Association Between Sexually Transmitted Diseases and Young Adults’ Self-reported Abstinence. Ralph J. DiClemente, Jessica McDermott Sales, Fred Danner and Richard A. Crosby.
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Association Between Sexually Transmitted Diseases and Young Adults’ Self-reported Abstinence
(PDF – 68 MB) Jan 3, 2011
Self-reported behavior has been the cornerstone of sexual health research and clinical practice, yet advances in sexually transmitted disease (STD) screening provide researchers with the opportunity to objectively quantify sexual risk behaviors.
How does HIV affect children and adolescents?
It is estimated that approximately 10,000 children are living with HIV infection in the United States. In the United States, the number of infants born with HIV infection has dramatically decreased from about 2,000 a year to fewer than 200 a year due to identification of HIV infection in pregnant women and use of anti-HIV drugs during pregnancy, cesarean delivery, and avoidance of breastfeeding.
In contrast to the United States, mother-to-child transmission in developing countries remains a major problem; about 700,000 infants are newly infected with HIV each year because most women are not screened for HIV during pregnancy, anti-HIV drugs are not available, and safe alternatives to breastfeeding are not available.
Prior to 1985, when screening of the nation’s blood supply for HIV began, some children as well as adults were infected through transfusions with blood or blood products contaminated with HIV, but this is now rare in the United States.
In contrast to the dramatic decrease in mother-to-child transmission of HIV infection, the number of cases of HIV infection in adolescents and young adults continues to increase in the United States. About one-third to one-half of new HIV infections in the United States are among adolescents and young adults.
Most HIV-infected adolescents and young adults are exposed to the virus through unprotected sex; some teens and young adults are also infected through injection drug use. In addition, an increasing number of children who were infected as infants are now surviving to adolescence.
Clue to Adolescent Immune System’s Response to HIV Infection
Half of all new HIV infections occur in young people under 25 years of age.[3] Since the time between HIV infection and AIDS diagnosis averages about ten years, scientists believe that many, if not most, adults diagnosed with AIDS in their twenties were infected with the virus as adolescents. However, little is known about the HIV disease process in adolescents and about the best ways to treat the disease in this age group. Because so many developmental changes are occurring, treatments suitable for adults may not apply to adolescents who are infected with HIV. Researchers recently uncovered an important clue to better understand HIV infection in adolescents. Adolescents with HIV appear to have a higher number of the infection-fighting T-cells than do adults with the virus. These cells are a special target for the HIV virus. Researchers discovered that adolescents in the early stage of HIV infection had an unexpectedly disturbed immune response. The disturbance coincided with the virus reproducing itself rapidly. This altered immune response may indicate that the adolescents’ immune systems are already affected even before the infection can be detected by standard monitoring. What appeared to be a clinical state of equilibrium between the immune system and the virus, in reality, may be masking a profound change in immune cell function in HIV-infected youth. This finding opens intriguing questions about the processes of HIV infection and immune-system destruction in adolescents and suggests that this age group may need interventions that go beyond the current approaches to treat HIV in adults.
[3] Office of National AIDS Policy. Youth and HIV/AIDS 2000: A new American agenda. Washington, DC: White House, 2000.