Five Reasons to Discuss HIV with Your Teen Now

Early Interaction Key to Reducing High Rates of Teen HIV Infections

Teenagers used under a Creative Commons license at http://en.wikipedia.org/wiki/Adolescence#mediaviewer/File:Teens_sharing_a_song.jpg
Photograph © SCA Svenska Cellulosa Aktiebolaget

Having "the talk" with your teenager can often be difficult in the best of circumstances. It can evoke a great sense of discomfort in many adults who are otherwise unaccustomed to discussing sexuality with others, much less their own teens. It often challenges moral and religious beliefs, and suggests to some a tacit approval (or even encouragement) of teen sex.

Whatever one’s beliefs or concerns, one fact remains: avoiding an open and non-judgmental discussion about sex—or assuming your child’s school will take care of it—is a mistake.

The consequences are no longer confined to unplanned pregnancies and treatable sexually transmitted infections (STIs).  Despite beliefs among some that HIV is no longer the problem that it once was, teenagers remain at great risk of contracting the disease and spreading it to others.

Here are five reasons why you need to discuss HIV with your teenager today:

1. While rates of infection remain highest among young adults, many of these infections occurred when the person is still in his or her teens.

According to the U.S. Centers for Disease Control and Prevention (CDC), nearly one in four new HIV infections occur in youth aged 13-24, and that rate has continued to rise year-on-year from 2008 to 2011.

While the data shows that teenagers aged 13-19 represent a far lower number of infections than young adults aged 20-24 (4.8% versus 18%), don’t let these figures mislead you. According to researchers at John Hopkins University, as many as 45% of persons under the age of 25 only seek treatment when their disease has reached an advanced stage, defined as having a CD4 count that has fallen below 350 cells/mL.

In short, persons presenting at this stage of infection will have been infected five or more years earlier while still in their teens.

This is supported by data from the CDC estimating that 60% of teens and young adults currently have no idea whether they’ve been infected or not.

2. Many teens are either unsure how to protect themselves or are unaware of their vulnerability to HIV.

Here are the facts: according to research published by the CDC, approximately 47% of American students reported having had sex before graduating from high school, with 13% had four or more sexual partners during those years.

Of these, one in four would have acquired an STI before they reached the age of 20, accounting for the nearly 3 million teenage STI diagnoses reported in the U.S. every year.

Underpinning these statistics is the fact that less than 50% of students reported using a condom on a consistent basis. While there are many reasons for this, confusion about both condom usage and HIV risk appears to play an important role as to why so many young people place themselves at risk.

As an example, in a survey conducted by the Rollins School of Public Health, nearly one in five college-aged men reported never having had received instructions about condoms, while a third did not appear to know how to use condoms correctly. The basic lack of knowledge about condoms and condom use—especially among men who are often expected be wholly knowledgeable about sex—is exacerbated by the way in which many students tend to prioritize HIV when having or discussing sex.

A survey conducted in 2014 by the M.A.C. AIDS Fund showed that, while 85% of teenagers said they had been taught about HIV/AIDS in high school, a full one-third did not know that HIV was an STI.

A similar study by the Councils of Ministers of Education in Canada showed that of the numerous reasons not to have sex, only 1% of 11th grade males and 1.9% of 11th grade females ever considered HIV as a factor.

Quite simply, HIV does not figure all that high on a teenager's list of sexual priorities.

3. Even when teens are concerned about HIV, they generally don't talk about it with each other.

The same study from the Councils of Ministers of Education found that interactions between peers on the subject of HIV were surprisingly low. Of the 3,627 11th grade students surveyed, 49% of males and 49% of females expressed concerns about getting an STI, while slightly less (47% and 43%, respectively) had worries about HIV.

Despite this, only 6% of the 11th grade males and 9% of 11th grade females ever discussed HIV with any of their friends.

One the reasons for this could very well be the negative attitudes many teens have about HIV or what it means to be HIV-infected. In the same cohort of students, 22% of 7th grade males and 17% of 7th grade females stated that they "could not be friends with someone who has HIV/AIDS" while 16% and 10% believed that "people with HIV/AIDS get what they deserve."

While those numbers tended to wane as the teens grew older, the significant stigma associated with HIV would likely discourage open and ready conversations about the disease, particularly among those who might fear they've been infected.

4. Despite what some might think, parent-teen talks do work.

Frank and open discussions about these condoms, HIV and STIs can mitigate many of the potential risks. One study showed that teens who had discussed condoms with their parent were three times more likely to use condoms and less likely to be infected by STIs than those who didn't, while being 20 times more likely to use condoms on  consistent basis.

Similarly, in a national survey of 8,098 U.S. high school students, teens who openly discussed HIV with their parents were seen to be less likely to have multiple sex partners or engage in unprotected sex. The opposite was seen to be true for students who engaged in conversations with their peers, whereby HIV risk was often minimized due to either misinformation, discomfort, or the underestimation of actual risk.

5. Parental discomfort is often the biggest reason why teens choose not to discuss HIV.

Having a frank discussion about HIV can be tough enough given society’s general discomfort with sexuality. Imagine then what it must be like for both parents and teens to discuss all of the so-called "secondary" issues relating to HIV risk—topics which, in some circles, may be considered unacceptable or even taboo.

But consider today that nearly 75% of all adolescent HIV infections are a result of male-to-male sexual contact. Consider that as many as 17% of teenagers have unprotected sex while on alcohol, while 8% who use cocaine and 24% who used marijuana also go without a condos. These are just some of the issues one often needs to touch upon when discussing HIV with their teen.

While keeping these subjects on the table may seem difficult-to-impossible for some families, sweeping them under the carpet can do far worse harm—isolating the teen and denying that person the outreach or treatment that he or she may need.

Moreover, ignoring the reality of teen sex by demanding abstinence will likely do little to impact sexual behavior. A comprehensive review of 30 randomized and non-randomized trials published in 2009 concluded that abstinence-based interventions neither decreased nor increased HIV rates among U.S. youth and were, in the authors' words, largely "ineffective."

If faced with issues beyond your expertise or scope of comprehension, seek support from a qualified HIV specialist or healthcare provider. Teens are often more forthcoming about their sexuality and other risk activities when allowed privacy with a third-party professional.

Learn more about how to find a qualified HIV doctor or contact your regional HIV/AIDS hotline to locate youth healthcare resources nearest you.

Sources:

U.S. Centers for Disease Control and Prevention (CDC). "Diagnoses of HIV Infection in the United States and Dependent Areas, 2011." HIV Surveillance Report. February 2013; Volume 23.

Grunbaum, J.; Kann, L.; Kinchen, S.; et al. "Youth risk behavior surveillance-United States, 2001." Morbidity and Mortality Weekly Report (MMWR). June 28, 2002; 51(4):1-62.

Kapogiannis, B.; Ellen, J.; Xu, J.; et al. "The Strategic Multisite Initiative for the Identification, Linkage and Engagement to Care of HIV-Infected Youth (SMILE): Can Treatment As Prevention Work for American Minority Youth?" 19th International AIDS Society Conference; Washington, D.C.; July 22–27, 2012; abstract TUPE211.

Rollins School of Public Health. "Condom Use Errors and Problem Among College Men." Atlanta, Georgia; October 2, 2001.

The M.A.C. AIDS Fund. "U.S. Teen Survey Headline Highlights." New York, New York; published June 2014.

Holtzman, D. and Rubinson. R. "Parent and peer communication effects on AIDS-related behavior among U.S. high school students." Family Planning Perspective. November-December 1995; 27(6):235-240, 286.

Shoop, D. and Davidson, P. "AIDS and adolescents: the relation of parent and partner communication to adolescent condom use." Journal of Adolescence. April 1994; 17(2):137-148.

Miller, K., Levin, L.; Whittaker, D.; et al. "Patterns of condom use among adolescents: the impact of mother-adolescent communication." American Journal of Public Health. October 1998; 88(10):1542-1544.

Council of Ministers of Education, Canada (CMEC). "Canadian Youth, Sexual Health and HIV/AIDS Study: Factors influencing knowledge, attitudes and behaviours." Toronto, Ontario; 2003: ISBN 0-88987-149-3.

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