HIV-positive teenagers are much less likely than adults to access specialist medical services after testing for HIV, even though they have high rates of psychiatric illness, sexually transmitted infections and pregnancy, according to research published in the 24th January 2003 edition of the journal AIDS.
Approximately 900 teenagers have been diagnosed HIV-positive in the UK since reporting began, and although the HIV and sexual health needs of this group are the focus of current UK government health promotion initiatives, they have been little studied.
Investigators at specialist HIV and sexual health clinics in London and south east England matched 62 HIV-positive teenagers (aged 15-19) with adult controls (aged 20 or above), who had accessed HIV medical services between 1985 and 2001. Researchers then compared reasons for HIV-testing; number lost at follow-up; rates of mental illness; and prevalence of sexually transmitted infections and unwanted pregnancy.
Reasons for HIV-testing were not statistically different between teenagers. However, at testing adults were more likely to be have symptomatic HIV disease or an AIDS defining condition (35% adults versus 13% of teenagers), and to have a CD4 count below 200 cells/mm3 (32% versus 10%).
Teenagers were much more likely (45% versus 15%) to be lost at follow-up (defined by the investigators as not returning to the clinic within a year of being diagnosed HIV-positive) and to have never returned for their positive HIV test result (11% versus 2%).
Although both teenagers and adults had high rates of pre-existing mental health problems, teenagers were much more likely to have suicidal thoughts (seven teenagers versus two adults).
Rates of sexually transmitted infections and pregnancy were comparable between teenagers and adults, with the investigators concerned that many teenagers lost to follow-up had untreated sexually transmitted infections or were not receiving appropriate antenatal care.
The investigators speculate that the large number of HIV-positive teenagers lost to follow-up “may be explained by the fact that teenagers are less likely to be symptomatic than adults at the time of presentation.”
Investigators were particularly concerned that large numbers of teenagers were not returning for their HIV test results “and therefore remained unaware of their HIV status.” They suggest that telephone or text message reminders could improve reattendance.
The study concludes that “a more focused approach tailored to the needs of teenagers may be required to engage with this particularly vulnerable group.”
Further information on this website
Prime K et al. Differences in presentation and follow-up between HIV-1 antibody positive teenagers and adults: the need for a more focused approach to care?. AIDS 17: 260-261, 2003.