Prevention Science, Vol. 1, No. 1, 2000
Prevention of HIV Among Adolescents
Mary Jane Rotheram-Borus,
and Hsin-Hsin Foo
Adolescents are at risk for HIV primarily through their sexual behavior. A comprehensive
prevention strategy includes a national HIV campaign based on social marketing principles;
targeted social marketing, intensive skill building, and sexually transmitted disease control
programs for youth at high risk; programs targeting institutions (e.g., school health clinics),
providers, and parents; and interventions to identify and reduce risk acts among seropositive
youth. The U.S. focus for HIV prevention has been single-session educational classes (an
ineffective strategy) or intensive multi-session, small-group interventions for youth at high
risk (demonstrated to increase condom use by about 30%). There is a need to expand the
range, modalities, and dissemination of HIV prevention programs nationally, to recognize
(especially by policymakers) limitations of abstinence programs, and to increase early detec-
tion of HIV among youth.
KEY WORDS: HIV; adolescents; prevention.
PREVENTION OF HIV AMONG ADOLESCENTS
HIV prevention among adolescents is a critical
national priority (National Institutes of Health
[NIH], 1997). AIDS has become the seventh most
common cause of death among youth aged 15 to 24
(Hoyert et al., 1999). Annually, youth comprise one
half of the estimated 40,000 new cases of HIV infec-
tion in the United States (Centers for Disease Con-
trol and Prevention [CDC], 1998a). Prevention of
sexual and substance-use risk acts remains the most
effective strategy against HIV infection. Wide-scale
implementation of AIDS prevention programs based
on scientiﬁcally tested models could substantially re-
duce HIV transmission, health care costs, and prema-
ture deaths among young people (NIH, 1997). Yet,
HIV prevention programs have not been broadly im-
plemented in the United States, as they have been
in other developed countries.
To increase the understanding of the strengths
Department of Psychiatry, University of California, Los Angeles.
AIDS Institute, University of California, Los Angeles.
Correspondence should be directed to Dr. Mary Jane Rotheram-
Borus, UCLA Department of Psychiatry, 10920 Wilshire Blvd.,
Suite 350, Los Angeles, CA, 90024.
1389-4986/00/0300-0015$18.00/1 2000 Society for Prevention Research
and limitations of current HIV prevention efforts for
adolescents, this paper reviews the epidemiology of
AIDS and risk behaviors in adolescents, outlines the
range of current HIV prevention programs for ado-
lescents, and identiﬁes gaps between demonstrated
efﬁcacious programs and current practices.
The Epidemiology of HIV Among Adolescents
Currently, the primary method of monitoring
HIV in the United States is the AIDS case data
(CDC, 1998b). We do not have national monitoring
of HIV infection among adolescents (National Cen-
ter for Health Statistics, 1999), and the long, relatively
asymptomatic period between HIV infection and the
emergence of AIDS-deﬁning illnesses makes it difﬁ-
cult to estimate the number of HIV-infected adoles-
cents (Alcabes et al., 1994; Beck et al., 1994). Table
1 summarizes the existing seroprevalence data avail-
able on subgroups of youth considered to be at high
risk and provides estimates from the census data on
the number of youth in these high-risk subgroups.
Based on current estimates of HIV infection among
persons in the United States (0.32%; McQuillan et
al., 1997) and the series of seroprevalence studies