Adolescents and HIV Infection: The Pediatrician’s Role in Promoting Routine Testing abstract

Pediatricians can play a key role in preventing and controlling HIV infection by promoting risk-reduction counseling and offering routine HIV testing to adolescent and young adult patients. Most sexually active youth do not feel that they are at risk of contracting HIV and have never been tested. Obtaining a sexual history and creating an atmosphere that promotes nonjudgmental risk counseling is a key component of the adolescent visit. In light of increasing numbers of people with HIV/AIDS and missed opportunities for HIV testing, the Centers for Disease Control and Prevention recommends universal and routine HIV testing for all patients seen in health care settings who are 13 to 64 years of age. There are advances in diagnostics and treatment that help support this recommendation. This policy statement reviews the epidemiologic data and recommends that routine screening be offered to all adolescents at least once by 16 to 18 years of age in health care settings when the prevalence of HIV in the patient population is more than 0.1%. In areas of lower community HIV prevalence, routine HIV testing is encouraged for all sexually active adolescents and those with other risk factors for HIV. This statement addresses many of the real and perceived barriers that pediatricians face in promoting routine HIV testing for their patients. Pediatrics 2011;128:1023–1029 INTRODUCTION AND BACKGROUND The HIV epidemic persists in the United States despite great progress in treatment and continued efforts to screen targeted populations. In 2006, an estimated 1 106 400 HIV-infected people were living in the United States, of whom 55 320 (5%) were adolescents and young adults aged 13 to 24 years.1 Between 2005 and 2008, the estimated number of HIV/AIDS cases increased among 15to 19-year-olds and 20to 24-yearolds.2 HIV continues to be among the top 10 leading causes of death in the 20to 24-year age group.3 Of the 1.1 million people living with HIV/AIDS in the United States, approximately 20% are unaware of their infection4; this is a group that accounts for 54% to 70% of new HIV infections.5 In 2006, an estimated 48% of HIV-infected adolescents and young adults were unaware of their infection.6,7 The American Academy of Pediatrics encouraged HIV testing of all sexually active youth in a 2001 policy statement.8 This updated statement reflects advances in diagnostic testing, changes in epidemiology, and updated recommendations. The risk of HIV infection varies with community prevalence rates, sexual behaviors, and concurrent substance use. The rate of new HIV COMMITTEE ON PEDIATRIC AIDS