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A pretest counselling session is recommended by the General Medical Council before carrying out an HIV test and it is generally accepted that adolescents deemed competent enough to understand the counselling process can have an HIV test without parental consent. A recent survey in the United Kingdom showed that 79% of clinics were prepared to test for HIV infection in children under the age of 16.1 We reviewed the characteristics of adolescents between the ages of 13 and 16 seen in the Coventry genitourinary medicine (GUM) clinic for an HIV test between 1990 and 2000 (table 1). This was part of a larger review of GUM attendances by children, the results of which have been published.2
The commonest mode of presentation was a specific request for an HIV test. This was the case in 32 (39.0%) adolescents. Eighteen adolescents (22.0%) coming in requesting a check up were also offered an HIV test, 22 (26.8%) alleged rape/assault, 14 (17.1%) complained of a discharge, and four (4.9%) had a needlestick injury.
Ten (12.2%) of the adolescents seen had a sexually transmitted infection diagnosed (eight girls (11.4%) versus two boys (16.7%); p=0.6). Genital chlamydial infection was diagnosed in five cases, gonorrhoea in two cases, and there was one case each of genital herpes, Trichomonas vaginalis, and genital wart infection. Having a sexually transmitted infection diagnosed was associated with complaining of a discharge (12.5% versus 50.0% p=0.003) and prostitution (1.4% versus 20.0% p=0.03) but not with any other presenting complaint.
Adolescents coming in specifically requesting an HIV test were more likely to accept it following counselling than those who did not (96.9% versus 78.0%, p=0.02). Acceptance of HIV test was, however, unrelated to the sex of child, prostitution, more than one partner in the previous year, or being diagnosed with a sexually transmitted infection. There was no statistically significant difference between those claiming rape/assault and those who were not in having an HIV test after counselling (95.5% versus 81.7%, p=0.1).
There is no specific literature regarding the factors associated with HIV testing in young adolescents. A study of sexually active 16–19 year olds in Massachusetts found that infrequent condom use and a history of sexually transmitted disease were not significantly associated with voluntary HIV testing.3 Having had more than one sexual partner in the past year and discussing HIV/AIDS with a doctor were however associated with voluntary HIV testing. Previous discussion of HIV testing with a healthcare provider was also identified as a predictor of HIV testing in another study.4 Misconceptions about HIV test results and condom use as well as not having discussed HIV with a teacher are also associated with voluntary HIV testing.3
It has been shown that most adolescents engaging in high or moderate HIV risk behaviour continued to do so into young adulthood. Knowledge about HIV infection and its prevention, estimates of personal risk or exposure to HIV test counselling were not associated with a change in behaviour.5 Effort must therefore be directed at research into adolescent risk behaviour change.
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