HIV/AIDS and Adolescents and Young Adults
A Factsheet for Practitioners
Social workers have a key role in helping adolescents and young adults (and their families) affected by HIV/AIDS. A recent NASW study showed that 39 percent of NASW members are employed in mental health settings: 14 percent in family and child services settings; 8 percent in medical clinics; 6 percent in schools; a combined 11 percent in aging, adolescents, addictions, and international settings; and 28 percent in multiple areas or other categories. (NASW, Practice Research Network, 2000).
Because adolescents and young adults receive services in all these practice settings, social workers have the opportunity to address the myriad of issues that are a part of living with HIV/AIDS. The broad range of practice settings also provides the opportunity for social workers to develop and improve prevention and harm-reduction strategies, identify treatment options, ensure access to care, and influence agency and public policy.
How pervasive is the HIV/AIDS epidemic among adolescents and young adults?
HIV/AIDS infections are on the rise among adolescents, particularly among racial and ethnic minority populations and young women. The following statistics highlight the incidence and correlative factors of HIV/AIDS among adolescents and young adults.
- Fifty percent of all new HIV infections occur in young people under the age of 25, with an estimated 20,000 or more young people infected annually. (Centers for Disease Control and Prevention, 2001).Approximately 50 percent of all high school students in grades nine through 12 have had sexual intercourse; almost 25 percent of all 12th graders have had four or more partners. About one-half of these same 12th graders reported using a latex condom during intercourse (American Association of World Health, 1999).Research shows that older male partners present a greater HIV transmission risk than adolescent males because they are more likely to have had multiple sex partners, more varied sexual and drug experiences, and to be infected with HIV. Older men engaging in sex with younger women is disproportionately high in African American and Latino populations (Department of Health and Human Services, 1998).
- A seven-city study conducted between 1994 and 1998 found that just over 7 percent of young men who have sex with men (MSMs) are HIV-positive; the study found that the rates increased with age and were higher among African-Americans; Hispanics, and men of mixed race than among Caucasians or Asian/Pacific Islanders. MSMs continue to be at high risk for HIV infection. In 1999, at least half of all reported HIV infections among males aged 13 through 24 occurred among young men who have sex with men (American Federation of AIDS Research 2001).
What role does substance use have in the spread of HIV/AIDS among adolescents and young adults?
According to a study by the American Federation of AIDS Research (2001), the sexual behavior of young people is highly influenced by the use of alcohol and drugs, which decreases decision-making skills and has a negative effect on behavior. This study found that an estimated 3 million teenagers were alcoholics. Several million more had a drinking problem that they could not handle on their own. A separate study showed that in high school youths, steroid was a problem among athletes of both genders.
Steroid use, including injecting steroids, occurs more often among young people who are involved in physical training because anabolic steroids increase muscle mass, strength, and stamina (Mathias, 1997). The fact that steroids can be injected intravenously places users at risk for contracting HIV/AIDS and hepatitis C.
The following statistics highlight the seriousness of alcohol and substance abuse among adolescents and young adults.
- Of youths 12 through 17 years of age who responded to a national household survey in 1999, approximately 1.3 million reported dependency on illicit drugs or alcohol. (Office of National AIDS Policy, 2000)
- Drug injection led to 6 percent of HIV diagnoses in young people13 through 24 years of age from 1994 to 1997; 57 percent of HIV cases were attributed to sexual transmission, of which 26 percent were contracted through heterosexual sex and 31 percent through male to male sex. (American Association for World Health, 1999)
What do I need to know about testing and reporting laws and HIV/AIDS?
It is important for social workers to be aware of state HIV/AIDS testing and reporting laws. All 50 states and the District of Columbia allow minors to receive testing for sexually transmitted diseases (STDs) without the consent of an adult. However, some states categorize HIV separately from STDs and may require minors to have the consent of a guardian to receive testing and treatment for HIV. Also, some states require that treatment for STDs and HIV be reported. It is advised that you contact your local public health authority for your state’s specific policies on testing and treating youths for HIV. (American Association for World Health, 2001)
What intervention strategies can be used with the adolescent and young adult population?
Social workers encounter adolescents and young adults in a variety of settings, ranging from schools, family welfare agencies, mental health settings, to community and faith-based organizations. Because adolescents and young adults receive services in all of these settings, social workers can affect change through individual, family, group, and community wide interventions.
It is important to conduct a risk assessment for all youths who receive services. A biopsychosocial assessment includes risk assessment for alcohol, tobacco, and other drugs (ATOD); violence and abuse; sexual activity and practices; history of other STD’s; pregnancy; and social supports. The following are suggestions that social workers can use when providing services for adolescents and young people affected by HIV/AIDS.
- Encourage your client(s) to be open and honest about their sexual history, current sexual activities, and substance use history.Learn about harm-reduction strategies for alcohol and other drugs, as well as safer sex practices, and share information with young adults.Understand how HIV/AIDS is (and is not) transmitted. Share accurate information with clients, including the benefits of testing, prevention, and intervention with HIV/AIDS.
- Provide support for and discuss the benefits of practicing abstinence with adolescents who are not sexually active.
Working with parents and other caregivers provides an opportunity to educate them about HIV/AIDS prevention and services. In working with families it is important to
- acknowledge that talking about HIV/AIDS can be difficult and uncomfortable because of the complexity of the issue and respect cultural differences with the goal of helping parents openly discuss issues related to HIV/AIDSlearn about school, community, and Internet resources and refer parents and other caregivers to resources that will maximize opportunities to learn culturally sensitive, age-appropriate content to share with their own family members
- identify creative opportunities for discussion—for example, how to use television and other forms of media or entertainment to talk to their children about HIV/AIDS, substance use, and other related issues.
Working with groups and in the community provides the opportunity to address a range of relationship issues, such as relationship violence, drug abuse, safer sex, and abstinence from sex and drugs. A few suggestions are to
- emphasize the importance of harm reduction practices, ranging from abstinence to consistent safer sex practices.(for example, using condoms).promote peer-group education and intervention among adolescents. This type of intervention improves HIV knowledge and decreases risk behaviors. Peer intervention can also increase condom acquisition and use and reduce the practice of unprotected sexual intercourse, frequency of intercourse, and the number of sexual partners (Jemmott & Jemmott 1997).
- start HIV/AIDS and STD prevention groups in schools. Because peer group intervention has proven to be effective, encourage all teenagers, including those living with HIV/AIDS, to be active in peer education groups.
Systems or Community Interventions
Because support from all segments of the population is vital, it is important to mobilize groups and organizations that work with young people to fully integrate information about HIV/AIDS in their programming. Prevention of HIV/AIDS is a community concern in which all members play a part in addressing the needs of adolescents and young people.
As professionals in the community, social workers should provide leadership and lobby with other groups at the local, state, and federal levels on behalf of people with HIV/AIDS to improve the quality of their lives and protect their civil liberties. Social workers across fields of practice must advocate for increased funding for HIV/AIDS research, education, and prevention (NASW, 2000).
Several ways for social workers to accomplish change in the community are to:
- encourage adolescent drug treatment agencies to address the issue of HIV/AIDS and hepatitis C through individual work with young adults and education of clients and their parents or caregivers
- attend and/or facilitate workshops and training programs that educate service providers about adolescents and HIV/AIDS; such workshops provide health and mental health professionals with up-to-date information regarding the most recent trends and issues associated with HIV/AIDS.
Despite the challenges to social workers in working with adolescents for HIV/AIDS prevention and treatment, it is vital for groups to be involved in supporting and motivating young people to maintain a healthy lifestyle and be aware of the risk factors associated with HIV/AIDS and other STDs. Parents; schools; religious institutions; the media; and community and state leaders are all responsible for providing a nurturing atmosphere for our youths.
- American Association for World Health. (2001). Youth and AIDS in the 21st century: I care, do you? Washington, DC: Author.
- American Association for World Health. (1999). HIV in specific populations.
- American Federation of AIDS Research (2001). Keeping count: HIV/AIDS and young people. [The Body website is available, but no longer run by amfAR.]
- Centers For Disease Control and Prevention. (2001) HIV prevention strategic plan through 2005. Atlanta: Author
- Department of Health and Human Services. (1998). New tools for HIV care: STD treatment. Rockville, MD: Health Resources & Services Administration.
- Jemmott, J. B., & Jemmott, L. S. (1997, February 11-13). Behavioral interventions with heterosexual adolescents. Paper presented at NIH Consensus Development Conference on Interventions to Prevent HIV Risk Behaviors, National Institutes of Health, Bethesda, MD.
- Mathias, R. (1997). Steroid prevention program scores with high school youth. Washington, D.C.: National Institute of Drug Abuse.National Association of Social Workers. (2000).
- Acquired immunodeficiency syndrome and human immunodeficiency virus: A social work response. In Social Work Speaks (5th ed., pp. 3–7). Washington, DC: Author.
- National Association of Social Workers, Practice Research Network. (2000). Informing research and policy through social work practice. Washington, DC: Author.
- Office of National AIDS Policy. (2000). Youth and HIV/AIDS policy 2000: A new American agenda. Washington, DC: Author.
Fact sheet created by Corey Beauford, MSW intern for the NASW HIV/AIDS Spectrum: Mental Health Training and Education of Social Workers Project. For more information contact Evelyn P. Tomaszewski, ACSW, at 202-408-8600.
The NASW HIV/AIDS Spectrum: Mental Health Training and Education of Social Workers Project is funded by CMHS Contract No. 280-01-8055.