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.

Risk factors for self-report of not receiving an HIV test among adolescents in NYC with a history of sexual intercourse, 2013 YRBS

“…Consistent with current CDC screening guidelines, NYC health care providers should plan to screen all adolescent patients for HIV unless they optout of testing (Branson et al, 2006). To decrease the likelihood that their adolescent patient opts-out, especially those who perceive their risk to be low, providers should explain the benefits of HIV testing to their adolescent patients while providing a supportive environment and encouraging discussion of sensitive topics such as sexual orientation (Flynn et al, 2011). HIV testing among NYC adolescents may also be increased by changing the hours of NYC HIV counseling and testing sites to minimize conflicts with regular school hours (Hyden et al, 2014).…”

Reappraisal of sexually transmitted infections in children: A hospital-based study from an urban area

“…Based on surveillance data, an estimated 1.2 million individuals are living with HIV/acquired immunodeficiency syndrome in the United States, 5% of whom are adolescents and young adults (13-24 years of age). [1213] Concurrent HIV infection has been reported in 1-5% of all pediatric STI patients. [614] Many bacterial and viral STIs can increase the predisposition of children to acquire HIV infection, particularly in the setting of homosexuality.…”

Opportunities for earlier HIV diagnosis in a pediatric ED

“…Secondary outcomes included whether or not the opportunity was missed (i.e. infected but not tested) and potential indications for HIV testing during PED encounters, including (1) clinician suspicion of HIV infection, (2) symptoms potentially indicative of HIV illness (3) risk factors, and (4) diagnoses potentially related to HIV.…”

“…Emergency departments (EDs) in particular have been called to expand HIV screening (3–6). Although progress has been made, implementation of HIV screening recommendations remains suboptimal (7–10).…”