Significant financial, institutional, legal and social barriers hinder adolescents' access to health care. The Federal government offers little help in breaking down these barriers.

But this report is not just a compilation of relevant statistics or a review of Federal efforts. It is an urgent plea to confront the problem of AIDS and adolescents and takes the first step by laying the groundwork for positive policy and community change that should prove valuable to policymakers and program planners.

The Select Committee has confirmed that experts agree early intervention is the best strategy to prevent further spread of the virus. It is easier to prevent risky behavior before it starts than to change entrenched behaviors. However, few efforts to control HIV infection have targeted adolescents who are initiating sexual and drug use activity at younger and younger ages. This failure has seriously hindered our ability to contain the epidemic and to meet the needs of young people and their families who have been devastated by it.

While the Select Committee found that the extent of the problem is alarming, there is good news as well. We identified many innovative programs which prevent or reduce risky behavior among youth. These model efforts often combine intensive individual attention with life skills training and involve peer educators, parents, schools, and community organizations, which provide resources and reinforce messages.

Unfortunately, these comprehensive programs are the exception rather than the rule. Few HIV prevention efforts have gone beyond "AIDS 101" to provide youth with the skills and support they need to be safe. Little has been done to reach outof-school youth who often face significantly greater risk of infection.

To understand how some programs root themselves successfully in their communities and overcome obstacles to providing services to teens, the Select Committee also conducted key informant interviews with front-line experts from prevention programs from across the country.

Most promising is the finding that although community resistance to HIV prevention efforts is often anticipated, it proves to be a relatively minor problem. Community apathy, while more prevalent, can be overcome, beginning with early and sustained involvement of parents and community organizations in HIV prevention efforts. Support seems to "snowball" once key community segments (including school officials, business leaders, and religious organizations) become involved. A still pervasive problem, however, is the inadequacy and lack of health care, drug treatment, and family planning services for teens in their communities.

Given the escalating and evolving nature of the disease, the Federal government cannot solve this problem alone. Adolescents, women, infants, and members of racial and ethnic minority communities are increasingly represented among persons with HIV disease and AIDS. A comprehensive strategy involving the experts and all concerned groups is required to slow the epidemic, provide care to everyone who is infected, and address the needs of all populations affected.

Most importantly for teens, parents and schools remain essential sources of support. We must reinforce their ability and confidence to respond to the epidemic.

In our 1987 report, "A Generation in Jeopardy: Children and AIDS," the Select Committee on Children, Youth, and Families warned that if we failed to limit the spread of HIV, thousands of children and youth would be lost and their families devastated. Tragically, our predictions are proving true.

As the Select Committee urged in its last report, we must put ideology aside and marshall every available tool to slow the epidemic and focus more attention on teens, who certainly will be the fastest growing group of persons with AIDS if we fail to act today. The support and involvement of parents, the commitment of resources and expertise from schools, businesses, and community organizations, as well as from local, state, and Federal governments are crucial.

We hope this report will alert teens, parents and the public to the still silent threat of AIDS and its effect on the nation's youth. It is the silence that is killing them and will continue to threaten the health and well-being of all the nation's youth. Every day that we ignore the epidemic, HIV gains ground and threatens the loss of another generation.

(signed) PATRICIA SCHROEDER. Chairwoman
GEORGE MILLER

WILLIAM LEHMAN
MATTHEW F. MCHUGH

TED WEISS

BERYL ANTHONY, JR.

BARBARA BOXER

SANDER M. LEVIN
J. ROY ROWLAND
GERRY SIKORSKI

ALAN WHEAT

MATTHEW G. MARTINEZ

LANE EVANS

RICHARD J. DURBIN

DAVID E. SKAGGS

BILL SARPALIUS

TIM JOHNSON

BARBARA-ROSE COLLINS

JOAN KELLY HORN

JIM BACCHUS

PETE PETERSON

BUD CRAMER

REPORT FINDINGS

MILLIONS OF TEENS IN DANGER OF CONTRACTING HIV INFECTION AND AIDS

By age 20, 68% of adolescent females and 86% of adolescent males are sexually active. Among sexually experienced teens ages 18-19, nearly 25% of females report having had six or more partners and nearly 20% of males report having had six to ten partners. The correct and consistent use of latex condoms prevents HIV transmission. Yet, only 47% of females and 55% of males report use of condoms at first intercourse.

Three million teens are infected with a sexually transmitted disease (STD) each year. In 1990, nearly two-thirds of the more than 12 million STD cases reported were among persons under age 25. The same risky sexual behavior that transmits HIV transmits STDs, and lesions from other STDs increase the risk of HIV infection.

Lack of recent and reliable data has prevented accurate assessment of the extent of homosexual behavior and anal sex among adolescents. Data from a 1970 national survey found that at least 20% of men had homosexual experience, with the majority reporting this activity during teenage years. Other smaller studies have found that 9% to 37% of male adolescents have had same-gender sexual experiences. More than 25% of teenage girls attending an adolescent outpatient clinic in New York City reported engaging in anal intercourse. Prevention program representatives interviewed by Select Committee staff said better information about adolescent sexual behavior is badly needed.

In 1990, 2.9% of high school seniors reported using steroids (injected by most users), and 1.3% reported heroin use. In addition, 3.5% of high school seniors reported having used crack cocaine, which is believed to play an important role in the spread of HIV due to its highly addictive properties and its association with unprotected sexual behavior.