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Health Department

Dr. Paul's Tennessean Guest Column - May 1, 2011
Youths have misconceptions on HIV/AIDS

Recent news of increases in HIV infection in people ages 30 or younger should be an alarming wake-up call here in Nashville. June will mark the 30th anniversary of the first reports of AIDS cases, and now most people becoming infected with HIV are younger than the epidemic itself.

As HIV now affects the next generation of adolescents and young adults, we cannot approach the epidemic with the same mindset we had 30 years ago. Tennesseans under 30 often view infection with HIV differently from older people.

Most did not witness the initial wave of the AIDS epidemic, which devastated individuals and families. Many gay and bisexual adolescents and young adults view HIV infection as inevitable, but manageable. Often, I've heard the comment "It's OK if I get HIV; the drugs will keep me healthy." While HIV infection has become a chronic, controllable condition for many, medications have side effects and risk of resistance. Drug treatment for HIV is not as safe and sure as avoiding infection in the first place.

Over the past 16 years, I've spoken with many classes of high school and university students. It is clear to me that too often their awareness of and knowledge about healthy sexuality is too little, too late. Parents have a responsibility to teach their values to children and youths, but it's especially critical that adolescents and young adults have access to accurate information and support to make informed decisions about their sexual health.

No matter what their sexual orientation or gender identity is, every adolescent and young adult should have support and accurate information available. A strategy that avoids talking about sex until after young people are sexually active is bound to fail.

Young people should learn about sexuality in the context of healthy and safe relationships of all types. Comprehensive curricula that put HIV prevention in context can help. Parents have the major responsibility here, but schools and faith communities play an important role in ensuring our young people know how to be safe and healthy. Children who lack a safe and supportive environment at home need access to safe places and caring adults.

HIV spreads very easily in communities that are marginalized because they are "different'' or that have less access to information, resources and clout. Men who have sex with men and African-Americans have markedly higher rates of infection across the U.S., and rates continue to rise in women of color. "Prevention messages" are hard to hear if you are bullied, devalued and defeated at the start.

To effectively address HIV for young people, we need to address issues of racism, homophobia and stigma head-on. Resources for families with gay, lesbian, bisexual or transgendered children should be easily and readily available. Parents and other responsible adults need to be equipped to help children develop healthy relationships and to create a climate where people who are different are not bullied.

Most of all, there must be a dialogue between young and old, and across different cultures. We must come together as a community, with new faces, voices, ideas and renewed determination to defeat HIV and its continued attack on Nashville's next generation.

William S. Paul, MD, MPH
Director of Health
Metro Public Health Department of Nashville/Davidson County