Selected Behaviors that Increase Risk for HIV Infection Among High School Students -- United States, 1990

From January 1987 through December 1991, the cumulative number of acquired immunodeficiency syndrome (AIDS) cases among adolescents aged 13-19 years in the United States increased from 127 (1) to 789 (2), and in 1989, AIDS became the sixth leading cause of death for persons aged 15-24 years (3). Because the median incubation period between infection with human immunodeficiency virus (HIV) and onset of AIDS is nearly 10 years (4), many 20-29-year-olds with AIDS may have been infected during adolescence. Surveillance of selected sexual and injecting-drug-use (IDU) behaviors among adolescents can provide critical information about the risk for HIV infection among this group. This article presents self-reported data from 1990 about HIV-risk behaviors among U.S. high school students and describes strategies to reduce HIV infection among adolescents.

The national school-based Youth Risk Behavior Survey is a component of CDC's Youth Risk Behavior Surveillance System (5) that periodically measures the prevalence of priority health-risk behaviors among youth through representative national, state, and local surveys. A three-stage sample design was used to obtain a representative sample of 11,631 students in grades 9-12 in the 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands. Students were asked: "How old were you the first time you had sexual intercourse?"; "With how many persons have you had sexual intercourse in your life?"; "The last time you had sexual intercourse, did you or your partner use a condom to prevent sexually transmitted diseases such as genital herpes, genital warts, gonorrhea, syphilis, clap, drip, or AIDS/HIV infection?"; and "During your life, have you ever injected (shot up) any drug not prescribed by a doctor, such as steroids, cocaine, amphetamines, or heroin?"

Of all students in grades 9-12, the median age * of reported first intercourse was 16.1 years (95% confidence interval (CI)=plus or minus 0.1) for male students and 16.9 years (95% CI=plus or minus 0.1) for female students. About one third (33.5%) of male students and 20.0% of female students initiated sexual intercourse before age 15 years. Nearly two thirds (64.8%) of male students and 52.4% of female students initiated sexual intercourse before age 17 years.

Of all students, 19.0% reported having had four or more sex partners during their lifetime (Table 1). Male students (26.7%) were significantly more likely than female students (11.8%) to report having had four or more sex partners. Black male students (60.4%) were most likely to report having had four or more sex partners. The percentage of students who had four or more sex partners increased significantly by grade from 9th (12.4%) and 10th (14.8%) to 12th (28.6%) grade.

Among students who reported sexual intercourse during the 3 months preceding the survey (i.e., currently sexually active), 44.9% reported that they or their partners had used a condom at last sexual intercourse (Table 2). Male students (49.4%) were significantly more likely than female students (40.0%) to report condom use at last sexual intercourse. Students who had four or more sex partners were significantly less likely to have used a condom at last sexual intercourse (40.6%) than were students with fewer lifetime sex partners (48.3%).

Of all students in grades 9-12, 1.5% reported IDU ** (Table 3). Male students (2.3%) were significantly more likely than female students (0.7%) to report IDU. Students with four or more sex partners were significantly more likely to report IDU (5.1%) than were students with fewer lifetime sex partners.

Reported by: Div of Epidemiology and Prevention Research, National Institute on Drug Abuse, Alcohol, Drug Abuse, and Mental Health Administration. Div of Adolescent and School Health and Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Although the risk for HIV infection is decreased by correct use of condoms and reduction of the number of sex partners, these approaches do not completely eliminate risk. The most effective means of preventing HIV infection are refraining from sexual intercourse, maintaining monogamous sexual relationships with an uninfected sex partner, and avoiding IDU. The findings in this report and previous reports from the United States and Italy (6,7) indicate that a substantial proportion of students engage in behaviors that place them at risk for HIV infection.

CDC is working with national, state, and local health and education agencies to help decrease the proportion of 9th-12th-grade students who have initiated sexual intercourse; decrease the proportion of sexually active 9th-12th-grade students who are currently sexually active; increase the proportion of currently sexually active 9th-12th-grade students who used a condom at last sexual intercourse; and decrease the proportion of 9th-12th-grade students who use injecting drugs. (Related national health objectives for the year 2000 include objectives 5.4, 5.5, 18.3, 18.4, 19.9, and 19.10 (8,9).)

Strategies to address these risk behaviors should include 1) using public health surveillance data to assist agencies in reducing HIV-risk behaviors among adolescents; 2) enhancing the capacity of state and local health and education agencies and national organizations to implement effective HIV-prevention education within comprehensive school health education programs; 3) using research to identify effective HIV-risk behavior interventions and applying these interventions through training centers; and 4) combining the efforts of numerous groups and organizations (e.g., families, public health agencies, schools, community and religious organizations, and media) to prevent HIV-risk behaviors among adolescents (9).

References

1. CDC. AIDS surveillance report. Atlanta: US Department of Health and Human Services, Public Health Service, January 1987.

2. CDC. HIV/AIDS surveillance report. Atlanta: US Department of Health and Human Services, Public Health Service, January 1992.

3. NCHS. Advance report of final mortality statistics, 1989. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1992. (Monthly vital statistics report; vol 40, no. 8, suppl).

4. CDC. AIDS and human immunodeficiency virus infection in the United States -- 1988 update. MMWR 1989;38(no. S-4):1.

5. Kolbe LJ. An epidemiological surveillance system to monitor the prevalence of youth behaviors that most affect health. Health Education 1990;21:44-8.

6. CDC. HIV-related knowledge and behaviors among high school students -- selected U.S. sites, 1989. MMWR 1990;39:385-8,396-7.

7. CDC. AIDS-related knowledge and behaviors among teenagers -- Italy, 1990. MMWR 1991;40:214-5,221.

8. CDC. Sexual behavior among high school students -- United States, 1990. MMWR 1992;40:885-8.

9. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

• Estimates calculated using standard life-table procedures and includes all students. ** Students were classified as injecting-drug users only if they 1) reported IDU not prescribed by a physician and 2) answered affirmatively to either of these questions: "During your life, on how many occasions have you used cocaine in any form (including powder, crack, or freebase)?" or "During your life, on how many occasions have you used any other type of illegal drug such as LSD, PCP, MDMA, `ecstasy,' mushrooms, speed, or heroin?" An additional 3.9% of students reported IDU but no lifetime use of cocaine or other illegal drugs. These students were not classified as injecting-drug users because of this inconsistency. Based on examination of other factors these students appear most similar to students who did not use injecting drugs, cocaine, or other illegal drugs.

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