Pediatricians Recommend Routine HIV Screening for Youths as Early as 15

Parents are being urged to sign up their older teens for routine HIV screenings. The Good Brigade/Getty Images
  • The American Academy of Pediatrics recommends that routine HIV screening begin as early as 15 years old for teens.
  • They say the chance of contracting HIV increases significantly once a youth reaches 15 years old.
  • They suggest that testing for other sexually transmitted infections should also be done for teens.
  • They add that parents and pediatricians may want to consider initiating a conversation with teens about sex with a barrier method.

Pediatricians may want to consider performing routine HIV screening for teens and young adults beginning at 15 years old.

That’s the recommendation from the American Academy of Pediatrics (AAP) that was released today.

Sexually active teens and others that could have a high chance of contracting HIV may want to consider getting screened at least annually, according to the organization’s clinical report published in the latest issue of the journal Pediatrics. 

That potentially includes the 44 percent of males and 42 percent of females ages 15 to 19 who report having had sex, according to the Centers for Disease Control and Prevention (CDC).

Teens who might commonly contract HIV may want to consider getting screened for HIV as often as every 3 to 6 months, the AAP report said, including:

  • male youths who report male sexual contact
  • active injection drug users
  • sexually active transgender youth
  • youth having sexual partners who are HIV-positive, of both genders, or injection drug users
  • youth exchanging sex for drugs or money
  • youth who have had a diagnosis of, or have requested testing for, other sexually transmitted infections

In the report, pediatricians were also urged to discuss and, if appropriate, prescribe PrEP (preexposure prophylaxis) — medication that can help prevent HIV infection — to teens with a higher chance of contracting HIV.

The chance of contracting HIV rises with age

Among youth in the United States, the rate of new HIV diagnoses per 100,000 people is about 0.2 in the 13- to 14-year age group and 8.1 among 15- to 19-year olds.

However, experts note that while HIV prevalence is low among teens, an estimated 45 percent of 13- to 24-year-olds living with HIV were undiagnosed in 2018. 

About 1 in 5 new HIV cases reported in 2018 were among people ages 13 to 24, according to the CDC.

“Most sexually active youth in the United States do not believe that they have a chance of contracting HIV and have never been tested,” according to the AAP report.

Some cost-benefit analyses suggest that HIV testing should not begin until 25 years old, but the study authors argued that this does not include the broader impact of continued sexual activity by teens who don’t know they are HIV-positive.

“The main rationale for our recommendation is the very high proportion of infections occurring in young people,” Dr. Natella Rakhmanina, a study author and the director of HIV services and special immunology at George Washington University Children’s National Hospital in Washington, DC, told Healthline.

“The chance of HIV infection rises as kids get older, and an estimated 40 percent of HIV transmission involves people who are undiagnosed. So, screening earlier has a double gain, for individual health but also to curb the chance of transmission in the communities.”

“The HIV rate is low, but is it because it’s really low, or because we’re not finding it?” said Dr. Ilan Shapiro, the medical director of health education and wellness at AltaMed Health Services, one of the largest providers of HIV care in Southern California. 

Comparatively, high rates of gonorrhea (up to 600 per 100,000 in the United States) and chlamydia (between 563 and 1,081 cases per 100,000 in resourced countries) “opens up doubt” about the true rate of HIV infection among teens, Shapiro told Healthline.

Normalizing conversations about HIV

The AAP report tasked pediatricians with “creating safe environments that promote confidentiality and respect, obtaining an accurate sexual and reproductive health assessment, and providing nonstigmatizing counseling around HIV.”

“We really need to normalize HIV prevention and make it part of the conversation about condom use and sex with a barrier method,” said Rakhmanina.

“We want the pediatric community to be more open to discussing HIV and introducing the concept of prevention, including PrEP use,” she said.

The AAP already advises pediatricians to screen all people under 25 years old for sexually transmitted infections such as chlamydia and gonorrhea. A previous clinical report released in 2011 had recommended that HIV testing begin at 17 years old.

The LGBT Community Center in New York, which works with youth, starts HIV screening for people as young as 13 years old, said Brandy Andrews, the center’s HIV and sexual health services manager.

“PrEP is proactively recommended to anyone engaging in sexual behavior without a barrier method,” Andrews told Healthline. “Teens as young as 15 years old are able to receive PrEP, too.”

“Not just HIV but other STIs need to be part of normal screening of teens,” said Shapiro. “Teens need to know their bodies and how to protect themselves. Whatever pediatricians can impress on them in their formative years, they will carry for the rest of their lives.”

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