       Document 0001
 DOCN  NAPO9601
 TI    (NAPO) Youth & HIV/AIDS: An American Agenda - A Report to the
       President
 DT    960305
 AU    Patsy Fleming, National AIDS Policy Coordinator
 SO    The White House: Office of National AIDS Policy Office,
       Washington, D.C., 5 March 1996.
 TX    Table of Contents

       Letter to the President
       Executive Summary
       Preface
       Part I - A GENERATION AT RISK
       Part II - PREVENTION
       Part III -  TESTING, TREATMENT AND CARE
       Part IV -   RESEARCH
       Part V  -  FURTHER STEPS
       The Federal Role
       Shared Responsibilities
       Acknowledgements
       Captions

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

       * Letter to the President

       The White House
       Washington
       March 5, 1996

       Dear Mr. President,

       Today, one-quarter of all new HIV infections in the United
       States are estimated to occur in young people between the
       ages of 13 and 20.  That means two Americans under the age of
       20 become infected with HIV every hour of every day.  The
       rate of infection among young people are growing as the
       epidemic spreads into suburban communities and the nation's
       heartland.

       It is heartbreaking to see another generation of our Nation's
       young people fall prey to this epidemic.

       At your direction, the Office of National AIDS Policy has
       prepared this report, "Youth and HIV/AIDS: An American
       Agenda," an examination of the current state of the impact of
       HIV and AIDS on America's young people and a series of
       actions that can be taken to reverse these very troubling
       trends.

       While progress has been made since this epidemic began, this
       report underscores a crying need for public and private
       sector institutions to work together even more vigorously on
       new prevention, treatment, and care strategies for youth.

       This report is the result of a unique collaborative effort of
       the public and private sectors sponsored by the National AIDS
       Fund and underwritten by the Until There's A Cure Foundation
       and James C. Hormel.  This office is especially grateful to a
       team of young people who played a critical role in collecting
       information and ideas -- Miguel Bustos, Alex Danford, Michele
       Kofman, and Mangierlett Williams.

       I will be sharing these findings widely with national and
       community leaders and with the thousands of young people who
       have already become involved in AIDS prevention, treatment,
       and care.

       As you said in your remarks to the White House Conference on
       HIV and AIDS, we all have a responsibility to make sure that
       young people "know we care about them and we want them to
       have a future."

       It is my hope that this report will begin a process that
       helps us reach that goal.

       Sincerely,

       Patricia S. Fleming
       Director, Office of National AIDS Policy

       *

       EXECUTIVE SUMMARY

       This report is neither a set of new recommendations nor a
       list of new ideas.  It is intended as a catalyst of change in
       the way Americans view the threat of HIV and AIDS to the next
       generation.

       This report was requested by President Clinton and written
       after numerous interviews were conducted with young people
       who are affected by this epidemic as well as professionals
       who are engaged in HIV research, prevention, and care.  What
       they said, and what is outlined in this report, is that even
       though progress has been made, this nation must increase its
       commitment to greater understanding, education,
       communication, research, and care to bring an end to this
       tragic disease among America's youth. Until then, adolescents
       across America will continue to be infected and affected by
       HIV and AIDS at troubling rates.

       One in four new HIV infections in the U.S. are estimated to
       occur among people under the age of 20.

       An estimated 40,000 to 80,000 Americans become infected with
       HIV each year, or an average of 110 to 220 a day.  Under
       current trends, that means that between 27 and 54 young
       people in the United States under the age of 20 are infected
       by HIV each day, or more than two young people every hour.  A
       significant number of young people are engaging in sexual
       intercourse as well as drug and alcohol use at earlier stages
       in their lives.  This fact, coupled with the disturbing
       number of adolescents who are prone to high risk behavior due
       to homelessness, sexual abuse, and other circumstances,
       places young Americans in a situation that leaves them
       extremely vulnerable to HIV infection.  Experts expect this
       high rate of infection to continue unless a greater
       commitment to HIV prevention is made by young people
       themselves, their families, their educational  and cultural
       institutions, their religious institutions, and their peers.

       HIV/AIDS does not discriminate by gender, geography, or
       sexual orientation.

       In the nearly 15 years since the first cases of AIDS were
       reported in the U.S., the epidemic has spread across the
       country.  Cases have been reported in every state, Puerto
       Rico, the District of Columbia, and the American territories.
       Earlier concentrations in urban centers have given way to
       waves of cases in suburban and rural communities.  Young gay
       men -- especially young gay men of color _ remain at very
       high risk for HIV.  Young women are also at an increased risk
       both biologically and behaviorally.

       A concerted effort must be made by parents, community
       leaders, policy makers, schools, and young people to
       communicate to America's youth that they have worth and that
       the decisions they make now can affect them for the rest of
       their lives.

       Reaching out to those who are most at-risk -- gay and lesbian
       youth, homeless and runaway youth, those in families with
       lower socioeconomic status, those who have lost a parent to
       AIDS, those born HIV positive, and illiterate adolescents --
       and communicating these important messages can mean the
       difference between life and death.  Homophobia in the design
       and implementation of AIDS prevention programs drives away
       many gay and bisexual adolescents from needed information and
       care.

       Unless education and prevention programs are made available
       and accessible to young people they will continue to be at
       risk for HIV.

       While many adolescents are aware of HIV/AIDS, enough
       information is not available to them on how to prevent
       infection and spread of the disease.  Education on HIV/AIDS
       prevention should begin at an early age and be continually
       reinforced both in and beyond the classroom.

       Educational programs and preventive messages need to be
       developed and delivered by parents, teachers, religious
       leaders, youth leaders, professionals working with
       adolescents, peers, media, and role models.  Young people
       themselves -- serving as peer educators -- need to be
       enlisted and relied on as an important part of the prevention
       effort.

       The lack of access to HIV counseling and voluntary testing
       for young people is a major barrier to prevention and
       treatment.

       In some areas, there is a clear lack of access to voluntary
       and confidential HIV counseling and testing for young people.
       Lack of insurance, parental consent laws, personal finances,
       and transportation logistics are all barriers to access.
       Enhanced education programs need to include information on
       how a young person can receive appropriate counseling and
       testing for HIV.  The nation's health care system needs to
       incorporate HIV prevention information for young people into
       consumer education programs and provide adequate financial
       coverage for young people who test positive for HIV.

       Adolescents must become a bigger part of the research
       process.

       Adolescent treatment approaches may vary from those used for
       adults or infants.  Because little definitive research has
       been conducted to date with HIV-positive adolescents, the
       specific impact of puberty on the course of HIV infection has
       not yet been determined.

       Behavioral trends that play a key factor in treatment and
       prevention have also not been sufficiently studied.  Barriers
       to more age-appropriate treatment research include the
       difficulties in enrolling young people in research programs
       and insufficient long-term funding for this research.

       Young people are an important resource in the Nation's
       response to this epidemic.

       Government, medical, and community leaders can learn a great
       deal by listening to the voices of young people as they
       articulate their needs for understanding, education,
       communication, and research. Young people must become more
       involved in our response to the epidemic and help each other
       understand the scope of this epidemic.

       They must work together with the nation's leaders to overcome
       a disease that threatens all our futures and the future of
       our country.

       The goals the Federal government has established to address
       the epidemic of HIV/AIDS affecting the youth population, and
       the methods that have been set forth to achieve them, can
       serve as an example for states, regions, and communities
       across the nation.

       The Federal government can further address the needs of
       adolescents affected by HIV/AIDS in the following ways:

       - Prevention programs increasingly address the needs of young
         people.  The Centers for Disease Control and Prevention has
         established the Prevention Marketing Initiative and an
         ambitious broadcast and print public service effort focused
         on HIV infection in young adults.  Young people and their
         advocates should be included in all HIV prevention
         community planning councils to provide their perspective on
         how to best address their needs for prevention programs at
         the local level.

       - The Department of Health and Human Services should create a
         forum of young people who are infected or affected by HIV
         as well as their parents, advocates, and health care
         providers to report to Federal officials and help identify
         and articulate the needs of adolescents in fashioning
         Federal responses to HIV and AIDS.

       - The Health Resources and Services Administration should
         encourage the inclusion of young people and their advocates
         on AIDS care planning councils to help identify local needs
         and ways to target Federal funds to help meet the distinct
         developmental and comprehensive care needs of youth.

       - The Centers for Disease Control and Prevention (CDC) should
         encourage the inclusion of young people and their advocates
         in AIDS prevention planning councils to provide their
         unique perspective of the needs of youth in prevention
         efforts.

       - The Federal government should continue to help the nation's
         schools and other youth serving agencies implement
         comprehensive programs to prevent the spread of HIV among
         young people.

       - The National Institutes of Health and the Food and Drug
         Administration should continue to encourage the enrollment
         of adolescents in government and industry sponsored
         HIV/AIDS clinical trials.

       - The Public Health Service should work with the researchers,
         clinicians, medical community, and patients to develop
         appropriate clinical practice guidelines for adolescents
         with HIV/AIDS.

       - In releasing data from clinical trials, NIH and FDA should
         include specific data related to adolescents.  In those
         cases where the number of adolescents participating in a
         trial is too small, anecdotal data should be released on a
         limited basis to allow clinicians an opportunity to begin
         building a base of information for their use in treatment.

       - The Federal government should support expanded access to
         testing and counseling for young people.  The CDC
         guidelines for testing and counseling should address the
         special needs of adolescents, such as developmental issues,
         processes for consent, confidentiality, and payment for
         services.  As part of a grant application for counseling
         and testing funding, states should demonstrate the
         availability of testing and counseling services for young
         people.

       - The Substance Abuse and Mental Health Services
         Administration (SAMHSA), the Centers for Disease Control
         and Prevention (CDC), and the Health Resources and Services
         Administration (HRSA) should collaborate on substance abuse
         treatment and prevention strategies affecting adolescents
         to ensure a coordinated effort.



       * PREFACE

       We are four 25-year-old people who carry many labels: white,
       black and Latino; male and female; straight and gay; HIV
       positive and HIV negative.  We are from different religious
       backgrounds and different parts of the country.  There are
       more things that distinguish us from one another than make us
       similar.  Yet, at our core, we are young people who have been
       affected or infected by HIV and AIDS, and we are deeply
       troubled by what the future may hold for us and our
       generation.

       More than seven million people in the world between the ages
       of 15 and 24 have been infected with HIV.  Many of them have
       already died.  Our generation has inherited an epidemic that
       is killing our parents, friends, and loved ones, teachers,
       doctors, and role models.

       In helping to prepare this report, we heard the voices of
       young people who are living with HIV/AIDS.  We heard from
       their friends, their caregivers, their parents, and their
       families.  Facts and figures help us understand the scope of
       the epidemic, but it is these voices that help all of us
       understand the pain, the frustration, and the suffering that
       so many young people are experiencing due to HIV and AIDS.

       We set out to examine the impact HIV and AIDS have had on
       America's young people.  We spoke with young people whose
       lives have been touched by AIDS; with public health
       professionals engaged in HIV prevention, treatment, care and
       research; and with activists advocating for change.  Each
       encounter brought us face-to-face with the realities of HIV
       and AIDS in the lives of young people.

       We have met young people who are fighting for their lives and
       dealing with issues that most Americans cannot imagine at
       such an early age: their own mortality.  We have also seen
       the fear and helplessness in the faces of young HIV-negative
       people who have grown up in the shadow of AIDS.  And we have
       seen the tremendous courage of those living with HIV and AIDS
       who have used their own experiences to educate and protect
       their peers.

       Our experiences are not unique and these stories are not new.
       For more than a decade, concerned professionals and policy
       makers have sought ways to address the threat that HIV and
       AIDS present to our nation's young people.  Hearings and
       conferences have been held; reports have been written and
       distributed; promises have been made.

       But not all of those promises have been kept and it is time
       to sound an alarm.

       We are running out of time.  HIV is cutting a deadly path
       through the future of this nation.  It does not respect
       nationality, social class, or sexual orientation.  It has
       invaded this nation's cities, suburbs, and rural communities.

       We cannot protect young people through ignorance.  We cannot
       protect young people by denying that they are inquisitive,
       sexually active, or given to experimentation.  They and we
       are all these things.  Yet, with education, information, and
       skills we can protect young people and prevent the spread of
       HIV.

       It is our hope that this report will open the hearts and
       minds of policymakers, parents, leaders, and young people.
       With strong leadership, a shared commitment to action and
       personal responsibility, and a compassionate nation we can --
       once and for all -- stop this epidemic in its tracks.

       We thank President Clinton for is leadership in the battle
       against AIDS and his willingness to focus on this
       controversial subject. We also thank Patsy Fleming for
       reaching out to young people for their ideas, their voices,
       and their leadership.

       Miguel Bustos, San Francisco, CA
       Alex Danford, Dayton, OH
       Michele Kofman, New York, NY
       Mangierlett Williams, Washington, DC


       * Part I - A GENERATION AT RISK

       Today's youth are tomorrow's future.  Yet, every year in the
       United States half of all new HIV infections occur among
       people under the age of 25 and one-quarter of new infections
       occurs among people between the ages of 13 and 21.  Based on
       current trends, that means that an average of two young
       people are infected with HIV every hour of every day.

       While the number of cases of AIDS among teenagers is
       relatively low, it has grown rapidly from one case in 1981 to
       417 cases in 1994.  The rate of HIV infection among teenagers
       becomes more apparent when you examine the number of AIDS
       cases among people in their 20s.  According to the Centers
       for Disease Control and Prevention (CDC), one in five AIDS
       cases in the U.S. is diagnosed in the 20-29 year age group.
       Looking at AIDS cases alone obscures the extent of the
       epidemic among young people.  Since a majority of AIDS cases
       are likely to have resulted from HIV infections acquired 10
       years before, most of these individuals are likely to have
       been infected as teenagers.

       Among adolescents (13-19 years of age), HIV infection is more
       prevalent among those in their late teens, males, and racial
       and ethnic minorities.  But recent trends also point to a
       rise in infection and diagnosis among adolescent females --
       increasing from 14 percent of diagnosed cases of AIDS among
       adolescents in 1987 to 43 percent in 1994.

       What is also clear is that American adolescents are engaging
       in behaviors that put them at risk for acquiring HIV
       infection as well as other sexually transmitted diseases,
       unintended pregnancy, and infections associated with drug
       injection.  According to the CDC, approximately
       three-quarters of high school students have had sexual
       intercourse by the time they complete the twelfth grade.
       About 50 percent of sexually-active high school seniors
       report consistent use of latex condoms and surveys indicate
       that condom use declines with age.  In a recent survey, one
       in 62 high school students reported having injected an
       illegal drug.  Recent reports indicate an increase in the use
       of non-injectable drugs, including marijuana, cocaine, and
       alcohol.  The use of alcohol and other drugs impairs judgment
       and can lead to risky sexual behaviors and practices,
       particularly for young people in the stage of
       experimentation.

       Also according to the CDC, about 12 million cases of sexually
       transmitted diseases (STDs) are reported in the U.S. each
       year. Roughly two-thirds of those cases are reported in
       individuals under the age of 25 and one-quarter are among
       teenagers.  About 3 million teens contract an STD each year,
       and many of these young people will suffer long-term health
       consequences as a result.

       Without forceful and focused action, these already troubling
       trends may worsen.  This is a particularly complex challenge.
       Adolescents are neither large children nor small adults, yet
       they often are treated as one or the other and their unique
       characteristics and needs are often overlooked.  Adolescents
       are in a developmental stage that can make them particularly
       vulnerable -- both physiologically and emotionally -- to
       activities that put them at risk of becoming infected with
       HIV.

       Young people are at greatest risk of HIV infection if they
       have unprotected sex outside of a mutually monogamous
       relationship between two HIV-negative individuals, use
       injection drugs, or use alcohol or other drugs that impair
       their decision-making abilities.

       Adolescents often do not have the maturity, experience, or
       range of options that adults usually bring to their
       decision-making processes. Adolescents are engaged in a
       developmental process that includes development of
       decision-making skills, sexual maturation and
       experimentation, emotional and cognitive changes, and the
       molding of identity and self-worth.

       Adolescents live in a world in which their families, cultural
       institutions, religious institutions, media, and peers
       compete to instill values, dictate actions, and impart
       positive and negative messages to them.  The mass media often
       glamorizes youth and sex at the same time that parents and
       schools are encouraging abstinence. Attempts to turn young
       people into sex symbols are particularly troublesome because
       of the message that sends to both young people and adults.

       Adolescents, particularly those in their early teens, tend to
       be short-term thinkers.  To many, the present is all
       important and the future often is perceived in very vague
       terms.  Some adolescents, then, feel invulnerable to harm and
       often make decisions based on immediate desires rather than
       after consideration of the long-term consequences of their
       decisions.

       Many young people have an enhanced sense of invincibility and
       may be unprepared to respond to situations that place them at
       risk. They may not perceive a need to avoid the risk or be
       aware that certain behaviors can place them at risk for
       contracting HIV.  At the same time, many young people
       experience stigmatization and discrimination because of their
       race, ethnicity, gender, sexual orientation, HIV status, or
       economic status.  Such discrimination hampers their ability
       to navigate successfully the many challenges and complex
       situations that they confront.

       Set against this backdrop is the fact that young Americans
       are beginning the physiological and emotional process of
       puberty earlier in their lives than did previous generations.
       Yet they are also postponing many traditional adult
       responsibilities including full-time employment, marriage, or
       a committed monogamous relationship.

       All young people need thoughtful guidance and loving care.
       The role of parents has never been more important in the
       successful development of adolescents.  But it is a job that
       has also become much tougher.  Parents, too, need assistance
       in learning how to best communicate with their children about
       the often difficult subjects of sex, drug use, and death.
       Many adolescents do not have adults in their lives who can
       effectively provide the nurturing and guidance that they
       need.

       Some young people are at particular risk of HIV infection due
       to circumstances that are often beyond their control.
       Adolescents who are victims of sexual abuse are at risk for
       direct transmission from their sexual partners and may also
       suffer emotional problems that lead them to later engage in
       high-risk behavior that can lead to HIV infection.

       There are also those youth who have left or been kicked out
       of their homes or who have fled abusive family relationships.
       They are highly susceptible to risky behavior just to
       survive.  Their sense of self-worth is usually low or
       non-existent.  They may trade sex for food, housing, drugs,
       and affection.  Adolescents challenged with homelessness
       rarely view reducing their risk factors for HIV as a high
       priority in comparison with their daily struggle for
       survival.

       Gay, lesbian, and bisexual youth often are isolated from
       positive adult role models and peers.  Personal,
       institutional, and societal homophobia can often deny them
       access to opportunities to address their developing sexuality
       and contribute to a feeling of worthlessness.

       Adolescents need the tools to successfully navigate an
       increasingly dangerous world.  Young people need to hear from
       parents and other adults that they are loved, valued, and
       have worth as individuals so they will internalize those
       feelings and believe they are worth protecting.  They must be
       shown the dangers they may encounter and taught negotiation
       and decision-making skills.  They need to be engaged in
       activities that will allow them and their peers to practice
       those skills.  And they need to exert personal responsibility
       to protect both themselves and others from infection.

       Adolescent HIV prevention is a job too big for any one
       segment of society.  All parents, adults, leaders,
       policy-makers, young people, and institutions must become
       constructively engaged in the important work of preventing
       HIV infection among our nation's most precious resource.


       * Part II - PREVENTION

       Until a vaccine is found, the only way to prevent new HIV
       infections is through education.  Adolescents can protect
       themselves if they are given comprehensive information and
       the tools, skills, and reasons to use them.  It is incumbent
       on all adolescents to demonstrate personal responsibility by
       protecting themselves and others.  Communities promoting the
       close cooperation of parents, teachers, coaches, clergy,
       physicians, and other adults interacting with youth can
       ensure that every young person has access to this
       information.  Every adult who touches a young person's life
       should be equipped to impart this knowledge in a clear,
       accurate, sensitive manner.

       Parents can be the best teachers for their children and HIV
       prevention approaches for adolescents should ideally start
       with parents.  Parents should be key participants in HIV
       prevention efforts.  If parents aren't convinced of the risk
       to their children, they may fail to recognize their child's
       risk-taking behavior.  More must be done to educate the
       parents of adolescents about the risks their children face
       and about the means that are available to protect their
       children from this disease.

       Efforts to encourage sexual abstinence should continue to be
       supported.  Teens who are thinking about becoming sexually
       active should be encouraged to consider the implications of
       their decision and to examine whether they are prepared to
       deal responsibly with these behaviors (including taking
       personal responsibility for the consequences of these
       behaviors and protecting themselves and their partners
       against disease and unintended pregnancy).  It is important
       that young people make healthy and safe choices about sex.
       To help them make those decisions, families and communities
       should help their young citizens to grow and develop to their
       full potential and provide them with a safe environment to
       accomplish that growth through schools, role models, and
       other opportunities. Without community support and
       reinforcement, even the best HIV prevention approaches will
       falter or fail.

       Effective HIV prevention is neither a single program nor a
       single event; it must take place over the course of many
       years and be developmentally appropriate.  Therefore, it is
       inadvisable to separate HIV prevention from sexually
       transmitted disease prevention, pregnancy prevention,
       substance abuse prevention, sexuality education, self-esteem
       activities, and human development education.

       National Institutes of Health programs on adolescent risk
       behavior and HIV infection include programs to identify and
       develop potential intervention strategies for decreasing the
       high-risk behaviors of young people.  Model programs are
       being developed to increase adolescent STD/HIV prevention
       knowledge, improve attitudes, and develop skills to delay
       adolescent sexual activity. Many of these programs are
       developing and testing culturally sensitive and gender
       appropriate interventions that target the reduction of AIDS
       risk behaviors among diverse groups of adolescents.  Some of
       these interventions have already produced positive behavior
       change among homeless and runaway youth.

       Successful prevention efforts concentrate on providing access
       to accurate information, personalizing this information to
       motivate change, providing training in behavioral skills for
       implementing decisions, and reinforcing and rehearsing skills
       to build competence, communication, and self-esteem.
       Reality-based approaches recognize that people sometimes use
       faulty judgment and incorporate efforts to emphasize the
       ability of individuals to recommit to their long-term goals.

       Schools are a highly effective and appropriate place to teach
       young people HIV prevention information and skills before
       they begin the behaviors that put them at risk for HIV
       infection.  An estimated 98 percent of young people between
       the ages of 5 and 17 are enrolled in schools.  The Centers
       for Disease Control and Prevention (CDC) has implemented a
       multi-faceted program to help schools and other agencies that
       serve youth across the nation provide effective health
       education to prevent the spread of HIV.  This program is
       based on the principle that the specific scope and content of
       HIV education in schools should be consistent with parental
       and community values.  CDC provides funding and technical
       assistance to the departments of education in every state,
       six territories, and 18 large cities.  CDC also has developed
       "Guidelines for Effective School Health Education to Prevent
       the Spread of AIDS.

       Beginning at the earliest appropriate age, young people
       should receive sexuality and HIV/AIDS education as part of a
       comprehensive curriculum of health education.  Such a
       curriculum should include accurate information about HIV and
       modes of transmission, the opportunity to assess personal
       risk of infection, and skills training.  HIV prevention
       information should be age-, language-, and
       culturally-relevant and designed to accommodate the context
       of the lives of young people and their families.

       There is a compelling need for comprehensive school-based HIV
       prevention education, yet those school-based efforts are just
       one step in a long journey to effectively protecting
       adolescents from HIV.  School-based programs do not reach all
       youths at risk.  Those adolescents not in school -- because
       they have graduated or dropped out -- will need to be reached
       with the same kind of basic information that schools provide
       to all others.

       Misconceptions and misunderstandings about HIV transmission
       and high-risk behaviors often arise when relevant information
       is omitted.  Sexuality education, when done properly,
       reflects the needs of the community and acknowledges the
       value of both abstinence and safer sex as tools to prevent
       HIV infection.  Yet in some school districts, education
       policies preclude discussion of subjects such as intercourse,
       homosexuality and bisexuality, and condom use.  Discussion of
       the facts concerning such matters is not inconsistent with
       also encouraging abstinence or delayed sexual activity.

       The job of HIV prevention is too important to be left to
       health educators alone.  As mentioned before, all adults who
       work with young people should be armed to impart HIV
       prevention information effectively and sensitively to
       adolescents in their charge.  This requires approaches that
       work -- those designed to work well in a given community --
       and that can be employed to meet a variety of prevention
       needs.

       Yet, teaching young people something and ensuring that they
       will follow through with what they've been taught are two
       separate things.  To be successful, HIV prevention efforts
       must be targeted and they must be sustained.  Lessons learned
       from efforts to prevent smoking, substance abuse, and teenage
       pregnancy demonstrate that such efforts can positively affect
       adolescents' behavior.

       In 1994, the Centers for Disease Control and Prevention (CDC)
       launched the Prevention Marketing Initiative (PMI), a
       comprehensive HIV/AIDS education and prevention program
       involving partnerships between Federal, state, and local
       government and national and community- based organizations
       throughout the U.S.  The PMI specifically targets young
       adults between the ages of 18 and 25. In 1994 and again in
       1995, CDC prepared and distributed public service
       announcements aimed at young adults that communicate two
       central messages.  First, sexual abstinence or delaying
       sexual activity is the most effective way to prevent sexual
       transmission of HIV.  Second, for those who are sexually
       active outside of a mutually monogamous relationship, the
       correct and consistent use of latex condoms is an effective
       method of preventing HIV transmission.

       Successful HIV prevention efforts also have recognized that
       behavior isn't changed with knowledge alone.  An analysis of
       approaches that are successful in reducing high risk behavior
       among young people found that schools often were at the focal
       point of these efforts and that community-wide, multi-agency
       efforts were needed both in terms of funding and
       reinforcement of messages. Successful prevention efforts also
       have been designed to meet the specific needs of target
       audiences and offer their services outside the traditional
       school-based setting.

       Community-based organizations are also a valuable and
       credible source of prevention messages.  They can supplement,
       support, and reinforce messages from within families and
       schools.

       Peer counselors -- young people trained in providing
       HIV/AIDS-specific information -- have been shown in
       NIH-sponsored studies to be particularly successful
       messengers.  Peer educators have repeatedly demonstrated that
       they can present material in a way that addresses the
       relevance of HIV and HIV prevention to young people's lives.
       Adolescents often find prevention messages more believable
       when they are delivered by their peers.

       Peer-led prevention efforts are currently being conducted at
       a variety of sites around the country but many more such
       efforts are needed.  The challenge lies in supporting the
       development and application of programs that are innovative
       and address the needs of adolescents.

       * Part III -  TESTING, TREATMENT AND CARE

       Advances in science and medical care have enabled individuals
       living with HIV to live longer, healthier lives.  Drugs and
       treatments now are available to arrest or even prevent
       opportunistic infections that previously led to death.  New
       classes of drugs now in development may hold promise for
       dramatic improvements in life expectancy and quality of life.
       However, in order to access such care, individuals must know
       their HIV status and be connected to a continuum of care.

       Millions of young people who have engaged in high-risk
       behaviors do not know their HIV status.  Adolescents should
       be strongly encouraged to learn their HIV status.  A negative
       test provides the best opportunity to reinforce the
       importance and efficacy of risk-reduction behaviors.  A
       positive test provides an immediate opportunity to link those
       who are HIV-positive to treatment, often at an early stage of
       disease progression.  Such early intervention has been shown
       to be highly effective at prolonging and improving quality of
       life.

       In 1994, the Centers for Disease Control and Prevention (CDC)
       supported HIV counseling and testing services in
       approximately 9,600 sites throughout the U.S.  Those sites
       accommodated approximately 400,000 visits by persons 19 years
       of age of younger.

       Many of those services are provided at little or no cost to
       youth with parental permission.  In addition, the CDC
       supports the National AIDS Hotline and the National AIDS
       Clearinghouse, which provide referral and information
       services through toll-free telephone services.  Both are
       private, free, and confidential and are well publicized.

       HIV testing should always include appropriate pre- and
       post-test counseling to ensure that both HIV-negative and
       HIV-positive young people understand their status and their
       responsibilities to themselves and others as a result of that
       status.  Pre- and post-test counseling is particularly
       important for adolescents. Counseling should be appropriate
       for the adolescents' social and emotional development,
       language, culture, and sexual orientation. Effective
       counselors are sensitive to the great anxiety adolescents
       feel about HIV testing because of fear of the disease as well
       as the stigma attached to the disease.  As with prevention
       efforts, the use of peer educators in pre- and post-test
       counseling has been shown to be effective in communicating
       critical information to adolescents at what is often a highly
       emotional point.

       The process of testing for HIV allows adolescents to evaluate
       their own behavior and think of the consequences of that
       behavior.  As a result, there are numerous emotional needs
       tat must be dealt with by both adolescent and counselor if
       the effort is to be a success. The involvement of parents and
       other family members is critical to an HIV-positive youth's
       ability to cope with this diagnosis and enter into a
       continuum of care.

       Whether the results are positive or negative, post-test
       counseling is equally important.  For adolescents who test
       negative, post-test counseling provides an opportunity for
       further risk reduction.  For some, this may be the only
       opportunity for meaningful prevention education.  Positive
       results require immediate intervention.  It is essential that
       adolescents have an opportunity to talk to knowledgeable
       persons who can help them understand what their HIV status
       means and help them deal with issues that may seem
       overwhelming.  HIV-negative youth should have that behavior
       reinforced.

       Adolescents' access to HIV counseling and voluntary testing
       often is severely limited by a variety of factors.  First,
       many adolescents don't know how to arrange for HIV testing
       and where to go for such services.  Second, adolescents do
       not have the money or means of transportation necessary to
       access some forms of counseling and testing.  Third, school
       hours often coincide with the hours of counseling and testing
       facilities.  Finally, parental consent requirements for
       counseling and voluntary testing also may pose a barrier for
       many young people -- especially those who know or feel they
       cannot communicate openly with their parents about this
       subject.

       Taken singly, these barriers can make it difficult for an
       adolescent to get counseled and tested.  Combined, they
       present a formidable barrier that only a truly determined
       adolescent can surmount.

       To address some of these concerns, HIV counseling and
       voluntary testing sites need to be designed to be accessible
       to adolescents. Business hours should complement rather than
       compete with school schedules and facilities should offer
       their services at low or no cost to adolescents.  This would
       accommodate adolescents who don't own a car and must use
       public transportation, are in school and involved in
       extra-curricular activities, and have little money or
       independent health insurance.

       A particularly challenging impediment to counseling and
       testing is the legal requirement in many states for parental
       consent.  Consent is usually necessary for medical care of
       individuals under the age of 18.  The conditions under which
       minors may consent to HIV testing vary across states.
       Ideally, parents, young people, and health care providers
       should all possess the skills and knowledge necessary to
       maximize a youth's access to services and support. However,
       consideration should be given to creating alternative access
       to counseling and testing where obtaining parental consent is
       not possible.

       Linking HIV-positive adolescents to a system of HIV primary
       care immediately after a positive diagnosis is vital in order
       to prevent or delay the onset of HIV-related opportunistic
       infections, such as Pneumocystis carinii pneumonia (PCP), and
       to prolong the healthy lives of HIV-positive individuals.  An
       integrated care system, in which medical services are
       connected to mental health, substance abuse, education,
       juvenile justice, and social support is necessary to meet the
       needs of these adolescents.  For runaway or homeless youth,
       housing and nutrition services are also critical. Currently,
       there are few programs that meet the full range of health
       care needs for HIV-positive youth.  Efforts are plagued by
       insufficient numbers of primary care physicians and other
       health care providers specifically trained to work with
       adolescents, lack of insurance and other financial
       assistance, a fragmented health care system, and
       geographically remote facilities.  NIH is supporting programs
       to identify better ways of facilitating access, utilization,
       and adherence to medical, mental health, and substance abuse
       treatment by adolescents.

       Large numbers of young people are uninsured or underinsured,
       and the sources for funds to pay for necessary services are
       limited. If an adolescent is HIV-positive access to insurance
       often is blocked by insurance policies that exclude
       individuals with pre-existing medical conditions.

       Federal grants for program development such as the Health
       Resources and Services Administration's Ryan White CARE Act,
       including Special Programs of National Significance (SPNS),
       have encouraged care models that consider the special needs
       of the adolescent population and provide communities with the
       tools they need to conduct effective outreach programs.
       Title IV of the Ryan White CARE Act provides support for the
       development of innovative models that link systems of
       comprehensive primary/community-based research, medical, and
       social services for children, adolescents, and families.

       Besides responding to an HIV-positive adolescent's physical
       and mental health needs, linkage with important social
       services is also an important element to care.  Social
       service providers should be trained to offer referrals for
       legal assistance, other treatment programs, information about
       housing, job-training assistance, and help in obtaining
       health insurance.  They also are more able to offer outreach
       services for adolescents who are homeless, pregnant, or
       trading sex for food and shelter.

       Medicaid provides coverage for a comprehensive set of
       benefits that includes counseling and testing, prescription
       drugs, physician visits, inpatient hospital care, substance
       abuse treatment, home care, and hospice care.  Medicaid
       coverage of children and adolescents has been improved in
       recent years but many low-income families may not be aware of
       their eligibility for such benefits. The Federal government
       and states should examine opportunities to ensure that all
       Medicaid-eligible HIV-positive youth have access to
       appropriate treatment and care.  Medicaid is the largest
       single payer of direct medical services for people living
       with AIDS, serving nearly 50 percent of all persons living
       with AIDS and more than 90 percent of children with AIDS.

       * Part IV -   RESEARCH

       HIV/AIDS research has made great strides on many fronts.
       Physicians have a growing array of medications to treat and
       even prevent a variety of HIV-related opportunistic
       infections. As a result, HIV-positive people who have access
       to care usually are not getting sick as often, their
       illnesses aren't as severe, and they are spending less time
       in the hospital than they did 10 years ago. But adolescents
       have not received the full benefit of recent research
       discoveries, and there is significant unmet need for
       adolescent-specific treatment and behavioral research.  We
       clearly do not know enough about adolescents in general,
       about how HIV affects them physiologically or behaviorally,
       and about the progress of HIV disease in young people.

       HIV/AIDS research efforts have primarily focused on two
       specific populations: infants and adults.  Funding for
       adolescent-related AIDS research has traditionally come from
       those pursuing pediatric research.  But adolescents are
       biologically more like adults than infants yet they still are
       not at the same developmental stage as most adults.

       Adolescents are not considered central to the pediatric
       mission, and researchers who focus on adults usually are not
       funded to include adolescents in their research programs.
       The result has been that adolescents appear only peripherally
       on the radar screens of most AIDS researchers, and when they
       do, it's only to the extent that they share adults  physical
       or behavioral traits.

       Additionally, a variety of developmental and behavioral
       factors challenge efforts to draw adolescents into the few
       adolescent-specific protocols that have been developed for
       their benefit.  Adolescents can sometimes be particularly
       challenging subjects for research.  Researchers have reported
       difficulty enrolling adolescents in protocols, keeping them
       enrolled, and ensuring that they are following the guidelines
       for protocol conduct.

       Basic research sponsored by NIH has provided and will
       continue to provide a better understanding of the pathogenic
       mechanisms and course of the disease in adolescents.

       In recognition of the fact that adolescent development is
       different from that of both adults and children, NIH is
       supporting studies on adolescents.

       While NIH has opened pediatric clinical trials to adolescents
       up to age 18 and adults trials to those who are as young as
       13, adolescents continue to face barriers to their
       participation in clinical trials.  This lack of participation
       has left significant gaps in the knowledge base about
       adolescents.  Scientists are quick to acknowledge that a
       great deal of catching up remains to be done.

       Basic research on adolescent reproductive and immune system
       development is lacking.  Data are just beginning to be
       gathered on how the adolescent's immune system differ from
       that of adults, an important consideration in defining the
       response of an adolescent's body to HIV.  Further studies are
       needed on the effect HIV has on adolescent growth and
       puberty.

       Additional studies are needed to understand the natural
       history of HIV in adolescents as well as expanded study of
       youth and their behaviors.  The NIH currently sponsors
       natural history studies designed to track the shifting
       demographics and the changing manifestations of HIV/AIDS.
       But there are things we need to know about HIV-positive
       adolescents that we don't know, such as how they become
       infected, how they effectively resist infection, how long
       they live, and how quickly they die.  We don't know enough
       about the factors that influence the behavior of young
       people, including why some choose to be sexually active and
       others do not; why some use drugs or alcohol and others do
       not; and why certain sexual behaviors are chosen over theirs.

       Surveillance of HIV infection among adolescents in the United
       States has not been comprehensive enough to accurately
       estimate the scope of the problem.  The family of HIV
       seroprevalence surveys should be expanded to target and teach
       us more about the epidemic as it affects young people.
       Accurate data help to target HIV prevention efforts and to
       forecast the kinds of services needed. Such studies would
       help to indicate which communities are experiencing high
       infection rates, how HIV is being transmitted, how long
       HIV-infected adolescents are ill, and the general scope of
       the epidemic among this age group.

       The inclusion of adolescents in clinical trials permits the
       identification of appropriate regimens of treatment for this
       age group.  The development of clinical practice guidelines
       with correct dosages and times to start treatment can only be
       developed from such studies.  Similarly, the rapid
       dissemination of information concerning clinical practice
       guidelines, results of clinical trials, and options for
       trials, as well as eligibility criteria for trial
       participation, must be a high priority for the NIH.

       There still is not enough information about the optimum time
       to begin anti-retroviral treatment, which treatments to use,
       and the correct dosages for adolescents.  The lack of a
       significant base of adolescents enrolled in trials has
       resulted in little dissemination of information.  At this
       early period in the study of adolescent-related HIV issues,
       even anecdotal information is important to clinicians and
       researchers if they are to begin building a response to the
       epidemic among young people.

       The NIH has recognized that current research efforts aimed at
       young people are few in number and much further behind than
       those for adults and children.  The Adolescent HIV/AIDS
       Research Network, a collaborative effort between the NIH and
       the Health Resources and Services Administration (HRSA), has
       been launched to plan and conduct research on the medical,
       biobehavioral, and psychosocial aspects of HIV and AIDS in
       young people.  This network,combined with other youth-focused
       efforts at NIH and CDC, can reduce the barriers to young
       people participating in research and narrow the information
       gap.  Working together the Federal government and its
       partners should achieve the goal of providing better
       treatments and health care to HIV-positive adolescents and
       crafting Federal responses that best meet their often
       changing needs.

       * Part V  -  FURTHER STEPS

       This examination of youth and HIV revealed six common themes
       that require action at all levels of American society.  There
       is strong consensus among scientists, educators, health care
       providers, community leaders, and young people themselves on
       these matters. They are:

       -  Young people, parents, schools, and communities must be
          integral partners in developing, delivering, and
          evaluating HIV prevention approaches for adolescents;

       -  Innovative, creative prevention efforts aimed at young
          people must be encouraged, adequately funded, and
          evaluated, and -- when found to be effective -- broadly
          disseminated;

       -  Comprehensive HIV/AIDS education - as part of
          comprehensive health education - should be available to
          all young people in all fifty states and U.S. territories;

       -  Routine counseling and voluntary HIV testing should be
          made more accessible, developmentally appropriate, and
          affordable to young people;

       -  HIV-positive adolescents should be linked to a continuum
          of care and services that will extend their life span and
          provide them with the information and skills they need to
          reduce the likelihood of further transmission;

       -  Adolescent-specific biomedical and behavioral research
          should be increased to enhance our knowledge of the
          progress of HIV disease in adolescents and of effective
          AIDS prevention approaches.

       THE FEDERAL ROLE

       The Federal Government has three central responsibilities in
       leading our country's battle against HIV and AIDS:

       (1)  Seeking a cure for those who are living with HIV/AIDS and a
            preventive vaccine to protect those who are uninfected;

       (2)  Helping communities cope with the financial costs of
            caring for those who are living with HIV/AIDS; and

       (3)  Working with communities to foster behaviors that
            prevent the spread of HIV.

       During the past three years, the Clinton Administration has
       sought to fulfill these obligations by submitting budgets
       that would increase overall funding for AIDS-related programs
       by 40 percent. Funding for AIDS-related research has been
       increased by 26 percent and the Office of AIDS Research at
       the National Institutes of Health has been strengthened.
       Funding for AIDS prevention efforts has also increased and a
       new community planning process has directly involved local
       organizations in the design of prevention programs.  Funding
       for AIDS-related care has increased by 90 percent, including
       a 108 percent increase in funding going to the Ryan White
       CARE Act.  New efforts have been made to involve young people
       in each of these areas.  The government has vigorously
       enforced provisions of the Americans with Disabilities Act
       prohibiting discrimination against people living with HIV and
       approval time for AIDS-related drugs has been cut in half.

       In conjunction with this report, the following new
       initiatives should be undertaken:

       Listening to the Voices of Youth.

       Young people should be encouraged and empowered to have a
       voice in the development and implementation of HIV/AIDS
       research prevention, and care efforts.  The Federal
       government should take the following steps to assure that
       voice is heard:

       -  The Department of Health and Human Services should create
          a forum of young people who are infected with or affected
          by HIV along with their advocates and providers.  This
          group should work with relevant federal agencies to help
          identify and articulate the needs of adolescents in
          fashioning Federal responses to HIV and AIDS;

       -  The Health Resources and Services Administration should
          encourage the inclusion of young people and their
          advocates on AIDS care planning councils to help identify
          local needs and ways to target Federal funds to help meet
          the distinct developmental and comprehensive care needs of
          youth.

       -  The Centers for Disease Control and Prevention (CDC)
          should encourage the inclusion of young people and their
          advocates in AIDS prevention planning councils to provide
          their unique perspective of the needs of youth in
          prevention efforts.

       -  The Federal government should continue to help the
          nation's schools and other youth serving agencies
          implement comprehensive programs to prevent the spread of
          HIV among young people.

       Examining the Impact of HIV on Youth.

       Sufficient scientific information exists to indicate that HIV
       may behave differently in infected adolescents and that there
       are adolescent-specific health-care needs and treatment
       protocols that must be identified in order to respond
       effectively.  The following steps should be taken to assure
       that this occurs:

       -  The National Institutes of Health and the Food and Drug
          Administration should continue to encourage sponsors to
          enroll adolescents, when feasible and appropriate, in
          HIV/AIDS clinical trials.

       -  In releasing data from clinical trials, NIH and FDA should
          include specific data related to adolescents.  When the
          number of adolescents participating in a trial is too
          small, anecdotal data should be released on a limited
          basis to allow clinicians an opportunity to begin building
          a base of information for their use in treatment.

       -  The Public Health Service should continue to develop in
          collaboration with researchers, clinicians, and the
          infected and affected community, clinical practice
          guidelines and expeditiously disseminate the latest
          information on state-of-the-art therapies, options for
          trials and eligibility criteria for entry into them, and
          health care and prevention techniques to U.S. and
          international communities affected by HIV/AIDS.

       Making Informed Decisions.

       HIV counseling and voluntary testing provide an important
       bridge between HIV prevention and care.  To assure that young
       people have access to such services, the following steps
       should be taken:

       -  CDC's counseling and testing guidelines should acknowledge
          and address the special needs of youth seeking such
          services.  This guidance should address such issues as
          processes for consent, confidentiality, and payment for
          services.  The guidance should be integrated into the
          training of all personnel at CDC-funded counseling and
          testing sites;

       -  CDC should require that, as part of the grant application
          for counseling and testing funds, states demonstrate the
          availability of counseling and testing for young people.

       SHARED RESPONSIBILITIES

       Any effort to protect young Americans from the threat of HIV
       and AIDS cannot begin and end with the Federal government.
       These Federal efforts should serve as the catalyst for action
       on all levels of society.  Throughout the history of the
       epidemic, states, localities, communities, schools, churches,
       synagogues, private foundations, and voluntary charitable
       organizations have been actively committed to combatting the
       spread of HIV.  These efforts should continue and should be
       expanded.  The Federal government seeks and looks forward to
       a closer partnership with communities involved in this effort
       and pledges its continuing support for the critical work
       being done.

       ACKNOWLEDGMENTS

       We are very grateful for this insight and appreciate the time
       taken by scores of individuals and organizations to draw out
       the many complicated issues surrounding HIV and AIDS among
       young people. This report reflects the knowledge, concerns,
       and commitments of those individuals and the people they
       serve.

       The National AIDS Fund coordinated the preparation of this
       report and supervised the administration of grants from the
       Until There's A Cure Foundation and James C. Hormel.  In
       addition, the Fund recruited the four interns who conducted
       much of the report's research and preparation.  The Fund also
       arranged visits to local programs of significance. Paula Van
       Ness, Fund President, brought together funders, youth experts
       and staff to help make this public-private initiative
       possible. The project was managed for the Fund by Jerry
       Atchison, Director of Communications. Providing important
       oversight and coordination efforts among youth groups around
       the country was Gretchen Wooden, Senior Program Officer for
       Youth Initiatives.

       In the Office of National AIDS Policy, Brenda Kunkel and
       Richard Sorian assisted in directing and completing this
       project along with Jeff Levi, LaHoma Romocki, Jane Sanville,
       and Carmena Parris. Several White House interns and
       volunteers were also helpful in the research and preparation
       of this report: Jesse Souweine, Julie Blessing, Lisa DaValle,
       Rachel Garfield, Brenda Hahn, Vanessa Potkin, Jessica Purdy,
       Katie Smeltz, and Rachel Smith.

       Numerous organizations, both national and local, were
       instrumental in providing us with direct access to young
       people and their advocates.  The AIDS Policy Center for
       Children, Youth and Families, the National Alliance of
       Positive Youth (NAPY), Metro TeenAIDS, the National
       Association of State Boards of Education, and participants at
       the National Youth Summit on the Prevention of AIDS Among
       Youth were especially helpful.  We also appreciate the
       assistance of the National Advocacy Coalition on Youth and
       Sexual Orientation (NACYSO) the National Youth Network, the
       Latino/a Lesbian and Gay Organization.

       Transportation for representatives of youth and HIV education
       and advocacy groups was generously provided by USAir.

       Several Federal agencies made major contributions to the
       content of this report:  the Centers for Disease Control and
       Prevention, Health Resources and Services Administration,
       Substance Abuse and Mental Health Services Administration,
       National Institutes of Health, Health Care Financing
       Administration, and Food and Drug Administration.

       The following list includes some, but certainly not all, of
       the individuals who provided assistance during the research
       and preparation of this report.  Many of the young people
       with whom we met preferred to remain anonymous and we, of
       course, respect those wishes.  Each of them should know that
       they have made an important contribution to this report and
       to our national response to HIV and AIDS.

       Alicia Beatty-Tee
       The Circle of Care
       Philadelphia, PA

       Val Bias
       National Hemophilia Foundation
       Washington, DC

       Ana Maria Branham
       Arizona Department of
       Health Services, Phoenix, AZ

       Angela Bryan, MA
       Prevention Marketing Initiative
       Phoenix, AZ

       Rea Carey
       National Advocacy Coalition on Youth and Sexual Orientation
       Washington, DC

       Tim Cincinato
       Names Quilt Project
       Sacramento, CA

       Daniel Daley
       Sexuality Information and Education Council of the U.S.
       Washington, DC

       Larry D Angelo, MD, MPH
       Children s National Medical Center
       Washington, DC

       Dale Dayton
       University of Cincinnati
       Medical Center
       Cincinnati, OH

       Jane Delgado
       Coalition of Hispanic Health & Human Service Organizations
       Washington, DC

       Bob Diairio
       Board of Education
       New York, NY

       Ralph DiClemente, PhD
       University of Alabama
       Birmingham, AL

       Kevin Doughtery, MD
       Payne Whitney Clinic
       New York, NY

       Abigail English, JD
       National Center for Youth Law
       Chapel Hill, NC

       Donna Futterman, MD
       Montefiore Medical Center
       Bronx, NY

       Kristy Galvan
       American Red Cross
       Falls Church, VA

       Thomas Gleaton
       Inner City AIDS Network
       Washington, DC

       David Harvey
       AIDS Policy Center for
       Children, Youth & Families
       Washington, DC

       Karen Hein
       Institute of Medicine
       Washington, DC

       Antigone Hodgins
       Bay Area Young Positives
       San Francisco, CA

       Bernice Humphrey
       Girls Incorporated
       Indianapolis, IN

       Joyce Hunter, MSW
       HIV Center for Clinical
       and Behavioral Studies
       New York, NY

       Jon Imparato
       Gay and Lesbian Community
       Services Center
       Los Angeles, CA

       Ibby Jebson
       Institute for Family Centered Care
       Bethesda, MD

       Paul Kawata
       National Minority AIDS Council
       Washington, DC

       Cinaro Kennedy
       Columbia University
       New York, NY

       Frances Kunreuther
       The Hetrick-Martin Institute
       New York, NY

       Carol Levine
       Adolescent Alone Project
       New York, NY

       Felicia Lynch
       National Association of
       People with AIDS
       Washington, DC

       Kevin McDermott
       Greater Mount Calvary Holy
       Church AIDS Ministry
       Washington, DC

       Kim Miller, PhD
       Louisiana State University
       Medical Center
       New Orleans, LA

       Kevin Mischka
       Metro TeenAIDS
       Washington, DC

       Demetri Moshoyannis
       Youth Positive DC
       Washington, DC

       Rudy Navarro
       Maricopa County Community
       AIDS Partnership
       Phoenix, AZ

       Kevin Neal
       Metro TeenAIDS
       Washington, DC

       Gretchen Noll
       National Network for Youth
       Washington, DC

       Judy Norton
       Arizona Department of
       Health Services
       Phoenix, AZ

       Phyllis Orosco
       Sacramento, CA

       Marj Plumb
       New York City Department of Health
       New York, NY

       Keith Pollanen
       National Association of
       People with AIDS
       Washington, DC

       Steve Rabin, JD
       IssueSphere
       New York, NY

       Michael Reece
       HIV Prevention/Education
       Community AIDS Council
       Phoenix, AZ

       Gary Remafedi
       University of Minnesota
       Minneapolis, Minnesota

       Jennifer Hinks Reynolds
       Advocates for Youth
       Washington, DC

       Sean Sasser
       AIDS Policy Center for Children, Youth & Families
       Atlanta, GA

       Janet Shalwitz, MD
       Health Initiatives for Youth
       San Francisco, CA

       Jane Silver
       American Foundation for
       AIDS Research
       Washington, DC

       Peter Simpson
       United Way
       Sacramento, CA

       Wayne Smith
       HIV Task Force
       San Francisco, CA

       William Smith, EdD
       Academy for Educational
       Development
       Washington, DC

       Stephen Thomas, PhD
       Emory University
       Atlanta, GA

       Michael Wallace
       Indiana State Department of Health
       Indianapolis, Indiana

       Kristen Weeks
       Prevention Marketing Initiative
       Sacramento, CA

       Mildred Williamson
       Cook County Hospital
       Chicago, IL

       Laurie Yosick
       Columbia AIDS Task Force
       Columbia, OH

       Toni Young
       National Women and
       HIV/AIDS Project
       Washington, DC


       The National AIDS Fund

       The National AIDS Fund is the nation's largest philanthropic
       and grantmaking organization dedicated to eliminating HIV and
       AIDS as a major health and social problem.  It works in
       partnership with communities to provide care and to prevent
       new infections through education, research, and outreach.
       Since it was founded, the Fund has provided almost $50
       million to communities for HIV/AIDS programs, supporting more
       than 2,400 such programs in 31 states. The Fund also provides
       program and technical assistance for hundreds of national and
       local educational programs -- such as the Youth and HIV/AIDS
       Report -- and programs of direct service.  The Fund also
       provides the nation's business community a network of leading
       corporate, government, and nonprofit experts who deal with
       HIV/AIDS policy issues, and it publishes a broad range of
       HIV/AIDS publications for both managers and employers.

       The Until There's A Cure Foundation

       The Until There's A Cure Foundation, principal funder of the
       Youth and HIV/AIDS Report, provides funding for innovative
       education programs to encourage safer behaviors among teens
       and young adults through peer-to-peer education.  For those
       living with HIV/AIDS, the Foundation provides financial
       support for care and other services.  For future generations,
       the Foundation supports AIDS vaccine development with funds
       being primarily contributed through the International AIDS
       Vaccine Initiative of the Rockefeller Foundation.  Through
       partnerships with professional sports teams, the Foundation
       has reached  audiences with its message of AIDS awareness.
       The Foundation was created by Kathleen Scutchfield and Dana
       Capiello, two mothers and entrepreneurs who have raised funds
       to support Foundation Initiatives through sale of The
       Bracelet, a 1/4-inch cuff bracelet featuring a familiar small
       raised AIDS ribbon.

       CAPTIONS:

       "It is one of the joys of childhood that children think they
       will live forever.  It is one of the curses of childhood in
       some of our meanest neighborhoods that children think they
       won't live to be much beyond 25 anyway.  In a perverse way,
       both of those attitudes are contributing to the problem,
       because one group of our children think that they are at no
       risk because nothing can ever happen to them - they re
       bulletproof.  Another group believes that no matter what they
       do, they don't have much of a future anyway.  And they are
       bound together in a death spiral when it comes to this.  This
       is crazy.  We have got to find some way to tell them you must
       stop this."   President Clinton, December 6, 1995, to the
       White House Conference on HIV and AIDS.

       "If you re going to educate kids about AIDS, you have to
       educate them about drugs as well.  If you re a youth, you re
       going to experiment with drugs, especially if you live in a
       metropolitan area.  Even though you get stupid with drugs,
       you still think about things you don't want to do, but you do
       it anyhow."   16-year-old HIV-positive youth from San
       Francisco.

       "We grow up hating ourselves like society teaches us to. If
       someone had been `out about their sexuality. If the teachers
       hadn't been afraid to stop the `fag  and `dyke  jokes. If my
       human sexuality class had even mentioned homosexuality. If
       the school counselors would have been open to a discussion of
       gay and lesbian issues. If any of those possibilities had
       existed, perhaps I would not have grown up hating what I was.
       And, just perhaps, I wouldn't have attempted suicide."
       Kyallee, 19.

       "People say HIV is this or that group's problem, not mine.
       But for HIV, it's a matter of risk behaviors, not risk
       groups.  Because if you say it's a risk group thing, I don't
       identify with that group, so I'm not at risk.  That makes
       people feel invincible to HIV." HIV-positive youth.

       "We, the young people of this country, need a place where we
       can go to ask our questions, where we won't be teased or
       ridiculed.  We need a place where we can ask about our mixed
       up feelings, about sex, and about AIDS."   15-year-old high
       school student from Concord NH.

       "If I could talk to the President, or a Senator, or anyone in
       the Federal Government who can make a difference, I'd tell
       them to take a look, learn a lesson from the youth that are
       currently dealing with the disease.  Listen to them, hear
       their stories and then see that they have a future.  If they
       don't have that future, then we won't have an America." --
       Allan, San Francisco.

       "I go to a free clinic that I feel really comfortable in.
       It's really family-oriented.  The people are really caring,
       and they all know me. When I was 19, I took the HIV test on a
       whim.  I really didn't expect a positive result.  But that's
       what it was. Everybody working at the clinic cried."
       Ayisa, 20, New York.

       "I was infected with HIV by my first partner when I was 16
       years old.  Now at 20 I have this virus that's taking my life
       because everything I heard when I was younger was sugar
       coated.  We need more complete information than what we are
       being given.Even the pamphlets concerning HIV/AIDS prevention
       are too basic and bland. We need to know real stuff."  --
       Ryan, age 20.

       "I'm HIV positive.  I'm a teenage mother.  I'm affected by my
       community.  How do you expect me to live?  Where is my future
       leading?  Where is the future leading for my 3-year-old
       daughter?" "Haitien"

       "The great burden we have as Americans is that when we have
       to deal with something new, too often we can't deal with it
       from imagination and empathy we have to actually experience
       it first. I do not want to wait until every single family has
       somebody die before we have a good policy on HIV and AIDS."
       -- President Clinton, December 6, 1995, to the White House
       Conference on HIV and AIDS.

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