Patients and Providers: The PWP Team

Understanding At-Risk Patient Populations

As discussed in previous modules, an estimated 25% to 50% of new HIV infections each year occur among young people aged 13 to 24. Health care providers are faced with several trends that are increasing the numbers of HIV-infected youth in their practices. First, a large cohort of perinatally infected adolescents is now transitioning from pediatric to adolescent medical settings. Second, HIV-infected adults often acquire the virus during adolescence, and there is now more outreach and HIV case finding among this age group. Third, improvements in treatment and care are allowing people with HIV infection to lead more normal lives.

Of the estimated 184,991 adult and adolescent HIV infections diagnosed during 2001-2005, more (51%) occurred among Blacks/African Americans than among all other racial/ethnic populations combined. Most (62%) new diagnoses occurred among persons aged 25-44; in this age group, Blacks/African Americans accounted for 48% of new diagnoses. Although adult and adolescent Blacks/African Americans accounted for 13% of the population in the 33 states for which data are available during 2001-2005, they accounted for 50.5% of the 184,991 new HIV/AIDS diagnoses; Whites accounted for 72% of the population and 29.3% of diagnoses; Latinos accounted for 13% of the population and 18.2% of diagnoses. Among racial/ethnic populations, Blacks/African Americans accounted for the largest percentages of cases diagnosed in both males (43.9%) and females (67.2%).

Although Asian Americans and Pacific Islanders (AA/PIs) account for approximately 1% of the HIV cases in the 33 states with long-term, confidential name-based HIV reporting, the AA/PI population in the United States is growing. In fact, increases in HIV diagnosis rates (the estimated annual percentage change) from 2001 to 2004 were greatest among AA/PI women (14.3) and men (8.1) in comparison with other racial/ethnic groups.

To understand how prevention efforts should be focused, it is useful to know how the virus is most often transmitted to youth:

1. Unprotected sex
2. Intravenous drug use
3. Perinatal infection

Providers should be aware of key societal and disease-related risk factors that are known to contribute to the elevated rates of HIV transmission among youth. Among these is a history of trauma such as physical or sexual abuse. Research has demonstrated that the chances someone will engage in behaviors that put them at risk of HIV infection are increased when the person has experienced a trauma.1 These behaviors include unprotected sex, use of alcohol, and exchanging sex to meet survival needs.2 Understanding these issues can aid in anticipating barriers to risk reduction and in designing prevention efforts that are tailored to each patient's individual set of risk factors.

References

1. Kalichman SC, Gore-Felton C. Trauma symptoms, sexual behaviors, and substance abuse: correlates of childhood sexual abuse and HIV risks among men who have sex with men. J Child Sex Abus. 2004;13(1):1-15.
2. Kalichman SC, Simbayi LC. Sexual assault history and risks for sexually transmitted infections among women in an African township in Cape Town, South Africa. AIDS Care. 2004 Aug;16(6):681-9.