The COVID-19 pandemic has overshadowed many other aspects of our lives and our health. Things such as routine immunizations and preventative health appointments were put on hold as visits to primary care offices decreased in the early days of the pandemic.
As we are digging ourselves out from the past two years, refocusing on preventative health care should be a priority. World AIDS Day is a chance to remember those who died of human immunodeficiency virus (HIV)/AIDS or an AIDS-related illness, recognize those who are living with HIV, and come together globally in the fight against HIV/AIDS – but it is also an opportunity to prioritize prevention. HIV can be preventable, even for those at high risk of acquiring it.
How Do We Help Prevent HIV Acquisition in Adolescents?
Before we can help prevent HIV acquisition in youth, we must understand what HIV is and how it is transmitted. The human immunodeficiency virus (HIV) affects the immune system of individuals, making them more susceptible to common and uncommon illnesses.
In 2019, there were over 36,000 new HIV diagnoses and nearly 1.2 million people living with HIV in the US. In 2018, 21% of new HIV infections were diagnosed in youth 24 years and younger. This age group is the most challenging to get tested for HIV, retained in care, and adherent to life saving antiretroviral therapy to achieve viral suppression.
HIV is most commonly transmitted through unprotected sexual activity and injection drug use. The risk factors are similar for both adults and adolescents. The most at-risk youth are young men or transgender women who have sex with men, due to the higher risk of transmission with anal intercourse. However, heterosexual activity is the second most common risk factor overall, and the number one risk for young women. Injection drug use continues to be a risk, especially if youth are sharing injection equipment with others.
As parents, caregivers, and pediatricians even when we know the risk factors it is difficult to know if the youth we care for are engaging in any at risk activities. These topics are sometimes difficult to talk about and we should not rely on our youth to openly share these things. If we want our youth to share these things, we must provide a safe and non-judgmental space for this discussion and ask the questions. These conversations can help identify who needs an HIV prevention plan and ultimately can be lifesaving.
HIV prevention comes in many forms including abstaining from sexual activity, using condoms and lubrication with intercourse, getting tested for sexually transmitted infections including HIV regularly, and using new equipment only for injection drug use. However, as pediatricians and parents it is also our responsibility to help the most at-risk youth access HIV prevention medication. Pre-exposure prophylaxis (PrEP) is a combination medication taken daily to prevent HIV. In May 2018, the Food and Drug Administration extended approval of this medication to teens and adolescents greater than 77 lbs (35 kg). This medication has been shown to be safe and effective in this age group. PrEP is nearly 99% effective at preventing HIV through sexual activity if used correctly and reduces the risk of acquiring HIV by 74% via injection drug use.
Despite it being safe and effective, PrEP is underutilized in adolescents and teens; only 11% of youth most at risk are getting access to this medication. It’s time to use this World AIDS Day as a reminder that we now have the tools to prevent HIV. Have those tough conversations and make it a priority to help prevent HIV acquisition in our youth.
To learn more about the Family AIDS Clinic and Educational Services Program (FACES) at Nationwide Children's Hospital, click here. Or, find more information (including the statistics used here) at www.cdc.gov.
Megan E. Brundrett, MD, is a physician at Nationwide Children's Hospital in the Section of Primary Care Pediatrics. She is an assistant clinical professor of pediatrics and internal medicine at the Ohio State University College of Medicine.
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