Half of all new HIV infections in the United States occur among 13 to 24 year olds, but adolescents rarely seek HIV testing. Now, new research from the Bradley Hasbro Children's Research Center suggests that early and widespread testing -- both in schools and community centers -- may be the key to effectively curbing the spread of HIV within this age group.
This study, which will be published in the December issue of the Journal of Adolescent Health and is currently available online, is the first to take a prospective look at the factors associated with HIV testing among adolescents.
"Our goal was to determine why some high-risk teens would get tested for HIV, and others would not," explained lead author Marina Tolou-Shams, Ph.D., of the Bradley Hasbro Children's Research Center and an assistant research professor of psychiatry with The Warren Alpert Medical School of Brown University.
Researchers assessed the sexual behavior, substance use and HIV testing behaviors of 1,222 sexually active adolescents, ages 15 to 21, from Providence, Miami, and Atlanta over three months. They found that teens were more likely to get tested for HIV if they've already been tested before. In fact, approximately half of all study subjects had a history of HIV testing, and of those, one-third got tested within three months -- even without having gone through a specific HIV testing intervention.
"These findings were a bit surprising, since we thought teens would be more likely to get an HIV test if they engaged in risky behaviors, such as substance use during sex, or attended an HIV prevention workshop," said senior author Larry K. Brown, M.D., of the Bradley Hasbro Children's Research Center and a professor of psychiatry and human behavior at Alpert Medical School. "Given that a history of HIV testing appears to be a major motivator for adolescents to get tested in the future, a widespread HIV testing approach could help control the spread of this disease among our nation's at-risk youth."
Adolescents who received HIV testing during the three-month study were also more likely to have a sexually transmitted disease, to be assertive about condom use with their partner, and to not use drugs or alcohol during sex. However, researchers saw no association between having sex with high-risk partners or one's own perceived susceptibility to HIV and getting tested for the disease -- although these are some of the reasons that often motivate adults to get tested.
In the study, teens were randomly assigned to either a wait-list control group or a brief, three-hour skills-based group HIV prevention intervention based on Project LIGHT -- a National Institute of Mental Health/National Institute of Health-funded multi-site trial for young adults at high risk for HIV. Baseline and three-month follow-up interviews were administered.
Based on these results, the authors conclude that it is critical for HIV testing to be made more readily available to adolescents in order to increase the chances that they will seek future HIV testing as they engage in more HIV high-risk behaviors. They also advocate for public health campaigns that focus on incorporating HIV testing as part of the general practice of being proactive about one's own health to also help increase rates of adolescent HIV testing.
"Implementing testing throughout various nontraditional adolescent venues, such as schools and community settings (e.g., boys and girls clubs, YMCA) could increase future testing thereby making more adolescents aware of their positive HIV status and reducing future HIV transmission among youth," the authors said.
Study co-authors are Christopher Houck, Ph.D., of the Bradley Hasbro Children's Research Center and an assistant clinical professor of psychiatry at Alpert Medical School; Nancy Beausoleil, M.S., of the Bradley Hasbro Children's Research Center; Nanetta Payne, Ph.D., formerly of the Bradley Hasbro Children's Research Center and a research fellow in psychiatry at Alpert Medical School; and David Pugatch, M.D., of The Miriam Hospital and an associate professor of pediatrics at Alpert Medical School, along with the Project SHIELD Study Group -- a federally-funded prevention/intervention program aimed at developing and testing ways to encourage and enable behavior change among two subgroups at high risk for HIV infection: adolescents/young adults and women.
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