Teenagers at risk of human immunodeficiency virus type 1 infection. Results from seroprevalence surveys in the United States
P. Sweeney, M. L. Lindegren, J. W. Buehler, I. M. Onorato and R. S. Janssen
Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga., USA.
OBJECTIVE: To describe the seroprevalence of human immunodeficiency virus
type 1 (HIV-1) and risk factors for HIV-1 infection among teenagers
attending selected clinics. DESIGN: Anonymous, cross-sectional serosurveys
conducted in 130 clinics in 24 cities. SETTINGS: Adolescent medicine
clinics, sexually transmitted disease clinics, clinics in juvenile
detention and correctional facilities, and homeless and runaway youth
centers. PATIENTS: Teenagers in whom serum samples were drawn as part of
routine medical services. MAIN OUTCOME MEASURES: Prevalence of HIV-1
infection and reported HIV risk behaviors. RESULTS: From January 1, 1990
through December 31, 1992, serum specimens were collected from 79,802
teenagers; 591 of these specimens were positive for HIV-1 antibody.
Seropositive test results were found in all 24 cities surveyed, and in 95
(73%) of the 130 clinics surveyed. The median clinic-specific prevalence
was 0.2% (range, 0% to 1.4%) in 22 adolescent medicine clinics, 0.3%
(range, 0% to 6.8%) in 33 correctional facilities, 0.5% (range, 0% to 3.5%)
in 70 sexually transmitted disease clinics, and 1.1% (range, 0% to 4.1%) in
five homeless youth centers. Rates exceeded 1% in 37 sites (28%). Excluding
sites with many men reporting sex with men, rates in women were similar or
somewhat higher than rates in men. Rates were highest among young men
reporting sex with men, with clinic rates ranging from 16% to 17% in two
homeless youth sites and 13% to 17% in two sexually transmitted disease
clinics. Most teenagers with risk information reported heterosexual
activity as their only potential risk exposure to HIV-1. CONCLUSIONS:
Seroprevalence of HIV was generally low but varied by type of clinic and
geographic area. The highest rates were observed among young women and gay
men in some settings, suggesting that targeted prevention messages are
needed.
