This newsletter was developed as part of the Centers for Disease Control and Prevention (CDC) Division of Adolescent and School Health’s (DASH) initiative, Expanding Partnerships and Disseminating HIV Prevention Materials to Reduce HIV and other STDs among Adolescents through National Non-Governmental Organizations (PS16-1603). The initiative was created to increase education of key stakeholders on CDC-developed approaches to school-based programs for creating healthier adolescents (10-19 years old) by reducing HIV and STD infection. This issue focuses on World AIDS Day and ending the HIV epidemic.
On Their Terms: Expanding PrEP Access for Young People (Authored by Kristina Santana, Senior Associate, Prevention & Health Care Access, NASTAD)
Every December 1, we commemorate World AIDS Day, a day to honor those living with HIV, those who have died from an HIV-related illness, and the history of the fight. Rooted in activism, people living with HIV and grassroot organizations demanded to not only be a part of the conversation, but lead the conversations around HIV prevention, HIV care, and sexual health. As support strengthens and we continue to bring awareness to all communities, it is important to acknowledge the work still needed and who is still missing from the conversation. With a renewed spirit in HIV activism, we are seeing a wave of young people demanding to be included.
Data from the U.S. Centers for Disease Control and Prevention (CDC) indicate that of all age groups, young people are the least likely to get linked to care. This impacts their ability to receive treatment and ultimately reach a suppressed viral load. In 2012, only 44% of young people living with HIV had a reported suppressed viral load, which was the lowest of any age group. As a secondary method of prevention, viral load suppression is crucial to decreasing the number of new infections. When the viral load of a person with HIV can’t be detected, then there is no risk of sexually transmitting the virus to an HIV-negative person. As research confirms, undetectable = untransmittable (U=U). In 2015, 22% of all new HIV infections were among young people (ages 13-24). When the data is further examined, we see that the majority of new infection cases are among gay and bisexual men. Representative of all age groups, this trend is indicative of larger lapses in prevention and care efforts for certain populations. Despite having a significant decrease in new infections since 2008, this disparity is unacceptable, as we know we have the tools and innovations to eliminate new cases.
Pre-exposure Prophylaxis (PrEP) could be one answer for many young gay and bisexual men. PrEP is a medication that works to prevent HIV by disrupting its ability to replicate. Without replication, acquisition is impossible. Research shows PrEP is up to 99% effective in preventing new infections when taken daily. Yet, to be a successful strategy, young people must 1) know about it and 2) be able to access it.
One of the biggest barriers to access to PrEP for young people is consent. As it relates to sexual health services, in all 50 states and Washington D.C. minors may consent to Sexually Transmitted Infection (STI) services.Typically HIV prevention and treatment is included in such services, however, depending on the jurisdiction’s laws, PrEP may not be considered an STI service or as HIV treatment and prevention. Most states have a statute that indicates in the case of an actual or suspected HIV exposure, minors can consent when it comes to diagnosis and treatment. What is unclear is if PrEP is considered a form of treatment for those who were exposed, but did not seroconvert. Legislators and courts need to clarify if treatment will include a prophylaxis, which would include PrEP. If these ambiguous areas are not addressed or clarified, the lives of so many young people could be at risk of seroconverting to HIV.
In addition to consent, confidentiality issues play a central role in impacting young people’s decision to seek care and treatment. In some jurisdictions, when minors are seeking services, providers may be required to inform a caregiver. For example, in Iowa a minor can consent to HIV testing, but if the test is positive then by law a caregiver must be informed of the results. Depending on the home life or community of that person, this could potentially be frightening, stigmatizing, or even life-threatening. The ambiguity of consent laws, specifically regarding PrEP coverage, create confusion and additional barriers for all clients and providers. If we are going to continue to reduce new infections among young people, integrating PrEP services with existing prevention efforts (e.g., testing, condom distribution, treatment as prevention) is crucial. That is why it is important to examine how we are promoting access for all young people.
The voice of young people must be heard in the prevention strategies we implement, in the patient-centered care that is delivered, and in the policies that guide decisions. In order to have that voice, we must start holding conversations with young people about PrEP, educating them about its potential benefits, and listening to their experiences. Once we do, then can we truly start moving toward ending the HIV epidemic.
Resources from the CDC
- For information about how to get involved in World Aids Day on December 1, as well as Federal HIV policies, programs, and resources available to the American public, visit gov.
- The Get Tested website enables individuals to find free, fast and confidential testing services near them.
- Take a look at this factsheet to learn more about HIV testing among adolescents and what schools and education agencies can do.
- Stay up to date on the latest CDC DASH resources by following them on Twitter and visiting their website!
UPCOMING CONFERENCES AND WORKSHOPS
AASA: Education in the Digital Age
Date & Location: February 15-17, 2018 in Nashville, TN.
Registration for the School Superintendents Association (AASA) annual conference is now open! Join school superintendents for interactive workshops and sessions discussing: Curriculum and Instruction, Digitizing Education, Leadership for Equity, Personalizing Education, Principal Supervisor Initiatives, Superintendent / School Board Relationships.
Time to Thrive Conference
Date & Location: February 16-18, 2018 in Orlando, FL.
Workshop: Building and Sustaining Systems of Support for LGBTQ Youth, a presentation by Lacey Rosenbaum, PhD (American Physiological Association) and Mary Beth Szydlowski MPH, CHES (Advocates for Youth).
This workshop is for school and education agency leaders who are working to build and sustain systems of support for LGBTQ youth. This workshop will focus on specific strategies and resources leaders can use to establish safe and supportive school environments and promote inclusive sexual health education for LGBTQ youth. National NGOs, the American Psychological Association (APA) and Advocates for Youth, will share examples from education agencies who have built sustainable systems of support for LGBTQ youth and provide resources that participants can use to provide professional development, develop policies and guidance, and adopt inclusive curriculum.
Registration for the fifth annual Time to Thrive conference is now open!
The Human Rights Campaign Foundation in partnership with the National Education Association and the American Counseling Association present Time To THRIVE, the annual national conference to promote safety, inclusion and well-being for LGBTQ youth…everywhere!
Date & Location: March 20-24, 2018 in Nashville, TN.
Registration for the 2018 SHAPE America National Convention & Expo is expected to open soon! At the conference you’ll connect and learn from innovative educators and leave inspired by new ideas! Click here for more information about registration rates.
IN CASE YOU MISSED IT
HTN Workshop: Serving the Individual: An Exploration of High Quality Sexual Health Education and Safe and Supportive Environments by Youth Experts, a presentation by Brittany McBride, MPH (Advocates for Youth). The workshop was designed for youth-serving professionals to further develop skills that enhanced their work by analyzing the impact social determinants of health play in the overall sexual health of youth. Kim Westheimer, Gender Spectrum; Scout Bratt, Chicago Women Health Center; Stella Shane Shananaquet; and Shane Shananaquet joined as youth expert panelists to provide insight on how the four levels of the Social Ecological model: individual, relationship, community, and society, play a role in the delivery of high quality sexual health education and safe and supportive environments. Participants engaged in small/large group discussions, interactive activities, and directly communicated with the panel to apply the content from the presentation in their current practices. Click here to view the presentation slides.
NCSD Workshop: Nothing About Us Without Us: Building and Sustaining Youth Adult Partnerships, a presentation by Jessica Anderson (Young Woman’s Project), Brittany McBride, MPH (Advocates for Youth), and Lillian Pinto (National Coalition of STD Directors). Young people should be involved in developing the programs and policies that will serve and affect them. Involving youth in design, development, and implementation of programs can provide important protective factors for young people. This session covered the key components of establishing effective youth-adult partnerships for reducing HIV/STD infections in adolescents, and strategies for actively engaging young people and including youth in decision making from the beginning of a project. The pre-conference session included presentations from local high-school students, Lavelle Taylor, Senior, Ballou High School and Terrionna Thomas, Senior, Roosevelt STAY High School, on their perspectives and experiences in working with the DC Department of Health on prevention programing. Click here to view the presentation slides.