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Why Are So Few Teens Getting Tested For HIV?

Less than a quarter of teens have been tested for HIV, according to new research from the Centers for Disease Control and Prevention.  

The study, published in the February edition of the journal Pediatrics, shows that testing rates did not increase between 2005 and 2013, despite government recommendations and campaigns to get teens screened. About half of high school students have had sex at least once and about a third are sexually active.

Rates were also low among young adults aged 18 to 24: Only a third had been tested according to data from 2011 to 2013. And for young adult women, testing rates went down during that time.

Reaching people in these age groups is important in the fight against HIV, the researchers note. Teens and young people make up more than a quarter of new HIV cases today and of those living with HIV, it's estimated that less than half know their status.

Those young people who did get tested for HIV typically did so based on their doctor’s recommendation. The CDC researchers say they plan to spread the word to doctors who work with young people, urging  more of them to screen their patients for the disease.

Side Effects’ reporter, Michelle Faust spoke with the lead writer on the study, Michelle Van Handel.

This interview has been edited.

Michelle Faust: Why is the CDC concerned about these testing rates?

Michelle Van Handel: The concern here is that knowledge of HIV status—and therefore having to get an HIV test—is key to accessing effective HIV prevention and treatment. And the CDC recommends that all adolescents and adults get tested at least once for HIV as a routine part of medical care. Yet, 44 percent of young adults and adolescents living with HIV don’t know it.

Until we can increase HIV testing, we’re going to have a hard time getting young adults and adolescents into the HIV care and treatment that they need to improve their health, increase their life expectancy, and prevent transmission to others.

MF: So the chances of spreading the disease could be higher because you may not necessarily be taking the precautions that you could take if you knew your status?

MVH: Exactly. So, when people are aware of their HIV diagnosis, they’re able to take different behavioral changes that can help protect their partners, and their also able to get on HIV care and treatment. And now, HIV treatment is recommended for all people living with HIV, regardless of some of their test levels related to HIV.

So, when you’re able to get on treatment, it reduces the viral load in your blood. So then, you have a lower risk of transmitting [HIV]. And it’s actually as high a reduction as 96 percent.

MF: When we look at these numbers, you’re talking about teenagers and young adults. Why are you targeting these populations?

MVH: And I think they really are the population that we want to target. A report by the Division of Adolescent and School Health found that 47 percent of high school students had ever had sexual intercourse, and 34 percent were currently sexually active. By the time you’re in the 18 to 24 age range, the majority of adults are sexually active. And so, this transition from young adolescence to adulthood is a really important time period to help increase the normalcy of HIV screening, so that we’re reducing the stigma and making it a routine and standard part of care.

MF: Part of what this study highlights is that young people are more likely to be tested if the doctor brings it up.

MVH: Exactly. Particularly for adolescents, they’re more likely to get tested if their provider recommends it. Unfortunately, other studies have shown that providers are either unaware of the recommendations or do not routinely offer it to their younger patients. So, we really want to focus on increasing awareness among providers for young adults and adolescents. And we have some activities through the CDC HIV screening standard care to help increase the tools that providers have available to them to help increase screening to their patients.

MF: Another factor that comes up here is that some of the populations at greatest risk for HIV transmission are also the populations that are least likely to be tested, including people of color.

MVH: Yes, as with other age groups, those in racial and ethnic minorities are disproportionately affected by HIV. In this study we found that there was no increase in testing among young males, and there was actually a decrease in testing among young adult females. And I do want to note that young adult black females actually have the higher testing rates. It’s great that they’ve had high rates historically, but we want to make sure that this decrease doesn’t continue, and to increase testing overall.

MF: What is the ultimate takeaway from this research?

MVH: The ultimate takeaway is that testing remains low among high school students and young adults, and that we need to do more to increase testing in this population.

Some of the activities that CDC has underway is a new HIV testing campaign called “Doing It” that promotes the idea that HIV testing is a normal and routine part of life. The Division of Adolescent and School Health provides funding to help schools deliver high quality sex education and increase adolescent access to sexual health services. Comprehensive sex education that includes information on HIV prevention has a potential to increase testing since youth have a better understanding of their own risk for infection.

So really, coming across this so that we’re dealing with in a multi-pronged approach. So, not only increasing provider education, but also increasing awareness of risk among young adults and adolescents.

MF: Should all sexually active adults be getting tested and know their status?

MVH: Yes. I think that is the key message is that knowledge of your status is key to accessing effective HIV prevention and treatment, and that we want HIV screening to be a routine and standard part of medical care.

Michelle Faust, MA, is a reporter/ producer whose work focuses strongly on issues related to health and health policy. She joined the WXXI newsroom in February 2014, and in short time became the lead producer on the Understanding the Affordable Care Act series. Michelle is a reporter with Side Effects and regularly contributes to The Innovation Trail. Working across media, she also produces packages for WXXI-TV’s weekly news magazine Need to Know.