IV. BACKGROUND: HIV/AIDS AMONG YOUNG PEOPLE IN THE UNITED STATES

Disease syndromes linked to the human immunodeficiency virus first caught the attention of the medical establishment in the U.S. in 1981. In the early years of the epidemic, the disease was associated in the minds of the public and of many experts with gay men and was even referred to as gay-related immunodeficiency disease.⁵ Over the years, though HIV prevalence in the U.S. overall has remained very low, HIV/AIDS became established more widely among young adults, particularly racial and ethnic minorities. For example, since 1991 AIDS has been the leading cause of death among African-American men aged twenty-five to forty-four, indicating that many infections are occurring in this group before age twenty-five.⁶

As a disease of young adults, HIV/AIDS calls for prevention strategies that target young people. The Centers for Disease Control and Prevention note that even though the incidence of AIDS declined overall during most of the 1990s, there was no decline in the number of new HIV cases among young people.⁷ Other experts have noted that at least through the early-1990s, the median age of HIV infection has dropped steadily from about thirty-four to about twenty-five.⁸ The Centers for Disease Control continue to emphasize strongly the centrality of young people and especially youth in schools as a target group for prevention efforts.⁹

Young African-Americans and Hispanics are heavily affected by the HIV/AIDS epidemic. African-Americans represent only 12 percent of the U.S. population, but 38 percent of new AIDS cases while Latinos represent 12 percent of the U.S. population, but 18 percent of new AIDS cases.¹⁰ The rates of infection have increased dramatically among young African-American and Hispanic women. A recent study found that the number of African-American women age eighteen to twenty-seven living with HIV infection rose 40 percent from 1988 to 1993.¹¹ Data from the Centers for Disease Control reveal that African-American women and Latina women, who comprise less than 25 percent of all U.S. women, account for 75 percent of cumulatively reported HIV cases among young women ages thirteen to twenty-four.¹²

HIV/AIDS in Texas
Human Rights Watch conducted the research for this report in Texas counties that include significant African-American and/or Hispanic communities. Texas has the fourth largest population of people living with HIV/AIDS in the U.S.¹³ African-Americans and Latinos in Texas, as in the rest of the United States, comprise a disproportionate share of the state's cases of HIV and AIDS. Overall, 37 percent of people with AIDS and 41 percent with HIV are African-American; 25 percent of people with AIDS and 20 percent of people with HIV are Hispanic. In the fifteen-to-nineteen age bracket, African-Americans account for 57 percent of AIDS cases and 64 percent of HIV infections, while Latinos account for 35 percent of AIDS cases and 18 percent of HIV infections.¹⁴

5 Laurie Garrett, The Coming Plague: Newly Emerging Diseases in a World Out of Order (New York: Penguin Books, 1994), pp. 292-293.

6 Centers for Disease Control and Prevention, Young People at Risk: HIV/AIDS Among America's Youth, http://www.cdc.gov/hiv/pubs/facts/youth.htm (retrieved on August 7, 2002).

7 Ibid.

8 Philip S. Rosenberg, et al., "Declining Age at HIV Infection in the United States," The New England Journal of Medicine, vol. 330, no. 11, March 17, 1994, p. 789; see also Philip S. Rosenberg and Robert J. Biggar, "Trends in HIV Incidence Among Young Adults in the United States," Journal of the American Medical Association, vol. 279, June 17, 1998, pp. 1894-1899.

9 Centers for Disease Control and Prevention, Young People at Risk: HIV/AIDS Among America's Youth, http://www.cdc.gov/hiv/pubs/facts/youth.htm (retrieved on August 7, 2002).

10 Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report: Midyear Edition, vol. 13, no. 1 (2001), p. 14; U.S. Census Bureau, Resident Estimates of the United States by Sex, Race, and Hispanic Origin: April 1, 1990 to July 1, 1999, with Short-term Projection to November 1, 2000, http://eire.census.gov/popest/archives/national/nation3/intfile3-1.txt (retrieved August 23, 2002).

11 Rosenberg and Biggar, "Trends in HIV Incidence Among Young Adults in the United States," pp. 1894-1899.

12 Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report: Midyear Edition , vol. 13, no. 1 (2001), p. 15; Centers for Disease Control and Prevention, HIV/AIDS Among U.S. Women: Minority and Young Women at Continuing Risk (Atlanta, Georgia: U.S. Centers for Disease Control and Prevention, May, 2002).

13 Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report: Midyear Edition, vol. 13, no. 1 (2001), p. 5.

14 Texas Department of Health, Texas HIV/STD Surveillance Report: Annual Report 2000, December 31, 2000, pp. 4-5.