They are thus one of the prime populations for targeting behavioral and biomedical preventions. However, the dynamics of the HIV epidemic in youth vary widely by geographic region as well as risk behavior profiles.
There are also biological and neurodevelopmental considerations that must be considered in the development, testing and ultimate dissemination of HIV prevention interventions. These concepts are broadly discussed here. It is widely known that adolescents and young adults are at or near the epicenter of the global HIV epidemic across almost all geographic risk profiles and locations. This article is meant to highlight some of the features of the global HIV epidemic in youth and set the background for discussions of prevention interventions targeting this population.
Characteristics of various global regions or risk profiles among youth that will impact development, testing and ultimately dissemination of HIV prevention interventions will be described. The definition of adolescence varies depending on the organization and the type of report being produced. For example, the Centers for Disease Control and Prevention often refer
Heterosexual hiv infection rates by age adolescents 10—19 and young adults 20—24 when discussing this transition period between childhood and adulthood 1.
The World Health Organization often refers to young people and includes individuals from 10 to 24 years of age 2 — 3. While this grouping is convenient for epidemiological purposes, there clearly are developmental, biological and legal reasons for segmenting these populations when considering development of behavioral or biomedical prevention interventions and their testing.
These types of issues will be discussed by other authors in appropriate sections of this collection. As ofthere were 1.
Different risk behaviors are driving the epidemic depending on the area of the world under consideration. However, a common theme throughout the differing epidemics in different parts of the world are the impact of individual-level risks as the core factors determining transmission and the many social network, community and public policy factors Heterosexual hiv infection rates by age impacting these Heterosexual hiv infection rates by age risks.
An example of the listing of these various levels of risk that make up an ecological model for Southern Africa is shown in Table 1. Heterosexual transmission is driving the epidemic in Africa, especially affecting young women of child-bearing age. For adolescent females the risk of HIV acquisition is Heterosexual hiv infection rates by age related to the age and risk profile of their partners.
Thus, in areas where heterosexual transmission propels the local epidemic as in sub-Saharan Africa, females are becoming infected Heterosexual hiv infection rates by age younger ages than males through exposure to older males. Data from several surveys from South Africa clearly illustrate such trends 5 — 7. Recently, concurrency 8 and circumcision 9 have been discussed as key elements driving the heterosexual HIV epidemic in sub-Saharan Africa but other factors must be considered as prevention strategies are being designed, Heterosexual hiv infection rates by age and ultimately "Heterosexual hiv infection rates by age," As in sub-Saharan Africa, in other areas such as the Caribbean, Guyana, and some Central American countries, heterosexual transmission is a dominant mode of transmission and similar patterns of acquisition are seen 4.
In general, in these areas where heterosexual transmission of HIV is predominant, males are becoming infected at slightly higher ages than females and at lower rates. This is attributed to males having either younger or more similar aged female partners at coital debut 6 — 7. Similarly there is evidence in many other regions of an expanding MSM epidemic even in the setting of decreasing overall HIV rates 41016 — The individual-level risk for MSM is unprotected anal intercourse, particularly anal receptive intercourse.
The ecological context for the MSM HIV epidemic in many areas is particularly confounded and challenged by policy and community factors, i. While IVDU transmission does occur in many other settings it is usually in an older population. IVDU is quite commonly the initial recreational drug exposure in Eastern Europe leading to this epidemic among youth 20 — As scientists research and eventually implement HIV prevention programs, it is important not only to consider the differences on location, but also differences across different neurodevelopmental strata of youth.
Neurocognitive differences between early adolescence ages 11—14middle adolescence ages 15—17late adolescence ages 18—21 and youth ages 21—24 must be taken into account when evaluating potential interventions. Other biological changes with pubertal development including changes in body mass, immune function
Heterosexual hiv infection rates by age sexual maturation will having significant effect on the efficacy and safety of specific interventions and should be evaluated during development and considered during ultimate deployment of biomedical interventions.
This overview of HIV epidemiology among youth is meant to establish the context for a discussion of prevention interventions targeting youth. These data will need to be updated and refined as this epidemic evolves in its many settings.
Further, the more dissected ecology of the local HIV epidemic will need to be considered for testing prevention interventions and will be crucial for ultimate dissemination of the multifaceted interventions it will take to impact the global HIV epidemic. The development of this paper was supported by any public or private funding sources. This is a PDF file of an unedited manuscript that has been accepted for publication.
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WrightMD, 2 Jeffrey T. Author information Copyright and License information Disclaimer. See other articles in PMC that cite the published article. Open in a separate window. Acknowledgments Sources of Support: A
Heterosexual hiv infection rates by age for States and Communities. Department of Health and Human Services; Young People's Transition Into Adulthood: World Health Organization; Nov [Accessed March ].
Young people's sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey. HIV risk exposure among South African children in public health facilities. Concurrent sexual partnerships and the HIV epidemics in Africa: Male circumcision for HIV prevention: Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries — Epidemiology of male same-sex behaviour and associated sexual health Heterosexual hiv infection rates by age in low- and middle-income countries: Am J Public Health.
The changing face of HIV in China. Changes in HIV prevalence and sexual behavior among men who have sex with men in a northern Chinese city: A world survey of laws prohibiting same sex activity between consenting adults.
Twenty eight percent of diagnoses were among heterosexuals, with 64% of heterosexual. Figure 2: Gender and age specific HIV notification rates (per. Heterosexuals and people who inject drugs also continue to be affected by HIV. In New HIV in the United States by age, Inyouth aged 13 to 24a made up 21% of all new HIV Four percent () of infections among young men were attributed to heterosexual undiagnosed HIV—the highest rate of undiagnosed HIV in any age group.