Advocates hope new guidelines for testing adolescents at risk for HIV/AIDS will help fight an increase of infections some say was brought on by the George W. Bush administration's abstinence-only sex education program.
"This abstinence-only education was a disaster, and I'm not using the word disaster lightly," said Janet Weinberg, chief operating officer of Gay Men's Health Crisis, the world's first HIV/AIDS prevention, care and advocacy group.
In the Bush era, states who taught abstinence in their schools received federal funding. Thus, a whole generation of American students was left in the dark about safe sex - at least within the school setting - and infection rates skyrocketed.
Weinberg used CDC statistics released in August to illustrate her point. Between 2006 and 2009, there was a 21 percent increase in HIV among men ages 13 to 29 years old. That number was driven by a 34 percent increase in men who have sex with men.
Hardest hit were young blacks between ages 13 and 24, who saw themselves testing positive in greater numbers than ever before.
The moral of the story: When we don't talk with adolescents about sex, their infection rate increases.
Routine testing also becomes an afterthought. A vast majority of at risk-youths do not receive routine testing for HIV/AIDS. Although 65 percent of students claim to be sexually active by the end of high school, only 13 percent have been tested for HIV, according to the 2009 Youth Risk Behavior Study.
"These individuals didn't get HIV by sitting at home by themselves," Weinberg said. "We have to talk about it."
Dialogue, which Weinberg says is a key preventative measure in the fight against HIV infection, can easily be started if at-risk youth are offered routine HIV tests every time they walk into a pediatrician's office or emergency care facility.
Dr. Howard Grossman, HIV/AIDS expert and owner of Manhattan-based Alpha Better Care, says making testing routine not only de-stigmatizes it, it also lets kids know there is a safe place to bring their questions and fears.
"How much easier to just make HIV testing routine and not have to challenge kids to disclose on a subject they are terribly shy about talking with anyone," Grossman said.
Many patients don't get tested simply because a doctor never presents the opportunity during routine visits and physicals, he said. Patients rarely decline the suggestion.
Worse, many physicians think they can eyeball who is at risk, something proven wrong in study after study, he said.
"I most often hear from folks who say they really wanted to get tested, but their doctor never asked, and they were forced to ask," he said. "In some cases, the doctor said, 'Oh, you don't need that test,' and the patient actually had to force the issue."
Soon, forcing the issue may not be necessary.
A study published last month in the journal Pediatrics issued new guidelines for testing at-risk youth for HIV. The Committee on Pediatric AIDS now recommends that healthcare providers offer routine HIV screenings to patients 16 to 18 years of age at least once "if the patient population is more than 0.1 percent" of the community.
In areas of lower concentration, sexually active teens should partake in routine testing, and high-risk youths should be tested annually, the study says.
Grossman takes things a step further.
"I'd say it makes sense to routinely test for all STDs, especially since other STDs can be transmitted in much more casual ways," he said.
Through this process, Grossman says healthcare provides can create both an opportunity for real sex education around these diseases and an atmosphere where kids know they can come for advice. By doing this, healthcare providers can be important tools for stopping STD epidemics in their communities.
"Stopping syphilis, gonorrhea and Chlamydia will have a much greater impact at younger age groups and can lead to more responsible sexual activity later in life, including avoiding HIV," he said.
But many doctors receive resistance from patients' parents, who view pre-marital sex to be at odds with their values.
"When I first came to (Gay Men's Health Crisis), there was a woman who was the director of testing, and she said, 'Janet, you have to know everyone is sleeping with everyone out there,'" Weinberg recalled. "It's not that everyone is sleeping with everyone, but sexuality is very fluid with adolescents."
Weinberg cautions parents not to be shy about HIV and other STDs - subjects that should be part of our everyday vernacular.
"It's a parent's obligation to protect their children, and part of protecting a child is talking about sex," she said.
Weinberg said it's time for parents to start thinking of HIV testing for their children as a need as basic as food and clothing.
"Why is it so hard for a parent to care for their child in this one way?" she asked.
Weinberg says stigma is the No. 1 driver of the HIV/AIDS epidemic, something parents and doctors can combat through their relationships with adolescents.
It was through Weinberg's initiative that New York became the first and only state to compel doctors to offer voluntary HIV tests during any patient examination.
Now, Weinberg is pushing for the same law to become a federal policy for healthcare providers who receive Medicare and Medicaid funding. Perhaps then far fewer lives will be added to the 3.4 million-long list of children across the world estimated to be infected with HIV/AIDS.
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