Young people didn't endure the AIDS terror of the 1980s and therefore don't grasp how devastating it can be.
Some engage in reckless sexual behavior, resulting in a growing share of new HIV cases in that age bracket.
“They don't have the same experience that the older people have,” said Dr. Amir Gholami, infectious disease specialist at Methodist Physicians Clinic. “Definitely, the fear factor has decreased substantially.”
The federal Centers for Disease Control and Prevention reported that while young people make up only 7 percent of the total number of Americans living with HIV, they account for more than a quarter of new HIV infections. That report came after an extensive study late in 2012.
The CDC also says that through studies and surveys, it knows that more than half of those young people, 13 to 24 years of age, don't know they have the incurable virus. Consequently their careless behavior persists and they infect others.
Dr. Susan Swindells, the head of the University of Nebraska Medical Center HIV Clinic, said potential solutions face challenges. Increased HIV education could have a small impact, Swindells said, but testing more young people for the virus would have a more profound effect.
“We've spent a lot of time and effort over the last 20 years with this kind of educational effort, and it's clearly failed. I mean, look,” Swindells said, running her finger over the CDC report. “People don't like when I say that, though.”
Getting people tested leads to early diagnosis, which prompts early treatment, which suppresses virus levels and makes people less contagious, she said.
A 21-year-old Metro Community College student said he had been told in Omaha Public Schools and by his parents about the importance of wearing condoms. He didn't listen.
A male partner assured him that he didn't have HIV, but the Metro student found himself sick and unable to keep food and drink down. He was diagnosed with HIV two years ago.
The young man, who spoke on condition of anonymity, was shocked. “I didn't think it would happen to me,” he said. “I just never thought I would be the person to be diagnosed with it.”
Local physicians and counselors say part of the problem stems from the fact that young people believe they are virtually indestructible.
“They don't believe they're at risk,” said Sherri Nared of the Douglas County Health Department. “They always think it's someone else and not them.”
Some HIV/AIDS experts suggest that general practitioners, emergency room doctors and urgent-care centers bring up the possibility of testing young people when they are treating them for other illnesses, Swindells said, or that the test be administered at school sports physicals.
This, too, has obstacles. Swindells said family physicians already are deluged and have little time to discuss why testing is important or to perform the blood draw or oral swab. If an emergency-room or urgent-care patient tested positive, who would inform him? And at sports physicals or any other setting, suggesting a teenager be tested for HIV could meet resistance from parents, she said.
The Douglas County Health Department offers many educational programs on sexually transmitted diseases and HIV at libraries and concerts. The department also offers free HIV testing or refers people to clinics for free or low-cost testing.
Swindells said the fact that there are many young people who don't know they have HIV means there's a pool of individuals who are infecting others.
Those people are jeopardizing their own health and the health of others, said Dr. Marvin Bittner, an infectious disease specialist and faculty member at Creighton University.
“It's very important for people to find out if they have HIV,” Bittner said.
In the 1980s, contracting AIDS meant almost certain death. Today, medications hold the disease virtually in check and reduce viral levels so that the risk of infecting others is diminished.
“Now we've got good drugs to treat it and they (young people) think, 'Well, I'll just take a bunch of drugs,'” said Dr. Anne O'Keefe, senior epidemiologist at the Health Department.
But the drugs cost about $1,200 a month when paid out of pocket. There are government programs that cover the cost for the poor and uninsured, and pharmaceutical companies offer discounts.
“It's lifelong,” O'Keefe said. “There are complications with the drugs, side-effects.” Side-effects can include nausea, diarrhea, headaches and rashes.
The CDC estimates that 1.1 million Americans live with HIV. Gay men, particularly gay blacks, are affected in vastly disproportionate numbers. More than 17,700 Americans died of AIDS in 2009, the CDC said. AIDS is advanced HIV.
Swindells said there's no question her clinic sees more young people with HIV than before. “They're just kids,” she said. “And then this just totally pulls the rug out from under them.”
For young people who are sexually active, Swindells said, getting an HIV test makes sense.
“If somebody suggests it, don't be offended,” she said. “It's a good thing.”
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Concern for young people, 13 to 24
The federal government estimated that 12,200 new HIV infections occurred in 2010 among people 13 to 24 years of age. That prompted a Centers for Disease Control and Prevention initiative two months ago to shed light on the problem. These are the numbers for that age group over a five-year stretch:
Sources: Nebraska Department of Health and Human Services, Iowa Department of Public Health