In a clinical report published online Dec. 20 in Pediatrics, recommendations are presented for addressing HIV testing and preexposure and postexposure HIV prophylaxis in adolescents and young adults.
Noting that most sexually active youth in the United States do not believe themselves to be at risk for contracting HIV and have not been tested, Katherine K. Hsu, M.D., M.P.H., from the Massachusetts Department of Public Health in Jamaica Plain, and colleagues discuss the pediatrician’s role in HIV testing and preexposure and postexposure HIV prophylaxis.
The authors note that pediatricians should create an environment of confidentiality and tolerance and facilitate open discussion related to sexual and reproductive health issues. All youth ages 15 years or older should be offered routine HIV screening at least once, in health care settings. After initial screening, those at increased risk, including those who are sexually active, should be rescreened at least annually; those at high risk (including male youth reporting male sexual contact, active injection drug users, transgender youth, and youth with a diagnosis of or requesting testing for other sexually transmitted infections) should be rescreened as frequently as every three to six months. HIV preexposure prophylaxis should be routinely offered to youth at substantial risk for HIV acquisition; after high-risk exposures, HIV postexposure prophylaxis is also indicated.
“Complex issues of confidentiality, disclosure of HIV status, and consent in adolescent care and variability in how statutes and regulations address these make implementation of these recommendations challenging,” the authors write.