The number of African-American high school students engaging in sexual risk behaviors for HIV has declined dramatically in 20 years, significantly reducing the disparities in risk between African-American youth and youth of other racial or ethnic groups, according to a new analysis by the Centers for Disease Control and Prevention.
Among students overall, however, behavior change has stalled during the last 10 years studied, the report said.
"We're encouraged by the progress we see over time in reducing HIV-related risk behaviors, especially among black youth, but we have more to do," said Kevin Fenton, M.D., director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention.
"Risk behavior remains far too high among all students, and it's clear that to realize our goal of an AIDS-free generation, parents, schools and communities will need to intensify efforts to ensure that every young person in America knows about HIV and how to prevent infection."
The data, covering 1991 to 2011, were presented this week by Laura Kann, Ph.D., at the XIX International AIDS Conference in Washington, D.C. and published as an early release in CDC's Morbidity and Mortality Weekly Report. The data come from CDC's National Youth Risk Behavior Survey (YRBS), a nationally representative biennial survey of public and private school students in grades 9-12.
Sexual risk behavior declined most dramatically among African-American youth over the 20-year study period. The gap in risk behavior between these students and their white counterparts has narrowed considerably. In 1991, African-American students were nearly two-thirds more likely to have had sexual intercourse and almost three times as likely to report having multiple partners, compared to white students. By 2011, the disparity between African-American students and white students who ever had sex was cut in half, and the difference in the likelihood of having multiple sex partners declined even more (58 percent).
While declines in risk behavior among African-American students generally persisted over the entire two decades analyzed, progress among youth overall was significant only through the early 2000s, and has stalled since that time. Since 2001, there has been no significant overall change in the proportion of U.S. high school students who reported ever having sex or who had multiple sex partners, and the percentage of sexually active students who used a condom the last time they had sex has been stable since 2003.
Additionally, while African-American students made greater progress than youth of other racial or ethnic groups, African-American students report higher levels of sexual risk behavior than their white or Hispanic peers, with the exception of reporting higher levels of condom use. Of concern, condom use has been declining in this group since 1999. There has been no significant change in sexual risk behaviors among Hispanic students since 1991.
People under the age of 30 represent approximately 4 of every 10 new HIV infections each year. Reducing sexual risk behaviors among America's youth is critical to reducing this toll and achieving the goals of the National HIV/AIDS Strategy, which calls for educating all young people on HIV, as well as intensified prevention efforts for populations at greatest risk, including youth.
"Our challenge is to build on the tremendous strides made by African-American youth, while again jumpstarting the progress among youth overall," said Howell Wechsler, Ed.D., M.P.H., director of CDC's Division of Adolescent and School Health. "We must also confront the persistent lack of progress among Hispanic and white students."
YRBS data do not contain information on some of the known social and economic determinants of risk behavior, such as family income and education. So researchers cannot assess the degree to which these factors may account for the higher levels of risk behavior among African-American youth in the study.
The analysis examines trends in several reported behaviors related to HIV risk by race and ethnicity and found that between 1991 and 2011:
Ever had sex: Overall, the proportion of U.S. high school students who had ever had sex declined from 1991 (54 percent) to 2001 (46 percent), and has stabilized since that time (47 percent in 2011). By race/ethnicity, the proportion significantly declined among African-American students (from 82 to 60 percent); remained stable among Hispanic students (from 53 to 49 percent); and, after an initial decline, has stabilized since 2003 among white students (50 percent in 1991, 42 percent in 2003, 44 percent in 2011)
Current sexual activity: Overall, the proportion of students who had sex within the preceding three months declined from 38 percent in 1991 to 34 percent in 2011. The proportion declined from 59 to 41 percent among African-American students; and remained stable among Hispanic students (37 to 34 percent) and white students (34 to 32 percent).
Multiple partners: Overall, the proportion of students who had multiple (four or more) sex partners decreased from 1991 (19 percent) to 2001 (14 percent) and has stabilized since that time (15 percent in 2011). The proportion declined among African-American students (from 43 to 25 percent); remained stable among Hispanic students (17 to 15 percent); and after an initial decline among white students (15 percent in 1991 to 11 percent in 2003), has stabilized since that time (13 percent in 2011).
Condom use: Overall, the proportion of sexually active students who used a condom the last time they had sex increased from 1991 (46 percent) to 2003 (63 percent) and has stabilized since that time (60 percent in 2011). Among African-American youth, condom use increased from 1991 (48 percent) to 1999 (70 percent) but declined since that time (65 percent in 2011). After initial increases, condom use stabilized among Hispanic and white youth (among Hispanic youth, from 37 percent in 1991 to 61 percent in 2007 and 58 percent in 2011; among white youth, from 46 percent in 1991 to 62 percent in 2003 and 60 percent in 2011).
(For more information, visit www.cdc.gov/healthyyouth or www.cdc.gov/mmwr.)
Source: U.S. Department Of Health And Human Services