New CDC Data on Youth HIV/AIDS Risk: Wide Range of Prevention Messages Needed

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VANCOUVER, British Columbia, July 9, 1996 -- Researchers from the Canters for Disease Control and Prevention (CDC) present new findings at the XI International AIDS Conference that document the continued need for HIV prevention messages that are targeted to reflect the diverse experiences of young people, including messages to delay sexual intercourse. Researchers found that many sexually active young women may be at increased risk for HIV infection through sex with older men.

"We cannot accept the repeated toll of HIV infection on our youth," stresses Helene Gayle, M.D., M.P.H., Director of CDC's National Center for HIV, STD, and TB Prevention. "There is increasing evidence that a wide range of prevention messages are needed to reduce this toll." A new study conducted by CDC Behavioral Scientist Kim Miller, Ph.D. underscores the importance of understanding the many factors that make young people vulnerable to HIV infection and the need for prevention messages that address the wide-range of adolescent sexual experience, including abstinence and delay of sexual activity. For young woman who are sexually active, Miller found that the age of their first sex partner may influence their risk of transmission. Young women whose first sex partner was an older man were less likely to use condoms and possibly at higher risk for HIV infection than young women whose first partner was the same age.

"Prevention messages must address the diversity of experience among young people. Risk behaviors varied widely among the adolescents in this study, and so must prevention messages," says Miller. "These findings suggest that in addition to other risk factors, sexually active young women need to understand that they may be at greater risk for HIV if they are having sex with older men..

Risk May Increase with Age of Partner

Miller's study analyzed risk behaviors among a group of 14- to 17 year-old students from New York, Puerto Rico, and Alabama. One component of the study compared the risk behaviors of young women whose first sex partner was at least three years older with risk behaviors of young women whose first sex partner was the same age. Miller found that 35X of the female students reported having their first voluntary sexual experience with older partners (from 3 to 21 years older). These women were more likely to be younger and less likely to use condoms at first intercourse than those whose first partner was the same age.

Moreover, researchers suspect that, due to more varied sexual and drug use experiences, older male partners may also be more likely to be HIV infected than teens sad, therefore, present a greater risk of transmission. The age difference may also make it more difficult for young women to negotiate condom use with their partner.

Surveillance Data Indicate Ongoing Risk

A related CDC study on trends in AIDS incidence (the number of cases diagnosed per year) supports Millers' findings, adding validation to the hypothesis that older men may be playing a role in the spread of HIV to young women. The study, presented by Pascale Wortley, M.D. examined AIDS incidence among women and found that between l990 and 1994. AIDS incidence increased most among women infected heterosexually who were born between 1970 and 1974. An analysis of current AIDS case reports suggest that most women infected heterosexually become infected through sex with an injection drug user. The study examined the relationship between AIDS incidence in men infected through injection drug use and women infected heterosexually and found that among people born between 1970 and 1974, women infected heterosexually outnumbered men infected through injection drug use by more than two to one. This pattern is consistent with the hypothesis that young women are being infected by sex partners older than themselves.

New national data on risk behaviors among 14- to 18-year-olds also demonstrate the potential for HIV risk among young people while, at the same time, showing encouraging signs of behavior change. The study by CDC's Janet Collins, Ph.D. reported trends in sexual behaviors among U.S. high school students by examining data from the national Youth Risk Behavior Surveys (l990 to 1995). No significant change was detected in the number of high school students ever having had sexual intercourse (52%) nor the number reporting sex with four or more partners (18%). However, Collins Pound significant evidence of increased condom use among sexually active young people -- particularly female and African American students.

"The leveling of sexual risk behavior rates and the reported increase in condom use represent important strides in preventing HIV infection among youth," says Collins. "We must continue to promote the delayed initiation of sexual activity and strengthen our efforts in this area as we, at the same time, continue to encourage condom use among those young people who are sexually active.'

New Approaches to Prevention

CDC is looking closely at new tools and approaches to improve prevention messages and programs for youth. In her research, Miller also sought to better define the behavioral intentions of young people using a new system that more clearly defines the range of adolescent sexual experiences so that effective prevention messages and programs can be designed. Miller developed a new typology that classifies a wider range of behavior than the traditional categories of "sexually active" and "sexually inactive." Miller used the typology to classify the adolescents in her study using several new categories. Thirty-seven percent of the young people, ages 14 to 17, fell into the "delayers" category, because they had no intention of initiating sexual intercourse. Twenty-two percent were "anticipators" (those who intended to initiate intercourse in the next year), 5% were "one-timers" (those who had intercourse only one time, but not again), 8% were "steadies" (those with a history of intercourse with one partner), and 28% were "multiples" (those who had a history of intercourse with multiple partners ) .

"Clearly, young people have varying levels of sexual experience. This typology recognizes the diversity of behaviors and intentions among young people and is an important first step in reaching them with messages that are relevant to them," says Miller. "For example, messages promoting delay of sexual activity are important for both 'anticipators' -- those on the verge of sexual activity -- and for 'one timers' -- those who have only had sex once. But the approaches would have to be very different and based on their experience," says Miller.

CDC hopes that these and other findings will lead to improved HIV prevention programs for young people. "CDC has for many years worked to provide state and local health and education agencies, and community based organizations assistance in designing effective HIV prevention messages and programs for young people," says Gayle. "We will continue this collaboration to improve HIV prevention. Our future depends on it."

CONTACT: CDC Press Office Vancouver, 604-844-2851