Research Watch AIDS and Young Women

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AIDS is a growing threat to women, including teenage girls. A new report by the U.S. Centers for Disease Control and Prevention (CDC) found that 18 percent of AIDS cases in the U.S. are now female, compared to less than 7 percent in 1986. Almost alf of those who contract HIV do so in their teens or early 20s.

Almost 11,000 women in the U.S. were diagnosed with AIDS in 1999, which is nearly one in every four new AIDS patients. Even more dramatic, approximately 7,000 females were newly diagnosed with HIV, which is nearly one in every three new diagnoses.

This study by Shannon Hader and her colleagues is based on a comprehensive review of the published research. They found that while women with AIDS used to live primarily in the urban Northeast, today many infected women and girls live in the South (41 percent), especially in rural areas. Most infected women and girls are African American (61 percent). Almost half the AIDS cases in the South are reported in Texas and Florida.

Among women ages 13-24, blacks and Hispanics are at the greatest risk for HIV, accounting for almost three-fourths of the infections. Although AIDS became the sixth leading cause of death in women by 1990, until recently scientists have known relatively little about the spread of the disease to women, or its consequences.

The causes of AIDS in women have changed over the years: Needle sharing was once the most common pathway of HIV transmission to women, but the CDC team estimates that 50 percent of women now get the virus through heterosexual sex.

 

Almost 11,000 women in the U.S. were diagnosed with AIDS in 1999, which is nearly one in every four new AIDS patients.

 

Hader says that better prevention services are needed for women, and prevention is more effective if it starts before they are sexually active, and continues thereafter.

 

 

Kids Start Early with Drugs and Alcohol

 

Although fewer teens are trying alcohol and drugs compared to 30 years ago, a new report shows that the children who are experimenting with drugs and alcohol are younger than ever.

According to Constance Horgan, a professor of health policy at Brandeis

University and the author of the report, "There have been some improvements since 1996, and it seems to be dropping off, except for certain substances like such club drugs as Ecstasy."

The report is based on data from several hundred public and private sources, and tracked trends in smoking, drinking, and drug use over the last three decades.

According to the report, drug experimentation among eighth graders dramatically increased between 1991 and 2000: The number of young teens who have tried marijuana nearly doubled._Drinking decreased slightly._In contrast, in 2000, 49 percent of high school seniors had ever used marijuana, compared to 37 percent in 1990; while 62 percent of seniors said they were ever drunk in 2000, a slight decline from 65 percent in 1991.

The report concludes that substance abuse causes more deaths, illnesses and disabilities than any other preventable health problem. Of the more than 2 million deaths each year in the U.S., one in four is attributable to alcohol, tobacco and illicit drug use.

"The younger use begins, the more likely the users are to have substance abuse problems later in life, especially if use begins before age 15," Horgan says. More than 40 percent of those who started drinking at age 14 or younger developed alcohol dependence, compared with 10 percent of those who began drinking at age 20 or older. High school students who use illicit drugs are also more likely to experience difficulties in school, in their personal relationships, and in their mental and physical health.

Awareness of the risks of drugs increases as children get older. Horgan believes that young teens are especially vulnerable to drug use because they are less aware of the risks.

 

Media Depictions of Substance Use

The report blames the media for helping shape youth perceptions of the risk of drugs, describing how movies and popular songs frequently depict the use of alcohol, tobacco and illicit drugs. In the 200 most popular movie rentals in 1996 and 1997, alcohol appeared in 93 percent and tobacco in 89 percent of the movies. Drugs appeared in 22 percent of movie rentals in 1996 and 1997, with marijuana and cocaine depicted most often. Findings from an analysis of the 1,000 most popular songs in 1996 and 1997 revealed that 27 percent of the songs referred to either alcohol or drugs.

"For parents, it must seem that everywhere they turn, there's a movie, song, music video or television ad that showcases the use of substances," Horgan says. She points out that with this kind of competition from popular culture and mass media, it's a challenge for adults to show children that the dangers of substance use are "very real."

Television also is part of the problem. In 1999, 44 percent of non-news programs aired by the four major television networks portrayed tobacco use in at least one episode. This may be especially difficult to change; in 1998, the tobacco industry spent $6.7 billion for advertising and product promotions, while the alcohol industry spent more than $1 billion on television, radio, print and outdoor advertising in 1997.

The authors conclude that treatment solutions are underutilized, probably because the success rates of treatment programs are not well understood. If success is defined as a 50 percent reduction in substance use after six months, treatment for alcoholism is successful for 40 to 70 percent of clients, cocaine treatment is successful for 50 to 60 percent, and opiate treatment for 50 to 80 percent. In contrast, if abstinence is seen as the only measure of success, these programs are considered ineffective. The report suggests a different view: If addiction is seen as a chronic, relapsing health condition, it is easier to accept that repeated attempts will be required before treatment is successful. Horgan suggests that the success rate of drug treatment is comparable to treatment for asthma and other chronic, relapsing health conditions.

 

 

Other Kinds of Sex

Teen pregnancy rates are down, but there are plenty of rumors that teens and even middle school children are more sexually active than ever before. A new study suggests that oral sex is a popular alternative to intercourse for many teens.

The study, by Gary Gates and Freya Sonenstein at the Urban Institute, is based on questionnaires completed by a nationally representative sample of 15- to 19-year-old males who had never been married. The teens were asked if they had ever engaged in oral sex, anal sex or intercourse. The data were from the "National Survey of Adolescent Males," and included responses in 1988 and 1995.

Unfortunately, changes in wording in the questionnaire made it impossible to draw direct comparisons for most responses from 1988 to 1995. In 1995, most teen males (55 percent) reported ever having had sexual intercourse and almost as many (49 percent) reported that they had ever received oral sex. Thirty-nine percent reported ever giving oral sex and 11 percent said that they had engaged in anal sex. A relatively small percentage (15 percent) that had never had vaginal intercourse reported having received oral sex. Overall, 64 percent of the teens reported that they had ever had vaginal, anal or oral sex.

Among 15-year-old boys, 28 percent have had intercourse, and 37 percent have had vaginal, anal or oral sex.   

Anecdotes in the national media suggest that children in middle school often perceive of oral sex as a safe alternative to intercourse, especially for girls who are concerned about pregnancy. Many children also do not realize that HIV and other sexually transmitted diseases can be spread through oral sex. Since the study does not include middle school children (the government probably isn't going to pay for that anytime soon!) or any teenage girls, it is impossible to determine whether those anecdotes represent a trend.

There is also no information about whether oral sex is the first step before youth "graduate" to sexual intercourse. However, the results indicate that even teens that do not engage in sexual intercourse may be at risk for diseases and the emotional turmoil that can accompany early sexual activity. 

 

Among 15-year-old boys, 28 percent have had intercourse, and 37 percent have had vaginal, anal or oral sex.   

 

"It is important for adults to realize that kids may be at risk for AIDS or other sexually transmitted diseases even if they are not engaging in sexual intercourse," Gates says. "And it is very important to collect this information so we will know what to do to help protect kids' health." 

 

Diana Zuckerman, Ph.D., is executive director of the National Center for Policy Research for Women & Families, based in Washington, D.C.