MENU TITLE: HIV/AIDS and STDs in Juvenile.
Facilities
Series: NIJ Research in Brief
Published: April 1996
17 pages
40,044 bytes

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U.S. Department of Justice
Office of Justice Programs
National Institute of Justice

National Institute of Justice
Research in Brief

Jeremy Travis, Director
April 1996

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Issues and Findings

Discussed in this Brief: The findings of a 1994
survey by the National Institute of Justice (NIJ)
and Centers for Disease Control and Prevention
(CDC) of policies, programs, and data regarding
HIV/AIDS and sexually transmitted diseases (STDs)
in State and local juvenile justice detention
centers and training schools.

Key issues: Although much research has been
conducted among incarcerated adults on HIV/AIDS and
sexually transmitted diseases, little has been done
among confined juveniles. NIJ and CDC
sponsored this survey of State and city/county
juvenile justice systems to gather information
about their HIV and STD education and prevention
measures. Although youths have basic knowledge
about how HIV and STDs are transmitted, confined
juveniles often lack a sense of personal risk and
its consequences when engaging in high-risk
behavior.

Key findings: Although only about 1 percent of
individuals diagnosed with AIDS between 1993 
and 1994 were between 13 and 19 years old, 
many youths engage in high-risk behavior that 
puts them in danger of contracting HIV and STDs. 
Among the survey's findings:

o Many detention centers and training schools offer
instructor-led education about HIV. Out of the
total respondents to the survey, 53 systems
provided complete data. Of these, approximately
three-quarters offered HIV prevention counseling in
juvenile facilities.

o Although some juvenile justice systems have
comprehensive HIV education and prevention
programs, many do not provide extensive information
because of societal pressure and juvenile justice
agency regulations against delivering explicit
messages and distributing materials such as
condoms.

o State systems, more than county and city systems,
include such topics as safer sex practices,
negotiating skills, self-perception of risk, the
meaning of HIV/STD tests, and proper condom use in
their education programs.

o Only 2 of the 73 systems that responded to the
survey conduct mandatory HIV screening of all
incoming juveniles (11 more systems screen pregnant
girls). Most systems provide HIV, STD, and
pregnancy testing on a voluntary basis and/or when
juveniles exhibit clinical indications of disease
or pregnancy.

o If voluntary testing is to be successful, it must
be easily accessible and include provision of
confidential services,
extensive education, and quality medical care.

Target audience: Juvenile justice system
administrators, State commissioners of corrections,
State and local policymakers, health professionals,
and researchers.

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HIV/AIDS and STDs in Juvenile Facilities
By Rebecca Widom and Theodore M. Hammett

Sexually transmitted diseases (STDs), including
HIV/AIDS, pose serious challenges to administrators
of both adult and juvenile justice systems.
Although extensive literature exists on HIV/AIDS
and sexually transmitted diseases among
incarcerated adults,1 little research has focused
on HIV and STDs among confined juveniles. 
High rates of HIV risk behaviors have been 
documented among high school students and
adolescents not in school.2 Juveniles in 
confinement are likely to be disproportionately 
at risk for HIV, STDs, and other health problems 
linked to substance abuse, unprotected sexual 
contact, and poor access to preventive and primary 
health care. Although most training schools and 
juvenile detention centers currently report few 
confined juveniles with HIV or AIDS, HIV 
infection may be spreading among this
population. Further, significant rates of STD
infection and unplanned pregnancy among confined
youths are cause for concern in and of themselves
and as indicators of the prevalence of HIV-risk
activities.

Thus, even though most terms of juvenile
confinement are short, juvenile justice systems
have an opportunity to help improve the health of
an underserved and vulnerable segment of society.
Moreover, intervention during confinement can
benefit those whom juveniles will encounter once
they are released.

The 1994 National Institute of Justice (NIJ) and
Centers for Disease Control and Prevention (CDC)
survey asked State and city/county juvenile justice
systems to report on their policies, programs, and
data regarding HIV/AIDS and sexually transmitted
diseases. In order to gauge the accuracy of central
office reports, samples of training schools in
selected State systems also
completed an abbreviated questionnaire that focused
on policies regarding HIV/AIDS and STDs.

Forty-one State juvenile justice systems, 32 city
or county detention centers, and 27 State training
schools responded to the questionnaire. Responses
to the NIJ/CDC survey do not constitute a random
sample of juvenile justice systems or facilities.
However, the data are extensive enough to support
some preliminary findings. This Research in Brief
outlines current knowledge regarding HIV and STD
risk behaviors among youths, epidemiological data
on HIV/AIDS and STDs from the NIJ/CDC survey and
other sources, and NIJ/CDC survey findings on
education, preventive measures, and testing
policies.

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Epidemiological data

Patterns of HIV/AIDS among adolescents in the
United States. Relatively few adolescents have been
diagnosed with AIDS in the United States; however,
a larger minority of people with AIDS have been
diagnosed in their early twenties. Because an
individual can be infected with HIV for 3 to 5
years or more before showing symptoms, many of
those diagnosed with AIDS in their early twenties
were probably infected with HIV as teenagers.3
Adolescent girls are more at risk for HIV infection
than women in other age groups, and adolescents of
color comprise a majority of adolescents with AIDS.
Eighty percent of female adolescents with AIDS are
African American and/or Hispanic.

Among the 239 males 13 to 19 years old in the
United States diagnosed with AIDS in 1994, 26
percent were infected through sex with other males,
5 percent through injection drug use (IDU), 3
percent through sex with other males and injection
drug use, and 5 percent through heterosexual
contact.4 Among the 1,857 males 20 to 24 years old
diagnosed with AIDS in the United States in 1994,
approximately 80 percent were infected through sex
with other men and/or injection drug use.5 Since
more than half the adolescents diagnosed with AIDS
in the United States were diagnosed in 1993 or
19946 and in light of documented risk activities
among adolescents, an increase in the number of
adolescents with HIV/AIDS is expected.

AIDS cases among confined juveniles. Respondents to
the NIJ/CDC survey reported a cumulative total of
60 juveniles with AIDS (50 boys and 10 girls, 54 in
State systems and 6 in city/county systems out of a
total of 73 systems responding). Cumulative totals
included cases among confined juveniles, those who
had been released, and those who had died while
confined. Only four currently confined juveniles 
with AIDS were reported: Three State systems and 
one city/county detention center each reported having 
one boy with AIDS. Four juveniles (three boys and 
one girl, two in State systems and two in city/county 
systems) had died from AIDS while confined.

Seven percent of the respondents did not know
either how many juveniles with AIDS were currently
in their systems, had died while confined, or had
been released with AIDS. Maintaining records of the
number of juveniles with AIDS released from
juvenile systems appeared to be particularly
difficult. Further, respondents reported almost no
information on racial breakdowns among confined
juveniles with AIDS. Of those systems that had
detained youths with AIDS, approximately half of
the cases were reported as race unknown.

HIV seropositivity7 among confined adolescents.
Currently, HIV seropositivity among confined
juveniles appears to be infrequent. Blinded studies
of confined juveniles in Colorado, Texas, and San
Bernardino County, California, found no HIV
positive juveniles in their samples.8 Studies in
Alabama and Illinois found HIV seropositivity 
rates of 0.7 percent and 0.1 percent, respectively. 
Screening of all incoming juveniles in New Mexico 
found no HIV positive adolescents among 1,053 boys 
and 260 girls tested. Similarly, screening of all 
incoming juveniles from September 1992 through 
October 1994 in Mississippi revealed only one 
girl to be HIV positive. All responses from other 
jurisdictions indicated that HIV testing for other 
purposes, including testing juveniles upon request 
and testing pregnant girls, resulted in less than 
1 percent seropositivity among confined juveniles.

Risk behaviors among adolescents

Although relatively few adolescents with HIV have
been identified, it appears that many adolescents
have engaged in risky behavior. Most research on
risk behavior among adolescents has focused on
those in school, somewhat less has dealt with
youths not in school, and very little has
considered confined juveniles.

Studies to date on risky behavior among adolescents
have produced somewhat disparate results, but they
generally support the conclusion that sexual activity 
among adolescents has increased over time.

One study found relatively stable levels of sexual
activity and drug use among adolescents between
1990 and 1993.9 Other research documented increases
in sexual activity, rates of STDs, and unintended
pregnancy among high school students since the
1970's and an increase in HIV infection among high
school students since the 1980's.10 Survey data
from a sample of 12,272 representative high school
students across the United States led to the
following estimates:

o Sixty-nine percent of high school students had
sexual intercourse during the 3 months preceding
the survey.

o Nineteen percent had sexual intercourse with four
or more partners during their lifetimes.

o Of those currently sexually active, 46 percent
used a condom during their previous sexual
encounter.

o Two percent had used injection drugs.11

Adolescents not in school, including confined
juveniles, appear to be at even more serious risk.
According to the CDC, "out-of-school adolescents
aged 14 to 19 years were significantly more likely
than inschool adolescents to report ever having had
sexual intercourse (70.1 percent versus 45.4
percent) and to have had four or more sexual
partners (36.4 percent versus 14.0 percent)."12
Confined juveniles represent what may be a
particularly at-risk subpopulation of adolescents 
not in school because of the overrepresentation 
among them of youths with histories of high-risk 
behavior and poor access to health care and 
prevention services.

STD and pregnancy testing results. According to
recent research, some of the highest rates of
gonorrhea during the 1980s were found among
adolescents 15 to 19 years old, and rates increased
or remained the same among adolescents throughout
the 1980's even while decreasing for other groups.
Further, confined youths tended to have higher
rates of STDs than adolescents in the community,
indicating significant risk for HIV among confined
youths.13

Slightly over half of the jurisdictions responding
to the NIJ/CDC survey provided data on results from
testing done on a routine or voluntary basis or
when clinically indicated. Most systems reported
testing juveniles who requested it or who exhibited
symptoms. In contrast to rates of HIV infection
under 1 percent, the mean reported rates were 2
percent (median 7 percent, standard deviation 5
percent) for syphilis and 14 percent (median 5
percent, standard deviation 22 percent) for
gonorrhea.14 These estimates do not accurately
indicate seroprevalence for gonorrhea or syphilis
because some jurisdictions tested only adolescents
who were most likely to have been exposed. However,
because most systems reporting results tested a total 
of 400 to 500 juveniles, this indicates that a large 
number of confined juveniles have syphilis or 
gonorrhea.

Similarly, some juvenile systems tested confined
girls who requested pregnancy tests or 
demonstrated clinical indications of pregnancy, 
while others reported conducting routine pregnancy 
testing. Among the systems that provided routine 
pregnancy testing, the mean pregnancy rate was 
14 percent (total tested: 2,230). Among systems 
that provided pregnancy tests on request of the 
juvenile or upon clinical indications, the mean 
pregnancy rate was 19 percent (total tested: 1,091).

HIV and STD education and preventive measures

Information alone is not sufficient to induce or
sustain changes in the often ingrained or addictive
behaviors that place adolescents (and others) at
risk for HIV infection. Effective HIV prevention
requires addressing the complex circumstances in
which high-risk behaviors occur and persist.
Leading researchers have proposed a two-level
prevention program comprising universal and
targeted elements. The universal components
include:

o Basic information on HIV/AIDS and risk-reduction
methods.

o Efforts to reduce discrimination against people
living with HIV.

o Removal of restrictions on access to condoms,
sterile needles, and other materials needed to
implement guidelines for safer behavior.

In addition, communities with a high prevalence or
risk of HIV should receive intensive interventions
addressing the "physiologic, emotional,
interpersonal, and cultural contexts" of behavior
and emphasizing face-to-face communication, changes
in social norms regarding sex and drug use, and
distribution of materials necessary for safer
behavior.15

Because of high rates of HIV risk behaviors among
confined
adolescents, juvenile facilities may be prime
settings for intensive HIV/STD education. Further, 
since virtually all confined juveniles are eventually
discharged, behavioral interventions could benefit
not only the youths themselves but persons they
encounter once released.

Prevention knowledge among adolescents. Research on
adolescents knowledge of HIV and STD transmission
has produced somewhat mixed results. One study
found similar and impressive levels of knowledge
about HIV transmission among confined youths and
adolescents in school but also found differences in
the particular knowledge between the two groups and
in their motivation to act on what they knew.
Although both confined and inschool youths
recognized that sexual intercourse could lead to
HIV transmission, confined adolescents were not as
motivated to change their behavior, and youths in
school were more likely to identify condom use as a
way to prevent transmission.16

Another study found significant differences in
perceived risk and personal consequences between
confined and nonconfined adolescents. Because
confined youths are more likely than other
adolescents to have lived in poverty, they may
simply need better access to health services to
obtain basic information.17 However, their lack of
a sense of personal risk and responsibility is of
equal concern.

Types of HIV education and prevention programs

Most systems responding to the NIJ/CDC survey
reported providing instructor-led education,
audiovisual materials, and written materials, but
only a few offer peer education programs. Rates of
agreement between systems and their facilities were
generally quite high.

Instructor-led programs. In many juvenile training
schools, HIV/STD education is offered as part of
the health component of the regular education
curriculum. However, the turnover in the population
may mean that many youths are not exposed to the
portion of the curriculum dealing with HIV and
STDs.

A particularly well-conceived HIV/STD education
program is offered by the Massachusetts Department
of Youth Services (MDYS).18 Two full-time
educators, funded through CDC's HIV prevention
cooperative agreement with the State's Department
of Public Health, cover HIV and STD issues in the
context of a comprehensive sexuality education 
program.

As part of the site visits conducted for this
study, sessions conducted by one of the MDYS
educators were observed at three Massachusetts
juvenile facilities: a long-term care facility and
a shelter care facility for boys, and a short-term
detention center for girls.

The MDYS educator was both respectful and sensitive
to the youths' diverse learning levels, emotional
states, and cultural backgrounds. Rather than lecturing, 
she used an innovative, interactive style that was youth-
centered. The educator spent significant time bonding 
with her students and listening to their concerns. She 
appeared to develop trusting relationships with the 
youths, even during one-time sessions in detention 
facilities.

In longer term facilities, the educator offered a
series of four 1 «-hour sessions. During the
first session, the youths selected issues they
wanted to address. This approach, while taking into
account the juveniles' feelings and concerns, was
also flexible enough for the educator to cover
important points she had prepared. She also created
exercises and materials addressing the topics
selected by the adolescents. In an environment with
little opportunity for choice, this educator has found 
an important way to win the youths support for the
program by offering them the chance to voice their
preferences.

Another important feature of the MDYS four-session
series was a visit from an HIV-positive guest who,
rather than simply relating his/her story and
drawing appropriate lessons about risk behavior,
was interviewed by the juveniles. The youths
"owned" the session and could ask any questions
they wished as long as they were respectful of the
guest. In the observed session, the youths asked
many candid and important questions, and the guest
responded with valuable information they could
apply to their own lives. The MDYS educator noted
that the interview session did not work well unless
the youths were given a previous session on
interviewing skills and an opportunity to consider
and discuss questions they might ask of the guest.

Finally, the Massachusetts program places a heavy
emphasis on educating staff. In addition to
building support for the program, education in HIV
and sexuality issues better equips staff to provide
information and followup in the facility during the
majority of hours when the HIV educator is not
present.

Peer-led programs. Several juvenile systems have
implemented HIV peer education programs. In New
Mexico, HIV prevention education is part of a peer
drug and alcohol prevention education program,
started 7 years ago as part of the Drug-Free
Schools Program.19 Approximately 20 confined
juveniles act as peer educators each year. In one
session in this series, confined juveniles learn
how HIV is transmitted and how to practice safer
sex, discuss their fears of HIV, and receive
referrals for HIV testing.20

In Los Angeles County, the Peer HIV Education
Research Project (PHERP) was designed to compare
the effectiveness of peer and adult educators.21
Peer educators team-teach classes with adult
teachers and cover prevention and transmission of
HIV, including safer sex and injection practices,
alcohol and drug abuse, STD symptoms and treatment,
and negotiation skills regarding condom use.
Students participate in role-playing exercises and
listen to a guest speaker discuss what it is like
to be HIV positive. At the beginning and end of the
program, participants are surveyed on their HIV
knowledge.

Three peer educators were trained and team-taught
HIV prevention classes, and the project coordinator
was able to report some preliminary evaluation
results. Her initial assumption was that peer
educators would be much more effective than adult
educators, but initial evaluation results suggest
that each type of educator has different strengths.
Although differences were quite small, peer-led
groups showed more positive changes in attitude and
behavior, while adult-led groups demonstrated
higher levels of HIV-related knowledge.22

Written materials. In order to implement effective
HIV prevention education, a system must provide
appropriate materials that confined youths are able
to read and understand. Participating systems
reported using HIV education materials with an
average of a sixth-grade reading level. Four
jurisdictions reported using materials with reading
levels of tenth to twelfth grades, and one reported
using materials with a third-grade reading level.

Since people of color are overrepresented in
confined populations and among adolescents with
AIDS, culturally specific HIV prevention materials
should be available to meet their needs. Similarly,
confined juveniles whose first language is not
English should have access to HIV prevention
materials in their primary language. Materials
specifically addressing issues facing girls also
should be available. Juvenile justice systems have
had mixed success in this regard.

Topics covered in HIV and STD education. To date,
most HIV prevention programs in juvenile facilities 
have emphasized provision of information. Practical
risk-reduction techniques have been insufficiently
addressed in juvenile and adult systems' HIV
education programs, often because authorities have
been reluctant to teach about proscribed behaviors
such as sex and drug use and to provide the means
to render such activities safer. (Similar concerns
have also limited HIV prevention programs for
nonconfined adolescents.) Providing effective HIV
prevention programs to confined juveniles is made
difficult by a central tension: The best programs
are explicit about precautionary and preventive
measures, yet public opinion and the regulations of
juvenile justice agencies often prohibit such
explicit messages. Additionally, most systems
forbid distribution of materials, such as condoms
and bleach, needed to put HIV prevention messages
into practice.

Discussing sex with youths is always complicated
and controversial, which is why the CDC has
encouraged input from parents and
communities in developing HIV prevention
curriculums for public schools.23 Obtaining
meaningful input from the parents of confined
juveniles into education for these youths may be
more difficult. However, because HIV prevention
depends on individual behavior, frank and honest
discussion of how HIV is transmitted is essential.

Although some juvenile justice systems have
implemented comprehensive HIV education and 
prevention programs, many systems have only 
minimal programs. Some justify this lack of programs 
by citing the very low HIV seropositivity among 
confined youths, but this disregards evidence of 
substantial levels of high-risk behaviors and STD 
infection in these populations.

All but one responding State system and most
city/county systems reported covering basic HIV and
STD information in their education programs. Many
more State systems than city/county systems
reported covering such topics as safer sex, the
meaning of tests for HIV or STDs, negotiating
skills, condom use, and self-perception of risk.
The fact that juveniles remain in city/county
detention centers for much less time than in State
training schools may explain some of this
discrepancy. In light of the research cited above,
however, topics such as self-perception of risk and
efficacy of prevention activities seem particularly
important.

Condom distribution. Only two jurisdictions
(Alameda and San Mateo counties in California)
reported making condoms available to confined
juveniles for use within the facility, and only one
additional jurisdiction (Miami, Florida) reported
future plans to distribute condoms. However, 40
percent of State systems and 32 percent of
city/county systems reported that they made condoms
available to juveniles upon release. Although none
of the systems in the validation study reported
distributing condoms, one facility within one of
the systems did report doing so.

HIV and STD testing policies

HIV mandatory screening. Few jurisdictions have
implemented mandatory mass screening for HIV.
Instead, most provide voluntary testing and/or test
for HIV when juveniles show clinical symptoms of
disease.

Only two State systems (5 percent) reported
mandatory screening of incoming juveniles. No
city/county juvenile detention centers reported
screening all incoming juveniles, which is not
surprising in light of the high rate of turnover in
these facilities. Juvenile justice systems may have
several purposes in mind in implementing mandatory
mass screening policies. They may screen to isolate
infected individuals. Of the two systems that
reported screening all incoming juveniles, only one
housed juveniles with HIV disease24 apart from other 
juveniles. Two other systems segregate juveniles with 
AIDS but did not report mass screening policies. 
Others might implement mass screening policies in 
order to ensure early detection and treatment of HIV
disease. However, in part because of discrimination
against people with HIV disease and in part because
of the cost of mass screening policies, most
jurisdictions prefer to educate confined youths and
allow them to choose whether or not to be tested
for HIV.

None of the responding jurisdictions reported
screening releasees. However, eight (19 percent)
State systems25 and three (9 percent) city/county
systems26 reported a policy of screening all
pregnant girls. All of the city/county detention
centers with this policy were located in
California, whose State system also reported
mandatory testing of all pregnant girls. This will
be an important policy to monitor in view of recent
evidence that treatment of HIV-positive pregnant
women with zidovudine (ZDV) reduces the risk of
perinatal transmission. Most facilities
participating in the validation study reported
testing policies consistent with those reported by
their systems; however, facilities and systems with
policies of testing on request showed higher rates
of agreement than those with mass screening
policies.

Voluntary HIV testing. It is often assumed that
persons who know they are at elevated risk for HIV
or believe they are infected will volunteer for HIV
testing. However, many high-risk individuals may
not come forward to be tested out of fear of the
results.27

Early treatment -- including prophylaxis for
Pneumocystis carinii pneumonia or other
opportunistic infections, immunizations, and
counseling regarding diet and food preparation to
avoid food-borne pathogens -- may lengthen and
improve the quality of life for HIV-infected
juveniles.

Voluntary HIV testing for juveniles may be
complicated by parental consent requirements.
Having to acknowledge high-risk behavior to their
parents may discourage juveniles from pursuing
voluntary testing. Thirty-seven State systems (90
percent) and 25 city/county systems (78 percent)
reported that juveniles do not need parental
consent in order to be tested for HIV infection.
Only five States (California, Colorado, Iowa,
Michigan, and Washington) explicitly allow minors
to consent to HIV testing.28 To implement
successful voluntary HIV testing programs,
administrators must consider how to make testing
accessible in addition to providing confidential
services, extensive education, and quality medical
care.

Confidentiality and disclosure. Ensuring
confidentiality of HIV test results is one of the
most important ways to encourage youths to be
tested, but this can be complicated and extremely
difficult. Although by official policy only 25
percent of systems notify parents or guardians of
their children's HIV status, parents often have
general access to their children's medical records.
Parents have good reasons for wanting to know the
HIV status of their children, particularly if their
children are at high risk for HIV infection.
Adolescents, however, may also have valid concerns
about informing their parents of their HIV status.
Juvenile justice systems should carefully consider
all ramifications before informing parents or 
guardians of HIV status without the consent of 
the juvenile. In many jurisdictions, such disclosure 
without consent may be illegal.

Almost all systems reported a policy of notifying
the juvenile (96 percent), her or his doctor (85
percent), and the local public health department
(80 percent) of HIV status. Half or more systems
also reported policies of notifying other medical
staff (63 percent), institution management (50
percent), and spouses or sexual partners of HIV-
infected youths (49 percent). A partner
notification policy might mean that the confined
juvenile notifies the partner(s) directly, that
juvenile justice staff notify the partner(s), or
that public health authorities are notified and
follow up with the partner(s). Only 20 percent of
responding systems reported a policy of notifying
nonmedical juvenile justice staff. Validation study
results on notification policies show a high rate
of agreement between central offices and individual
facilities.

HIV pretest and posttest counseling

Pretest and posttest counseling are critical
components of programs dealing with HIV in juvenile
justice systems. Fifty-nine percent of State
systems and 22 percent of city/county systems
reported providing HIV prevention counseling in
some or all of their facilities. (There may have
been uncertainty regarding the meaning of the
survey questions that dealt with "HIV prevention
counseling." The questions were intended to refer
to ongoing prevention counseling, but most systems
probably answered in terms of pretest and posttest
counseling.) Overall, questionnaire responses
indicate that approximately two-thirds of all
facilities provide HIV prevention counseling.

In order to maintain confidentiality, counseling
must be individualized. By offering increased 
individual attention, such counseling can encourage 
youths to express their feelings honestly. However, 
limited resources among juvenile justice systems often
preclude offering this service. Sixty-two percent
of State systems and 38 percent of city/county
systems reported providing individual HIV
counseling. More than half of the participating
State juvenile justice systems reported providing
HIV counseling that covered the meaning of HIV
antibody test results, safer sex practices, condom
use, effects of alcohol and drug use on HIV risk,
self-perception of risk, and/or referrals to other
services.

STD testing and notification

Many more systems perform routine screening for
syphilis, gonorrhea, and chlamydia than for HIV. 
STD testing on request and in cases of clinical 
symptoms also appear at least officially available 
in the vast majority of juvenile justice systems.

Similarly, more systems require that sexual
partners be notified of a juvenile's syphilis,
gonorrhea, or chlamydia infection than of HIV
infection. Approximately 80 percent of
participating systems reported having policies
requiring sexual partner notification of syphilis
and gonorrhea infection, and 75 percent of systems
reported having a policy requiring sexual partner
notification of chlamydia infection. However, only
5 percent of State systems and 13 percent of
city/county systems said they officially require
notification of parents or guardians when a
confined juvenile tests positive for an STD.

Pregnancy testing. Sixty-four percent of State
juvenile justice systems, compared with 19 percent
of city/county systems, reported routine pregnancy
testing policies. This difference may be due to
youth's short length of stay in detention centers.
However, 94 percent of all systems, both State and
local, reported testing girls demonstrating
symptoms of pregnancy, and 94 percent of all
systems reported providing voluntary pregnancy
testing.

Conclusion

Many juveniles in confinement have engaged in
activities that place them at elevated risk for HIV
and STDs. Nevertheless, HIV has not yet become as
widespread as STDs among adolescents in detention
centers and training schools. Thus, a unique
opportunity exists to prevent HIV infection,
improve public health, and provide important
preventive and therapeutic services for youths who
may have no other means of accessing them. Most
juvenile systems have implemented some form of 
prevention program, including HIV/STD education, 
but there is still considerable work to be done to 
improve education and prevention. If juvenile 
justice systems do not seize this opportunity, HIV 
infection among confined juveniles will likely 
escalate. In order to take full advantage of this 
opportunity, more juvenile systems should 
make counseling, education, and voluntary HIV 
testing available. Further research, especially 
on the prevalence of HIV and STDs among confined 
juveniles and on the efficacy of various behavioral 
interventions, would also be of value.

Notes

1. Hammett, T., R. Widom, J. Epstein, M. Gross, S.
Sifre, and T. Enos, 1994 Update on HIV/AIDS and
STDs in Correctional Facilities, Washington, D.C.:
U.S. Department of Justice, National Institute of
Justice, 1995.

2. The following reports were cited in DeClemente,
R.J., M.M. Lanier, P.F. Horan, and M. Lodico,
"Comparison of AIDS Knowledge, Attitudes, and 
Behaviors among Incarcerated Adolescents and a 
Public School Sample in San Francisco," American 
Journal of Public Health, 81(5) (May 1991): 628-630; 
Alexander-Rodriguez, T., and S.H. Vermund, 
"Gonorrhea and Syphilis in Incarcerated Urban 
Adolescents: Prevalence and Physical Signs," 
Pediatrics, 80 (1987):561-564; Bell, T.A., J.A. Farrow, 
W.E. Stamm, C.W. Critchlow, and K.K. Holmes, 
"Sexually Transmitted Diseases in Females in a 
Juvenile Detention Center," Sexually Transmitted 
Diseases, 12 (1985):140-144; and Council on Scientific 
Affairs, "Health Status of Detained and Incarcerated
Youths," Journal of the American Medical
Association (JAMA), 263 (1990):987-991.

3. Centers for Disease Control and Prevention
(CDC), "Guidelines for Effective School Health
Education to Prevent the Spread of AIDS," Morbidity
and Mortality Weekly Report (MMWR), 37(S-2)
(January 29, 1988):1-14.

4. Of males 13 to 19 years old diagnosed with AIDS
in 1994, 48 percent were at risk through
hemophilia/coagulation disorder or receipt of a
blood transfusion, and 13 percent did not have a
risk category reported or identified. CDC, HIV/AIDS
Surveillance Report: U.S. HIV and AIDS Cases
Reported Through December 1994, Washington, D.C.:
U.S. Department of Justice, National Institute of
Justice, 6(2) Year End Edition.

5. Ibid.

6. Ibid.

7. HIV seropositivity indicates the presence of HIV
antibodies in the blood.

8. Blinded epidemiological studies and mass
screening both avoid selection bias, which provides
the best estimates of seroprevalence.

9. "Trends in Sexual Risk Behavior Among High
School Students" United States, 1990, 1991, and
1993," MMWR, 44(7) (February 24, 1995): 124,
131-132.

10. "Selected Behaviors that Increase Risk for HIV
Infection, Other Sexually Transmitted Diseases, and
Unintended Pregnancy Among High School Students
"United States, 1991," MMWR, 41(50) (December 18,
1992):945-950.

11. Ibid.

12. "Health Risk Behaviors Among Adolescents Who Do
and Do Not Attend School -- United States, 1992,"
MMWR, 43(08) (March 4, 1994):129-132.

13. Morris, R.E., C.J. Baker, and S. Huscroft,
"Incarcerated Youth at Risk for HIV Infection," in
Adolescents and AIDS: A Generation in Jeopardy, ed.
R.J. DeClemente, Newbury Park, CA: Sage
Publications, 1992:52-69.

14. On average, systems reporting results on
syphilis seroprevalence tested approximately 500 juveniles.
On average, systems reporting results on gonorrhea
seroprevalence tested approximately 400 juveniles.

15. DesJarlais, D.C., N.S. Padian, and W.
Winkelstein, "Targeted HIV-Prevention Programs,"
New England Journal of Medicine, 
331(November 24, 1994):1451-1453.

16. DeClemente, R.J., M.M. Lanier, P.F. Horan, and
M. Lodico, "Comparison of AIDS Knowledge,
Attitudes, and Behaviors among Incarcerated
Adolescents and a Public School Sample in San
Francisco," American Journal of Public Health,
81(5) (May 1991):628-630.

17. Morris, Baker, and Huscroft, "Incarcerated
Youth at Risk for HIV Infection," 52-69.

18. For information on the Massachusetts program,
contact Gary Shostak, Director of Health Services,
Massachusetts Department of Youth Services, 27-43
Wormwood Street, Suite 400, Boston, MA 02210.

19. For more information on the New Mexico program,
contact Dorothy Martinez, Children, Youth, and
Families Department, P.O. Box 38, Springer, NM
87747.

20. Dorothy Martinez, New Mexico State Juvenile
Justice System, personal communication, May 12,
1995.

21. For more information on the Los Angeles County
program, contact Maureen Valentine, Peer HIV
Education Research Project Coordinator, Los Angeles
Juvenile Court Health Services, 1925 Daly Street,
Los Angeles, CA 90033.

22. Jace Anderson, Peer HIV Education Research
Project Coordinator, personal communication, May 12
and 16, 1995; and Morris, R.E., C. Baker, J.
Anderson, and M. Valentine, "A Comparison of Peer,
Adult, and Mixed (Adult and Peer) HIV Prevention
Educators for Probationary Youth," abstract presented 
to the Society for Adolescent Medicine, 1996.

23. CDC, "Guidelines for Effective School Health
Education to Prevent the Spread of AIDS," MMWR,
37(S-2) (January 29, 1988):1-14.

24. HIV (human immunodeficiency virus) disease
refers to the spectrum of disease from the
incubation period (usually with no obvious symptoms
but HIV seropositivity) to the stage of serious
disease (active AIDS-acquired immunodeficiency
syndrome).

25. Arkansas, California, Illinois, Michigan,
Mississippi, South Carolina, Tennessee, and
Wyoming.

26. Alameda, Riverside, and Ventura, California.

27. Behrendt, C., et al., "Voluntary Testing for
HIV in Prison Populations with a High Prevalence of
HIV," American Journal of Epidemiology, 139
(1994):918-926.

28. Morris, Baker, and Huscroft, "Incarcerated
Youth at Risk for HIV Infection," 62.

------------------------------------

This research was conducted by Abt Associates Inc.
The study team consisted of Rebecca Widom, research
assistant, and Theodore M. Hammett, vice president.

Prepared under contract OJP-89-C-009 to Abt
Associates Inc. from the National Institute of
Justice, Office of Justice Programs, U.S.
Department of Justice. Findings and conclusions of
the research reported here are those of the authors
and do not necessarily reflect the official
position or policies of the U.S. Department of
Justice.

------------------------------------

The National Institute of Justice is a component of
the Office of Justice Programs, which also includes
the Bureau of Justice Assistance, Bureau of Justice
Statistics, Office of Juvenile Justice and
Delinquency Prevention, and the Office for Victims
of Crime.

NCJ 155509