To get any sort of grasp on the issue of AIDS, one must first examine recent statistics. As of March 1992, 218,301 cases of AIDS had been reported in the United States. Of these, more than a fifth involved persons 29 years of age and younger. More than 140,000 people have died of AIDS-related illnesses, and in 1989, AIDS was the sixth leading cause of death among people aged 15–24. It was the second leading cause of death among men aged 25–44.
These numbers alone are frightening, but the National Centers for Disease Control (CDC) estimate that AIDS cases have been underreported and that official figures account for only 70 to 90 percent of actual cases. Also, these figures only concern cases in which AIDS has fully manifested itself. The CDC estimates that up to 1 million people have been infected with HIV but are not yet displaying AIDS symptoms and may be completely unaware of their infection.
HIV and AIDS clearly have the potential to become like other sexually transmitted diseases, which are now widespread among teenagers. Twenty-five percent of all cases of gonorrhea and syphilis occur to persons between the ages of 10 and 19. Because of its long incubation period, very few cases of full-blown AIDS exist among teenagers, and most teens infected with HIV at age 14 will not be counted among AIDS patients until their early twenties. But we can assume that many AIDS-symptomatic individuals between the ages of 20 and 29 were probably infected with HIV even before they left elementary school.
HIV Transmission
The human immunodeficiency virus (HIV) is transmitted primarily through unprotected sexual activities and the injection of intravenous (IV) drugs. Although AIDS first came to national attention as a disease mainly afflicting homosexual men, it quickly moved over to the heterosexual community. The World Health Organization estimates that 60 percent of HIV transmission worldwide is through heterosexual intercourse, a percentage that will likely rise to 75 or 80 in the next 10 years.
Some educators doubt that significant numbers of teenagers participate in high-risk activities. Unfortunately, we have plenty of evidence to the contrary. Recent surveys have been remarkably consistent in reporting numbers of sexually active teens. The 1988 National Survey of Adolescent Males states that 60 percent of never-married males between the ages of 15 and 19 are sexually active. About a third of all 15-year-old males reported having had intercourse, and the number jumps to about half of 16-year-olds. Among 17-year-olds, the number is 66 percent; among 18-year-olds, 72 percent; and among 19-year-olds, 86 percent. An earlier National Longitudinal Survey of Youth reported numbers only slightly lower. Twenty-nine percent of males surveyed reported engaging in their first sexual experience before age 16, and 48 percent of 16-year-olds had become sexually active. The Canada Youth and AIDS Survey of 1989 also revealed comparable numbers.
Teenage females are only slightly less sexually active than males. In the 1988 National Survey of Family Growth, 50 percent of never-married females 15 to 19 years old reported having had sexual intercourse. Further, 39 percent of those had had intercourse within the previous three months. When teens who had since married were included, the percentage of all teenage women who had engaged in premarital intercourse rose to 52 percent. The survey broke its figures down by age: 26 percent of 15-year-olds, 32 percent of 16-year-olds, 51 percent of 17-year-olds, 70 percent of 18-year-olds, and 75 percent of 19-year-olds indicated having had intercourse.
A number of studies suggest that sexual activity among inner-city youth begins at a much younger age than the national average. One survey among inner-city boys specified an average age for first intercourse of 11.8 years. Twenty-three percent of the boys surveyed maintained that their first experience of intercourse occurred before their 10th birthday.
As might be expected, the highest rates of sexual activity among teenagers occurred among out-of-school youth. Over 80 percent of male and female school dropouts report being sexually active. Teens living on the street had the highest rate, 94 percent. Thirty-three percent of street youth reported having had sexual intercourse before their 13th birthday, and 12 percent had had intercourse before they were 10, when they would still have been a part of our schools. We can safely assume that more than a few children currently in our elementary schools are being inducted, either by force or by choice, into sexual activities.
Vaginal intercourse, of course, is not the only sexual method of transmitting HIV. Anal intercourse is an even riskier activity. One study found this act to be 2.8 times more likely to transmit HIV than vaginal intercourse. Although anal intercourse has often been associated with homosexual men, it is certainly not limited to that group. Adult heterosexual couples often engage in the activity, and some speculate that the occurrence of anal intercourse may be even higher among adolescent heterosexual couples than adults as it provides an effective form of contraception and allows the adolescent female, technically at least, to retain her virginity.
Condoms and Risk
As these numbers indicate, teenagers are not taking the new dangers of sexual activity into account when pursuing sexual ventures. Despite the growing public awareness of HIV and AIDS, the rates of premarital intercourse among female teenagers between the years 1985 and 1988 grew 44 to 52 percent, an increase not seen since the early 1970s.
Sexually active teenagers currently can reduce their risk of infection by using condoms, though they cannot provide 100 percent protection against HIV, infection by other sexually transmitted diseases, or unwanted pregnancy. Only abstinence can do that. Routine use of condoms, however, can provide the most protection currently possible for sexually active people. In fact, the strict use of condoms with a variety of sexual partners is statistically safer than inconsistent condom use with only two or three partners.
Unfortunately, a large percentage of teenagers report using condoms during intercourse inconsistently or not at all. A 1988 study reported that two-thirds of sexually active 16- to 19-year-old teens failed to use a condom during sexual intercourse at least once over the previous year. When all youth surveyed, including those who have never had intercourse, are included, 42 percent reported regularly engaging in intercourse without the use of condoms. When stacked alongside the soaring rates of HIV infection, this number provides little comfort.
Making matters more dangerous for teens is the teenage practice of serial monogamy. While many take the advice of the health community and practice sex only within a stable relationship, their definition of a “stable relationship” differs from that of most adults. In one study, 58 percent of teenage boys and 43 percent of teenage girls regard a one- or two-month relationship as stable. A quick look at high school romance suggests that many relationships don't last six months. In CDC's 1990 Youth Risk Behavior Survey, 19 percent of respondents reported four or more partners. For monogamy to be an effective shield against HIV transmission, it must be lifetime monogamy. The odds of becoming infected with HIV as a result of multiple partners do not change depending whether those partners are contemporaries of each other or spread out over a number of years.
Intravenous Drugs and AIDS
Sharing needles to inject intravenous drugs is another way of transmitting HIV. The virus can live for a short time in the traces of blood remaining in a needle or syringe. Therefore, IV drug users who share needles are at risk for HIV infection, a risk that goes up with the number of needles shared and the number of people with whom needles are shared. Once HIV is introduced into the IV drug population of a geographical area, it spreads rapidly. In Manhattan, for instance, HIV infection among IV drug users grew from 20 percent to 50 percent in only three years. IV drug use does not appear to be the problem among teenagers that it is among adults, however, with only 2–7 percent of males surveyed in CDC's Youth Behavioral Risk Factor Survey reporting injecting drugs. Between 0.5–4.0 percent of these drug users claim to share needles. Results of other surveys are less alarming. The Secondary School Student Health Risk Survey, which surveyed over 8,000 students across the country, reported only 3 percent of high school students injecting illegal drugs, with a third of them sharing needles.
A sometimes overlooked use of drug-injection equipment among high school students is to inject anabolic steroids. A national survey of high school seniors found 7 percent who reported using steroids, a number the researchers suspected is underrepresentative of the actual percentage. Thirty-eight percent of these students using steroids injected them at least once. Using this conservative estimate of steroid use as a basis, we can determine that between 250,000 and 500,000 high school seniors use steroids, with more than a third of them injecting the drug.
