educator,
youth advocate and editor of Peer Power, a teen friendly newsletter
about HIV, relationships and sexuality. Diaz takes her work
seriously. “I have to do something.” As the incidence
of HIV escalates in urban youth, grass roots groups such as
AAP are responding with novel HIV education, testing and treatment
programs in their communities.
Convincing others that there’s
a problem isn’t easy. “People don’t ‘get
it’ that teens are getting HIV,” says Kathi Kuntz,
outreach coordinator at Montefiore’s AAP. Sexually active
youth may assume that their partners are monogamous and HIV
negative or free of other STDs (sexually-transmitted diseases).
Often they are in relationships with a power imbalance. Adults
may deny that teenagers have sex, or hope that fear of HIV
will encourage abstinence. But perceptions differ markedly
from reality. A 1997 study found that 55% of high school students
(from eight U.S. cities) have had sexual intercourse by grade
12, while 21% had four or more sex partners. Despite the implementation
of HIV education in American schools, one in three students
weren’t using condoms during their last sexual encounter.
In 1987, Dr. Karen Hein, founding
director of the Montefiore AAP, observed increases in teen
pregnancy and STDs. She predicted that teenagers would carry
more of the HIV burden in the following ten years, since adolescents
were already in the midst of an STD epidemic. Today, 25% of
new HIV infections occur in American youth between 13 and
21 years of age, which corresponds to one new infection every
hour. In 1997, AIDS was the seventh leading cause of death
in adolescents aged 15 to 24 years. This trend will continue
as the high rate of STDs among teenagers (25% of all reported
cases) translates into an ever-growing HIV population. Girls,
15 to 19 years old, are particularly at risk since they represent
almost half of all reported cases of chlamydia, a common STD.
Adolescents are as susceptible
as anyone else to sexually transmitted diseases, but access
to condoms is a problem. “Kids don’t know where
to get condoms at local health clinics,” says Kathy Kuntz.
“Some can get them at school clinics, but they have to
ask. They can buy them at drug stores, but it’s hard
for teens to navigate these things.” So the people at
Montefiore hand out condoms and “kids dump baskets of
them into their bags.” Even if they come prepared, boys
and girls are still vulnerable, since their partners may resist
using rubbers. Kuntz also points out that these women pick
partners from a pool of men with a higher HIV seroprevalence
than other neighborhoods. “It’s not a case of these
girls prostituting, drug using or drinking,” she says.
“They do what every teen is doing.” Boys face additional
issues, Kuntz explains. “The boys are getting infected
through male to male sex, but no-one is [acknowledging] that
you don’t necessarily need to identify as gay. Teen boys
experiment.”
A recent New York City study
demonstrated that young men who have sex with men (MSM) are
particularly susceptible to HIV infection. Researchers reported
that 13% of the MSM that they surveyed were seropositive.
HIV incidence was highest among African-American males, with
a 22% infection rate, followed by mixed race (16%); Latinos
(10%) and whites (4%). Seroprevalence increased with age,
from 4% between 15 and 18 year olds to 19% between 19 and
22 year olds, but half of the 56 HIV positive men were HIV-negative
two years earlier. Kathy Kuntz believes that prevention messages
aren’t effectively reaching youth. “There are an
enormous number of kids in [New York] City,” she says.
“Even if every school had additional health education,
peer mentors and after school programs, they are still missing
all the kids not at school, the kids who aren’t going
to classes and not involving themselves in these activities.”
Dr. Donna Futterman, director
of the Adolescent AIDS Program since 1994, believes that educators
need to tailor HIV education to the communities they serve,
and speak in their language. It should be relevant and inclusive
of all teenagers, including gay youth. Just as important,
at-risk youth need access to HIV counseling and testing, social
support and treatment.
In 1997, the Adolescent AIDS
Program and an advertising agency conceptualized and created
a social marketing campaign that targeted adolescents with
references to sex they understood. Phrases such as “hittin’
the skins” and “knockin’ boots” became
slogans on flyers and cards that encouraged teenagers to learn
their HIV status: “Hittin’ it? HIV. Live with it.
Get tested. If you’re 13–21 call citywide 718-881-TEST.”
When youth call the hotline, they are referred to one of eight
New York City clinics that provide free, confidential HIV
counseling and testing, and specialized care for HIV positive
adolescents.
Montefiore’s AAP hired
a medical PR firm to generate community awareness and to promote
the New York City “Get Tested Week” in April of
1998. The firm proposed launching the event with a public
town hall meeting. In the lead up to the HIV testing week,
the campaign ran broadcast and print news stories, public
service announcements on television and cinema slides, advertisements
on radio and bus shelters, and with other community partners
distributed over 220,000 pieces of literature to peers, schools,
stores, churches, restaurants, clubs and hair/nail salons
throughout New York City.
Approximately 250 New York
City adolescents attended that first “Let’s talk
about HIV” town hall meeting in the Bronx, a forum comprised
of skits and discussions about HIV/AIDS and teen sexuality
issues. During the “Get Tested Week,” 500 calls
were received on the listed hotline number. Of the 230 calls
that were answered by volunteers, 55% were from 13 to 21 year-olds,
and 93% accepted a referral. With increased funding from the
federal government, the campaign was expanded to six U.S.
cities in 1999: Baltimore, New York, Philadelphia, Washington
DC, Los Angeles and Miami. Each city will provide similar
literature as in New York, and all adolescents will be counseled
and offered HIV testing with an oral HIV test.
For youth who take the next
step and learn their HIV status, Alice Myerson, nurse practitioner
at the Montefiore AAP says, “The majority of the kids
[we] counsel and test are fortunately negative.” Of the
one hundred HIV positive adolescents who are currently receiving
care at Montefiore Medical Center, half are girls and half
are boys. The majority of young people are exposed sexually:
females through heterosexual contact and males through sex
with other males. Approximately ten to fifteen percent of
teens were infected perinatally, but only identified during
adolescence, and a handful were infected by injecting drugs.
Myerson points out that there is also a very high incidence
of sexual abuse among both the female and male teens that
she sees. “Keep in mind,” she says, “when we
think of risk factors we think of promiscuity, [but] we have
many young people—both male and female—who have
become infected, who only had one or two partners. They’re
not promiscuous.
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