Most Pediatricians Aren't Talking to At-Risk Teenagers About HIV Testing

Among the general US population, an estimated 14.5% of people living with HIV have not been diagnosed. In the 13- to 24-year-old age group, that estimate rises to 51.4%.

The investigators of a new study, published in Pediatrics have uncovered concerningly low rates of HIV testing among gay and bisexual teenage boys. Less than 1 in 4 members of the study population had ever received an HIV test. Additionally, among teens who reported having anal sex without a condom, only 1 in 3 reported undergoing an HIV test.

The results are worrying, given earlier HIV treatment initiation can alter the course of the disease for the better.

The study team collected data between 2018 and 2019 as part of SMART, a trial evaluating the benefit of an online HIV prevention resource among adolescent men who have sex with men (MSM).

Eligibility criteria required participants to be between 13 and 18 years of age, male, to identify as gay/bisexual/queer/attracted to cisgender men, to have a history of sexual experience, to have internet access, and to be able to read English or Spanish.

The mean age of participants was 16.6 years.

Participants were assessed by socio-economic status, rural or urban residency, and whether they were open about their sexual orientation.

“The sample had strong representation of racial and/or ethnic minority participants and youth from low-socioeconomic-status backgrounds,” study authors wrote.

Transmission risk behaviors were evaluated using the HIV Risk Assessment of Sexual Partnerships test.

Other items in the study shed light on doctor-patient interactions about sex and STD testing that the trial participants had experienced.

Of the 699 participants, 23.2% had received an HIV test. Increasing age was associated with testing, with 5.6% of 13-14 year-olds, 15.8% of 15-16 year-olds, and 37.8% of 17-18 year-olds reporting being tested.

Testing with a parent present was found to be rare, with 121 participants who had been tested (74.7%) reporting that their parents were not present when they received an HIV test.

Notably, the study identified that 67.5% of participants had a regular doctor, yet only 21.3% reported having a conversation about same-sex behaviors and only 19.2% had ever discussed HIV testing.

Among those who had spoken with a doctor about HIV testing, 75.4% reported testing, compared with 10.8% who had not had such a conversation.

“Data indicate pediatricians are an important, but largely untapped, source of testing and could be integral to achieving testing rates needed to end the epidemic,” study authors noted.

“Finally, for pediatricians who do not want to engage in conversations about sexual orientation, defaulting to HIV testing with an informed opt out option would be effective as well.”