St Louis M E, Conway G A, Hayman C R, Miller C, Petersen L R, Dondero T J
Division of HIV/AIDS, Centers for Disease Control, Atlanta, Ga 30333.
JAMA. 1991 Nov 6;266(17):2387-91.
OBJECTIVE--To describe the human immunodeficiency virus (HIV) epidemic among socially and educationally disadvantaged young persons in the United States.
-We analyzed demographic and geographic findings from the screening of Job Corps students for antibody to HIV. SETTING--The Job Corps is a federal training program for disadvantaged, out-of-school youth. POPULATION SCREENED--Residential students aged 16 to 21 years who entered the Job Corps from October 1987 through February 1990. MAIN OUTCOME MEASURE--Rates of observed HIV infection in entering students, stratified by demographic and geographic features. RESULTS--Of 137,209 Job Corps students screened, 488 were HIV seropositive (3.6 per 1000), a seroprevalence rate higher than that among military applicants of the same age. Overall seroprevalence was slightly higher in male (3.7 per 1000) than in female (3.2 per 1000) Job Corps students, but among those students aged 16 and 17 years, seroprevalence was higher among females (2.3 per 1000) than among males (1.5 per 1000) (P less than .05). For students aged 16 to 21 years, seroprevalence increased with year of age: 1.8 per 1000 per year for males and 0.7 per 1000 per year for females. Among those aged 21 years, HIV prevalence was 8.9 per 1000. For black and Hispanic students from large Northeastern cities, seroprevalence increased by 4.3 per 1000 per year of age and reached 24.8 per 1000 (one of 40) in students aged 21 years. However, among students from rural areas and small towns, HIV seroprevalence was disproportionately high in the Southeast. Compared with recently described US patients with the acquired immunodeficiency syndrome, HIV-infected students who entered the Job Corps were much more likely to be female. CONCLUSIONS--These findings show that disadvantaged, out-of-school adolescents are at high risk for HIV infection. The screening results identified surprisingly high seroprevalence in the southeastern United States and demonstrated a marked shift in the HIV epidemic to young women. Controlling the HIV epidemic among teenagers must include interventions that will reach adolescents early and outside of the formal educational system.
目的——描述美国社会和教育背景不利的年轻人中的人类免疫缺陷病毒（HIV）流行情况。
设计——我们分析了职业团学生HIV抗体筛查的人口统计学和地理数据。背景——职业团是一项针对处境不利的失学青年的联邦培训项目。筛查人群——1987年10月至1990年2月进入职业团的16至21岁住校学生。主要观察指标——按人口统计学和地理特征分层的入学学生中观察到的HIV感染率。结果——在接受筛查的137,209名职业团学生中，488人HIV血清学检测呈阳性（每1000人中有3.6人），血清阳性率高于同年龄的军事应征者。职业团学生中，男性总体血清阳性率（每1000人中有3.7人）略高于女性（每1000人中有3.2人），但在16岁和17岁的学生中，女性血清阳性率（每1000人中有2.3人）高于男性（每1000人中有1.5人）（P<0.05）。对于16至21岁的学生，血清阳性率随年龄增长而增加：男性每年每1000人中有1.8人，女性每年每1000人中有0.7人。在21岁的学生中，HIV患病率为每1000人中有8.9人。对于来自东北部大城市的黑人和西班牙裔学生，血清阳性率每年每1000人增加4.3人，在21岁的学生中达到每1000人中有24.8人（40人中有1人）。然而，在农村地区和小城镇的学生中，东南部的HIV血清阳性率异常高。与最近描述的美国获得性免疫缺陷综合征患者相比，进入职业团的HIV感染学生中女性的比例要高得多。结论——这些发现表明，处境不利的失学青少年感染HIV的风险很高。筛查结果显示美国东南部的血清阳性率高得出奇，并表明HIV流行明显向年轻女性转移。控制青少年中的HIV流行必须包括能在早期及正式教育系统之外接触青少年的干预措施。
