This month, U.S. Pharmacist focuses on health issues of younger patients. Maybe that’s why a recent CDC Fast Facts release caught my attention. The alarming report indicates that in 2014, youths aged 13 to 24 years accounted for an estimated 22% of all new HIV diagnoses in the United States, primarily impacting young gay and bisexual males. Young black/African American and Hispanic/Latino gay and bisexual males, the CDC report said, are especially affected.
Long before this population of adolescents and young adults was even born, the AIDS epidemic ravaged society, primarily urban areas at first. I can recall the sight of young men sauntering solemnly in and out of a health crisis center sandwiched between the brownstone apartment I rented with some friends and St. Vincent’s Hospital in New York’s Greenwich Village. The AIDS epidemic cast a wide pall over the city then, and indeed the country, in the early and mid 1980s, with throngs of young men seeking support against the devastation.
In stark contrast, the CDC report says that today’s adolescent and young adult HIV-positive patients are the least likely to “connect with care.” Making this situation all the more unfortunate is the fact that in the intervening years since the epidemic took hold, HIV infection has morphed into a more or less manageable chronic illness from a sentence of almost certain death—the fate of those who had contracted the virus.
The very success of science in combating HIV/AIDS has, ironically, lead to this complacency among adolescents and, more than likely, other groups. The development of innovative medications, including various antiretroviral drug therapies (ARTs) that target key sites to prevent resistance-causing viral mutations, has improved the outlook of those with HIV/AIDS. Nonetheless, among youths aged 18 to 24 years who were living with HIV in 2012, the CDC report says, just 21% were prescribed HIV medicines, and only 16% saw a suppressed viral load.
Always invincible in their own minds, adolescent men are perhaps the most unlikely to seek treatment once diagnosed with HIV, and the statistics bear this out. At the end of 2012, says the CDC, an estimated 57,200 U.S. youths aged 18 to 24 years were living with HIV. Some 25,000 of these youths were undiagnosed, representing the highest rate of undiagnosed HIV in any age group.
Things did not improve the next year. In 2013, the CDC says, nearly one-quarter (22%) of youths aged 13 to 24 years with HIV were not being treated within 3 months of their diagnosis; this was the lowest treatment rate of any demographic, solidifying a dour trend. Among youths diagnosed with HIV in 2011 or before, contrastingly, more than half (52%) were in treatment by the end of 2012. (In 2013, 109 youths aged 15 to 24 years died of HIV or AIDS, according to the CDC.)
The reason for this trend is at least in part cultural. In a 2012 Kaiser Family Foundation survey, 84% of youths aged 15 to 24 years said there is stigma around HIV in the United States; this indicates that this group might not be comfortable discussing their status with others and practicing measures to protect their partners and themselves.
For its part, the CDC’s Division of Adolescent and School Health disseminates data on youth health-risk behaviors and finances 19 state and 17 local education agencies to help schools deliver sexual health education emphasizing HIV/sexually transmitted disease prevention, increase teen access to sexual health services, and establish safe and supportive environments for students.
The pharmacist community, too, should work to quash the stigma of HIV/AIDS and help HIV-positive patients avail themselves of the impressive treatment advances. Pharmacists can also employ their strong medication knowledge to ensure appropriate dosing and ART combinations, accurate screening for interactions, and effective management of adverse events.
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