Today's youth are tomorrow's future. Yet, every year in the United States, half of all new HIV infections occur among people under the age of 25 and one-quarter of new infections occurs among people between the ages of 13 and 21. Based on current trends, that means that an average of two young people are infected with HIV every hour of every day.

While the number of cases of AIDS among teenagers is relatively low, it has grown rapidly from one case in 1981 to 417 cases in 1994. The rate of HIV infection among teenagers becomes more apparent when you look at the number of AIDS cases among people in their 20s. According to the Centers for Disease Control and Prevention (CDC), one in five AIDS cases in the U.S. is diagnosed in the 20-29 year age group. Looking at AIDS cases alone obscures the extent of the epidemic among young people. Since a majority of AIDS cases are likely to have resulted from HIV infections acquired 10 years before, most of these individuals are likely to have been infected as teenagers.

Among adolescents (13-19 years of age), HIV infection is more prevalent among those in their late teens, males, and racial and ethnic minorities. But recent trends also point to a rise in infection and diagnosis among adolescent females--increasing from 14 percent of diagnosed cases among adolescents in 1987 to 43 percent in 1994.

What is also clear is that American adolescents are increasingly engaging in behaviors that put them at risk for acquiring HIV infection as well as other sexually transmitted diseases, unintended pregnancy, and infections associated with drug injection. According to the CDC, approximately three-quarters of high school students have had sexual intercourse by the time they reach the twelfth grade. About 50 percent of sexually-active high school seniors report consistent use of latex condoms and surveys indicate that condom use declines with age. In a recent survey, one in 62 high school students reported having injected an illegal drug. Recent reports indicate an increase in the use of non-injectable drugs, including marijuana, cocaine, and alcohol. The use of alcohol and other drugs impairs judgment and can lead to risky sexual behaviors and practices, particularly for young people in the stage of experimentation.

Also according to the CDC, about 12 million cases of sexually transmitted diseases (STDs) are reported in the U.S. each year. Roughly two-thirds of those cases are reported in individuals under the age of 25 and one-quarter are among teenagers. About 3 million teens contract an STD each year, and many of these young people will suffer long-term health consequences as a result.

Without forceful and focused action, these already troubling trends will worsen. This is a particularly complex challenge. Adolescents are neither large children nor small adults, yet they often are treated as one or the other and their unique characteristics and needs are often overlooked. Adolescents are in a developmental stage that can make them particularly vulnerable -- physiologically and emotionally -- to take actions that put them at risk of becoming infected with HIV.

Young people are at greatest risk of HIV infection if they have unprotected sex outside of a mutually monogamous relationship between two HIV-negative individuals, use injection drugs, or use alcohol or other drugs that impair their decision-making abilities. Adolescents often do not have the maturity, experience or range of options that adults usually bring to their decision-making processes. Adolescents are engaged in a developmental process that includes development of decision-making skills, sexual maturation and experimentation, emotional and cognitive changes, and the molding of identity and self-worth.

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Adolescents live in a world in which their families, cultural institutions, religious institutions, media, and peers compete to instill values, dictate actions, and impart positive and negative messages to them. The mass media often glamorize youth and sex at the same time that parents and schools are encouraging abstinence. Attempts to turn young people into sex symbols are particularly troublesome because of the message that it sends to both young people and adults.

Adolescents, particularly those in their early teens, tend to be short-term thinkers. To many, the present is all important, and the future is often perceived in very vague terms. Some adolescents, then, may feel invulnerable to harm and often make decisions based on immediate desires rather than after consideration of the long-term consequences of their decisions.

Many young people have an enhanced sense of invincibility and may be unprepared to respond to situations that place them at risk. They may not perceive a need to avoid the risk or be aware that certain behaviors can place them at risk for contracting HIV. At the same time, many young people experience stigmatization and discrimination because of their race, ethnicity, gender, sexual orientation, HIV status, or economic status. Such discrimination hampers their ability to navigate successfully the many challenges and complex situations that they confront.
Set against this backdrop is the fact that young Americans are beginning the physiological and emotional phenomenon of puberty earlier in their lives than did previous generations. Yet they are also postponing many adult responsibilities as full-time employment, marriage, or a committed monogamous relationship.

All young people need thoughtful guidance and loving care. The role of effective parents has never been more important in the successful development of adolescents. But it is a job that has also become much tougher. Parents, too, need assistance in learning how to best communicate with their children about such often difficult subjects as sex, drug use, and death. Many adolescents do not have adults in their lives who can effectively provide the nurturing and guidance that they need.

Some young people are at a particular risk of HIV infection due to circumstances that are often beyond their control. Adolescents who are victims of sexual abuse are at risk for direct transmission from their sexual partners and may also suffer emotional problems that lead them to later engage in high-risk behavior that can lead to HIV infection.

There are also those youth who have left or been kicked out of their homes or who have fled abusive family relationships. They are highly susceptible to risky behavior just to survive. Their sense of self-worth is usually low or nonexistent. They may trade sex for food, housing, drugs, and affection. Adolescents challenged with homelessness rarely view reducing their risk factors for HIV as a high priority in comparison with their daily struggle for survival.

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Gay, lesbian, and bisexual youth often are isolated from positive adult role models and peers. Personal, institutional, and societal homophobia can often deny them access to opportunities to address their developing sexuality and contribute to a feeling of worthlessness.

Adolescents need the tools to successfully navigate through an increasingly dangerous world. They need to hear from parents and other adults that they are loved, valued, and have worth as individuals so they will internalize those feelings and believe they are worth protecting. They must be shown the dangers they may encounter and taught negotiation and decision-making skills. They need to be engaged in activities that will allow them and their peers to practice those skills. And they need to exert personal responsibility to protect both themselves and others from infection.

Adolescent HIV prevention is a job too big for any one segment of society. All parents, adults, leaders, policy-makers, young people and institutions must become constructively engaged in the important work of preventing HIV infection among our nation's most precious resource.

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