Adolescents and Young Adults: The Pediatrician’s Role in HIV Testing and Pre- and Postexposure HIV Prophylaxis

Abstract

Most sexually active youth in the United States do not believe that they are at risk for contracting HIV and have never been tested. Creating safe environments that promote confidentiality and respect, obtaining an accurate sexual and reproductive health assessment, and providing nonstigmatizing risk counseling are key components of any youth encounters. Pediatricians can play a key role in preventing and controlling HIV infection by promoting risk-reduction counseling and offering routine HIV testing and prophylaxis to adolescent and young adult (youth) patients. In light of persistently high numbers of people living with HIV in the United States and documented missed opportunities for HIV testing, the Centers for Disease Control and Prevention and the US Preventive Services Task Force recommend universal and routine HIV screening among US populations, including youth. Recent advances in HIV diagnostics, treatment, and prevention help support this recommendation. This clinical report reviews epidemiological data and recommends that routine HIV screening be offered to all youth 15 years or older, at least once, in health care settings. After initial screening, youth at increased risk, including those who are sexually active, should be rescreened at least annually, and potentially as frequently as every 3 to 6 months if at high risk (male youth reporting male sexual contact, active injection drug users, transgender youth; youth having sexual partners who are HIV-infected, of both genders, or injection drug users; youth exchanging sex for drugs or money; or youth who have had a diagnosis of or have requested testing for other sexually transmitted infections). Youth at substantial risk for HIV acquisition should be routinely offered HIV preexposure prophylaxis, and HIV postexposure prophylaxis is also indicated after high-risk exposures. This clinical report also addresses consent, confidentiality, and coverage issues that pediatricians face in promoting routine HIV testing and HIV prophylaxis for their patients.

Factors affecting risk‐taking behaviors among sexually active adolescents tested for HIV/STD

“…Pediatricians, pediatric nurse practitioners, family nurse practitioners, nurses, and local public health departments can play a key role in assessing the needs of adolescents for safe‐sex interventions and further counseling. These professionals can help in preventing and controlling HIV infection by promoting risk‐reduction counseling and offering routine HIV testing (Hsu et al., 2022). The American Academy of Pediatrics (AAP) encouraged HIV testing of all sexually active youth in its 2011 policy statements (Emmanuel & Martinez, 2011).…”

“…These professionals can help in preventing and controlling HIV infection by promoting risk-reduction counseling and offering routine HIV testing (Hsu et al, 2022). The American Academy of Pediatrics (AAP)…”

HIV Syndemic Factor Associations Among Adolescent Gay and Bisexual Men in the Youth Risk Behavior Survey 2015–2019: A Secondary Data Analysis

“…Recommendations for HIV testing in adolescent well-care visits are aligned with the United States Preventive Services Task Force, which suggests that HIV testing be completed at least once between the ages of 15 and 21 years (US Preventive Services Task Force et al, 2019). After initial HIV screening, adolescents who remain at an increased risk for HIV acquisition should have HIV testing completed annually or as frequently as every 3–6 months (Hsu et al, 2021). These same clinical guidelines also recommend that adolescents with a substantial risk for HIV acquisition be routinely offered HIV pre- and post-exposure prophylaxis.…”

Factors associated with late presentation for HIV care in adolescents in Spain

“…Regarding sexual transmission, the American Academy of Pediatrics recommends that routine HIV screening be offered at least once to all youth aged ≥15 years. After initial screening, youth at increased risk, including those who are sexually active, should be rescreened at least annually and potentially as frequently as every 3–6 months if at high risk [20].…”