• Alcohol use is associated with impaired judgment and reduced condom use during sexual activity. In 1991, an estimated eight million junior and senior high school students (40% of this population) reported weekly consumption of alcohol, including 5.4 million students who "binged" with five or more drinks in a row and 454,000 who reported an average weekly consumption of 15 alcoholic drinks.

THOUSANDS OF TEENS THOUGHT TO BE ALREADY INFECTED WITH HIV

Each year at least 40,000 new HIV infections occur among adolescents and adults. The national prevalence of HIV in adolescents is unknown. However, large studies have found that more than one in 300 Job Corps entrants and more than one in 3,000 military applicants were infected with HIV. In both studies, males had higher HIV infection rates. However, among youth ages 16-18, females were more likely than males to be infected with HIV.

Smaller studies have found high rates of HIV infection among youth. In New York City, one in 170 teenage women delivering live births was infected with HIV. Among teenagers attending STD clinics, an average of one in 200 teens was infected. Seroprevalence studies of runaway and gay youth have found even higher rates of infection.

AIDS IN ADOLESCENTS INCREASING AT ALARMING RATE/FEMALES AND MINORITIES REPRESENT GREATER PROPORTION OF CASES IN YOUTH THAN IN ADULTS

During the past two years alone, the number of teens and young adults (ages 13-24) who were diagnosed with AIDS increased by 62%. More than half of U.S. AIDS cases among persons ages 13-24 have been reported during the past three years of the decade-old epidemic.

By the end of 1991, AIDS cases had been reported among persons ages 13-24 in 49 states and the District of Columbia,

nearly 100 large metropolitan areas, and numerous small towns and rural communities across the country. Nearly onethird of AIDS cases among teens has been reported in areas with populations less than 500,000.

In adults over 25, one in ten people with AIDS is female. In teenagers, this ratio drops to one in four. Heterosexual transmission accounts for 45% of AIDS cases among teenage girls, compared with 33% among women over age 25. Seventy percent of female adolescents with AIDS are racial or ethnic minority youth.

Racial and ethnic minority populations are disproportionately represented among AIDS cases at all age levels, particularly in teens. While African-Americans and Hispanics comprise 15% and 12% of the U.S. teenage population (ages 13-19) respectively, they represent 37% and 19% of reported AIDS cases among teens. Among adults, African-Americans and Hispanic persons account for 28% and 16% of AIDS cases, respectively.

Each year, an estimated one million adolescents run away from home or are homeless. Lacking skills and resources to support themselves, many resort to unprotected "survival sex" (the exchange of sex for money, food, shelter or drugs). Runaway and homeless youth also report high levels of alcohol and other drug use, and increased rates of STDs, pregnancy, sexual abuse and rape.

In 1991, the San Francisco Department of Public Health found that among more than 250 gay and bisexual men ages 17-25, youth under age 20 had the highest rate of HIV infection (14.3%), and were significantly more likely than older men to report unprotected oral or anal sex. High rates of risky sexual and drug-related behavior have also been found in gay and bisexual male teens in Minnesota and New

York City. Despite elevated risk, few prevention efforts and services have been targeted to gay and bisexual youth.

A 1989 survey found that 95,621 youth were held in public and private juvenile facilities and adult jails on census day. Although data on risk-taking and services available to detained and incarcerated youth are scarce, one study found that virtually all (99%) detainees were sexually experienced, more than half reported first intercourse before or at age 12, only 28% reported consistent condom use, and 13% reported having injected drugs. Other studies have shown high rates of STDs and low knowledge about HIV risk-reduction strategies.

High rates of sexual activity, pregnancy and drug use have been found in youth in foster care. In one study of girls ages 13-18, those in foster care were 50% more likely to report having had sex and were significantly less informed about birth control than girls who were not in foster care. Confusion about who should provide HIV prevention and services to adolescents in foster care is widespread, and most states do not have specific policies to address HIV-related issues affecting children and youth in foster care.

Injected drug use plays an important role in fueling the HIV epidemic. While rates of injected drug use are lower among youth than adults, sharing "works" is most common at the earliest stages of injected drug use, and 10% of persons in drug treatment programs who reported intravenous drug use were age 21 or younger.

Crack use has contributed to high levels of HIV and other STDs in a number of states, including Georgia, New Jersey and New York. A study of teenage crack users in Oakland and San Francisco, California, found that 96% were sexually active, 51% had combined crack with sex, 41% had a history of STDs, 25% had traded sex for drugs or money, and first use of condoms occurred two years after sexual activity began.

Among applicants to the military, African-American youth were five times more likely than whites to be infected with HIV. By age 21, nearly one in 80 minority entrants to the Job Corps was infected with HIV. Higher rates of STDs and sexual activity and lower knowledge about AIDS have been reported in minority youth than in white youth.

An estimated one in four girls and one in six boys are sexually assaulted before age 18. One recent study found that compared with persons who were not sexually abused as children, survivors of sexual abuse were four times more likely to be working as prostitutes, almost three times more likely to become pregnant before age 18, and twice as likely to have multiple sexual partners during one year, increasing their risk of HIV infection.

Out-of-school youth, who are at increased risk of infection,
are unlikely to have access to HIV prevention information.
In FY 1989, only 4% of state educational agency funds and
7% of local educational agency funds had been allocated to
prevention for out-of-school youth, and after two years of
funding, one-third of the state agencies had no programming
in place.
Respondents to Select Committee interviews
reported that once these youth are identified, HIV
prevention efforts are often successful.

While few new cases of AIDS have been attributed to contaminated blood and blood products, more than half of Americans with hemophilia may already be infected with HIV. Sexual partners of infected hemophiliac teens are at increased risk of infection.

COMPREHENSIVE HIV PREVENTION PROGRAMS THAT COMBINE SKILLS TRAINING, ACCESS TO CARE, AND COMMUNITY SUPPORT HAVE SHOWN PROMISE IN REDUCING RISKY BEHAVIOR

A recent analysis of 100 programs that were successful in reducing high-risk behavior among youth found several common strategies: early intervention; intense one-on-one

attention; social skills training; involvement of parents; schools as the focal point; and community-wide, multi-agency approaches to provide resources and reinforce messages. Peer educators have been used in several successful prevention programs, and many effective models include preparation for entering the labor market.

The Youth and AIDS Project at the University of Minnesota provides individual risk reduction counseling, peer education, and referral to psychosocial services to gay and bisexual youth. Initial data indicate that participants report decreases in risky sexual behavior, regular use of alcohol during sexual situations, dysfunctional substance abuse, and denial of personal vulnerability to AIDS. Consistent use of condoms during anal intercourse nearly doubled.

A 1991 study of 145 runaway and homeless youth in New York City found that comprehensive intervention, including discussion of knowledge about HIV, coping and social skills training, and access to medical and other services significantly reduced risk-taking behavior among these youth. After participating in the program, reports of consistent condom use increased from less than 25% to more than 60%. Very high-risk sexual behavior (multiple sexual partners and encounters, and failure to use condoms) decreased from nearly 25% to zero.

COST OF

HIV-RELATED

TREATMENT SKYROCKETING/SPECIFIC COSTS FOR YOUTH UNKNOWN, ACCESS TO CARE LIMITED

By 1994, the cost of caring for all persons with HIV disease and AIDS may reach $10.6 billion. The annual costs per person of treating AIDS and HIV disease are estimated at $32,000 and $5,150, respectively. Estimates for the cost of treating adolescents are not available.

In recent years, Medicaid has covered an increasing share of medical costs associated with the HIV epidemic. However, an estimated 4.6 million adolescents ages 10-18 lack health