Patients at Adolescent Medicine Clinics

HIV prevalence rates among adolescents are likely to reflect recent infections because of the limited time since they began the high-risk behaviors that led to infection. Clinics specifically serving adolescents and young adults are of special interest because they serve a population that may not be seen at other health care facilities. These clinics offer a wide range of services, including family planning, physical examinations, prenatal care, counseling, STD treatment, and general medical care. Of the five adolescent medicine clinics in three metropolitan areas that collected data each year from 1993–1997, four were hospital-based and one was community-based.

Eligible patients were those aged 13–24 years who initially visited the clinic during the survey period and from whom a blood specimen had been drawn as part of routine clinic procedures. Patients who visited the clinic for HIV testing, for treatment of HIV infection, or for follow-up were excluded from the survey.

During the study period, 23,886 specimens from five adolescent medicine clinics in three metropolitan areas (Baltimore, Houston, and New York City) were collected and tested according to the CDC protocol. HIV prevalence was low among patients at these clinics. The overall clinic prevalence rate was 0.4% (range, 0.2%–0.5%). Rates were the same for male and female patients (0.4%) and were approximately the same among patients 13–19 years of age (0.4%) and those 20–24 years of age (0.5%). Rates were higher among black patients (0.6%) than among Hispanic and white patients (0.1%) (Table 6). Trends analyses were not conducted because of the small number of HIV-positive patients at the participating adolescent medicine clinics. Data from these surveys provide important HIV prevalence information for the survey population in a given clinic. However, those prevalence rates cannot be generalized to all adolescents and young adults in the surrounding areas.

Job Corps Entrants

The Job Corps, administered by the U.S. Department of Labor, is an occupational training program for socially and economically disadvantaged out-of-school youth from rural and urban areas in all 50 states and U.S. territories. Data sent to CDC from the Department of Labor provide a system for monitoring the HIV epidemic in this population, which may be at higher risk for HIV infection than are adolescents and young adults in the general population.

The Job Corps recruits high school dropouts or high school graduates who need additional education or training so that they can obtain and hold jobs. Although no one is excluded from the Job Corps because of sexual orientation or history of illicit drug use, applicants with current drug addictions or serious medical or behavioral problems and those on supervised probation or parole are not accepted into the program. All entrants residing at Job Corps centers during training are counseled and tested for HIV within the first two days of residency. Entrants who test positive for HIV are allowed to continue as residential trainees, and they receive medical care and social support.

The analyses in this report include Job Corps entrants in the United States and Puerto Rico who were 16–21 years of age when they entered the program. For the trends analyses, data were standardized to the 1993 population of Job Corps entrants by region, sex, race/ethnicity (black, Hispanic, white, American Indian/Alaska Native, and Asian/Pacific Islander), age group (16–17, 18–19, and 20–21 years), and metropolitan statistical area (MSA). During the study period, 253,932 specimens from Job Corps entrants were tested for HIV. The largest group of entrants was composed of blacks (49%), followed by whites (31%), Hispanics (15%), American Indians/Alaska Natives (4%), Asians/Pacific Islanders (2%), and unreported (less than 1%). The entrant’s reported home state is the basis for the state-specific rates in this report (Figure 16).

Figure 16. HIV Prevalence Among Job Corps Entrants, by State of Residence, 1993–1997

Source of data: U.S. Department of Labor.

HIV prevalence rates for all Job Corps entrants during the 5-year period were 0.32% among blacks, 0.08% among Hispanics and American Indians/Alaska Natives, 0.05% among whites, and 0.02% among Asians/Pacific Islanders (Figure 17).

Figure 17. HIV Prevalence Among Job Corps Entrants, by Race/Ethnicity, 1993–1997

Source of data: U.S. Department of Labor.

HIV prevalence rates for Job Corps entrants fluctuated from 1993–1997 in all regions. However, rates were higher for entrants in the South and the Northeast than for those in the Midwest and the West: in 1997, prevalence was 0.26% in the South, 0.20% in the Northeast, 0.11% in the Midwest, and 0.01% in the West (Figure 18).

Figure 18. HIV Prevalence Among Job Corps Entrants, by Region, 1993–1997

Note: Standardized to 1993 population of Job Corps entrants by sex, race/ethnicity, age group, and metropolitan statistical area.
Source of data: U.S. Department of Labor.

Although prevalence rates were similar in 1993 and 1994 for male entrants (0.22% and 0.17%, respectively) and female entrants (0.23% and 0.17%, respectively), they decreased during the 5-year period among men but increased among women. By 1997, prevalence among these women (0.27%) was more than twice that of the men (0.12%) (Figure 19).

Figure 19. HIV Prevalence Among Job Corps Entrants, by Sex, 1993–1997

Note: Standardized to 1993 population of Job Corps entrants by region, race/ethnicity, age group, and metropolitan statistical area.
Source of data: U.S. Department of Labor.

Figure 20. HIV Prevalence Among Male Job Corps Entrants, by Race/Ethnicity, 1993–1997

Note: Standardized to 1993 population of Job Corps entrants by region, age group, and metropolitan statistical area.
Source of data: U.S. Department of Labor.

The highest prevalence rates among Job Corps entrants were those for black women. During 1993–1997, prevalence in this group varied between 0.29% in 1994 and 0.52% in 1995 and 1997. Rates for Hispanic and white women were much lower, ranging from 0% to 0.07% during the survey period (Figure 21).

Figure 21. HIV Prevalence Among Female Job Corps Entrants, by Race/Ethnicity, 1993–1997

Note: Standardized to 1993 population of Job Corps entrants by region, age group, and metropolitan statistical area.
Source of data: U.S. Department of Labor.

Prevalence rates were higher among men who were 20-21 years of age than among those who were younger. For the age group 20-21 years, prevalence among men decreased from 0.50% in 1993 to 0.25% in 1997. For the age group 18-19 years, rates varied between 0.22% in 1994 and 0.09% in 1996; among the youngest group (16-17 years), rates decreased from 0.14% in 1993 to 0.05% in 1997 (Figure 22).

Figure 22. HIV Prevalence Among Male Job Corps Entrants, by Age Group, 1993–1997

Note: Standardized to 1993 population of Job Corps entrants by region, race/ethnicity, and metropolitan statistical area.
Source of data: U.S. Department of Labor.

Among female Job Corps entrants in all age categories, prevalence rates fluctuated between 0.12% and 0.30% during the survey period and showed no decline and little difference by age group (Figure 23).

Figure 23. HIV Prevalence Among Female Job Corps Entrants, by Age Group, 1993–1997

Note: Standardized to 1993 population of Job Corps entrants by region, race/ethnicity, and metropolitan statistical area.
Source of data: U.S. Department of Labor.

Because HIV testing is routine and HIV-positive youth receive medical care, self-selection for enrollment in the program could either decrease or increase the number of HIV-infected entrants. Although Job Corps entrants may not fully represent the larger population of disadvantaged youth in the United States, the data from these surveys can provide important national information that can be used for planning HIV prevention programs for disadvantaged out-of-school youth.

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