Press Briefing Transcript

Vital Signs: HIV Infection, Testing, and Risk Behaviors among Youths—United States

Tuesday, November 27, 2012 at 12 p.m. ET

• Audio recording (MP3, 8.28MB)

OPERATOR: Welcome, I would like to thank you for holding and inform you that your lines are on a listen only during today’s conference until the question and answer session.  At that time to ask a question, you press star one on your touch tone phone.  This call is being recorded, if there any objections you may disconnect at this time.  Now I would like to turn it over to Tom Skinner, Senior Public Affairs Officer at the CDC, you may begin.  

TOM SKINNER: Thank you all for joining us today at this Vital Signs telebriefing.  Today's topic is HIV among youth and with us today are Dr.  Thomas Frieden, the Director for the Centers for Disease Control and Prevention and Dr. Kevin Fenton, who is the Director of  CDC's National Center for HIV/AIDS, Viral hepatitis, STD and TB prevention.  Both will provide some opening remarks and then we will move to your questions, so I like to turn to the call over to Dr.  Frieden.

THOMAS FRIEDEN:  Good afternoon everyone or good morning depending on where you are. This is Tom Frieden, CDC Director, thanks very much for joining the call. Today, we are releasing a new Vital Signs report for December that provides a detail look at HIV among young people in the United States.  This is our future generation and the bottom line is that every month 1,000 youth are becoming infected with HIV. HIV despite the great treatments that we have remains an incurable infection. And the cost of care of a single patient is approximately $400,000 over their lifetime. That means every month we're accruing about $400 million of health care costs, and every year, $5 billion from preventable infections in youth.  Given even everything we know about HIV, and how to prevent it after more than 30 years of fighting the disease, it’s just unacceptable that young people are becoming infected at such high rates. Reducing HIV among young people is a top priority for CDC. This is about the health of a new generation and protecting from an entirely preventable disease.

The report includes CDC data showing young people today account for about 1 out of every 4 new HIV infections in U.S.  In 2010, people aged 13-24 were 26 percent of all new HIV infections. And African Americans and gay and bisexual men were hardest hit. The report tells us two very important things: first, too few young people are getting tested for HIV.  In fact, well over half of youth living with HIV today don’t know they’re infected. That’s a much higher proportion, than the less than 20 percent  we estimate overall don’t know they are HIV infected.  Just 13 percent of high school students overall have been tested for HIV, and only 22 percent  of sexually active high school students. Among those aged 18-24, only 35 percent  have been tested. Second, young gay and bisexual men report much higher levels of risky behavior than their heterosexual peers. A large analysis of high school students shows that gay and bisexual males much more likely to have multiple sex partners, to inject illegal drugs, to use alcohol or drugs before sex  and very unfortunately, also much  less likely to use condoms. That was true in general across every race ethnic group. New data included in today’s release helps us better understand why HIV is taking such a heavy toll on young men who have sex with men, and it highlights the importance of addressing risk behaviors and improving our education and our efforts to address the epidemic in young people. As we work to drive down new HIV infections in all populations, we have to give particular focus attention on the next generation; especially African Americans and gay and bisexual young men. Every young person should know how to protect themselves from HIV and should be empowered to do so. Protecting our next generation from HIV is key achieving the vision of an AIDS-free generation in the U.S. which a key part in the National HIV/AIDS Strategy. I would now like to ask Dr. Kevin Fenton, Director of the National Center for HIV/AIDS, Viral hepatitis, STD and TB prevention, to discuss the report further.

KEVIN FENTON: Thank you Dr. Frieden. Good morning or good afternoon everyone.  This new Vital Signs report shows why driving down new HIV infection rates among young people is so important. I’ll start by providing a more detailed look at what CDC’s data on new HIV infections also referred to as HIV incidence-tell us about young people and HIV in the United States. As Dr. Frieden noted, in 2010 young people ages 13 to 24 years accounted for 1 in 4, or 26 percent, of all new HIV infections in the United States – but let’s take a closer look at which groups of young people are most at risk of  HIV infection. The vast majority of newly infected young people – 83 percent of them – are males. More than half of new HIV infections in this age group – or 57 percent – are among African Americans, while Latinos and whites each account for 20 percent of new HIV infections. By risk group, nearly three-quarters or 72 percent of new HIV infections among youth occur through male-to-male sexual contact, while 20 percent are infected through heterosexual sex.  Relatively few were infected through injection drug use. Young black gay and bisexual men are particularly affected – accounting for 39 percent of all new infections among youth, and more than half or 54 percent of new infections occurring from male-to-male sexual contact.

In this report we also examined risk behaviors among high school students to better understand why the impact of HIV is so high among young men who have sex with men. In a large study of high school students in 12 states and 9  urban school districts, young men who have sex with men overall reported substantially higher levels of risk behavior than their heterosexual male peers. So, for example: young men who have sex with men were more likely to report having four or more sexual partners, that’s approximately 39 percent versus 27 percent. They were far more likely to have ever injected an illegal drug – a startling 20 percent compared to 3 percent. Among the young males who were currently sexually active, those who reported sex with other males were more likely to have used alcohol or drugs before their last sexual encounter, 39 percent versus 24 percent and they were less likely to have used a condom the last time they had sex, 44 percent compared to 70 percent. One finding worth noting is that young men who have sex with men were also less likely to report being taught about HIV or AIDS in school, 75 percent versus 86 percent.

A number of factors increase HIV risk among youth, including inter-related social and economic conditions that can help to fuel HIV infection in this population.  So for example: high rates of HIV and other STDs in many African American and gay communities increase the risk of becoming infected with each sexual encounter. Young gay and bisexual men having sex with older partners, who themselves maybe more likely to be infected, also increases risk. Stigma, discrimination, and homophobia also serve as significant barriers to prevention. And many lack access to health care, so they don’t receive the preventive services they need.

As Dr. Frieden mentioned at the top of this briefing, the new report also contains data that show too few young people have been tested for HIV. Now, while CDC recommends routine HIV testing in medical settings for Americans age 13 and older, only 13 percent that 13 percent of high school students overall have ever been tested for HIV.  Among those who have had sex, the percentage is slightly higher at 22 percent, though still far too low. Looking at a slightly older age group, those aged 18 to 24 years we found that just 35 percent had ever been tested for HIV. CDC estimates that 60 percent of young people currently living with HIV do not even know they are HIV infected.  And, HIV-infected people under the age of 25 are significantly less likely than, significantly less likely than those who are older to get and to stay in care, and to have their virus controlled at a level that helps them stay healthy and that reduce the risk of transmitting HIV to partners. Now, I’d like to turn the call back over to Dr. Frieden.

THOMAS FRIEDEN:   Thank you very much, Dr. Fenton. The Vital Signs makes clear that, if we are going to see a generation free from AIDS, we going to have to intensify HIV prevention for all young people especially for young gay and bisexual males. At CDC we are working on many fronts. For example: expanding access to HIV testing and proven behavior change programs targeting those at greatest risk including young men who have sex with men but in the health care setting and in the community. Because we know there are many young people who are not regularly seeing health care providers so community locations like schools, community organization and other places are key for health education, outreach and services. Second, we’ve launched and are supporting print, broadcast, and social media campaigns that help young people get the facts about HIV and other STDs so that they can protect themselves and reduce risky behavior.

But dramatically reducing HIV among young people is going to require that all of us do our part – in schools, at home, and in communities across the nation: young people themselves need to know the facts about HIV; resist pressure to have sex, drink or inject drugs; and talk to parents, doctors and other trusted adults about HIV and sexual health and get tested. Parents and families can talk to their kids early and often about HIV and sexual health and staying safe. They can ask their insurer if HIV screening is available without a co-pay, as required by the Affordable Care Act for most health plans. Health care providers should test people ages 13 and above for HIV, and provide appropriate prevention services tailored for youth. And all Americans can talk honestly and openly about HIV to help combat the stigma and fear that people from seeking the prevention and treatment.

In addition, by improving what we call the treatment cascade, increasing the number and proportion of people whose infection is controlled, whose viral load is suppressed, we will reduce the risk for everyone in society.  That's a critical goal for us to work with communities, health care providers, and most importantly with people who are infected with HIV so they can get the care and services they need to lead long, productive lives, be healthy, stay out of the hospital, and to not infect other people.  At this time we will be happy to take questions.  Operator can you please provide the instructions?

OPERATOR:  Thank you, at this time if you would like to ask a question, please press star one on your touch tone phone.  You will be prompted by our automated service to state your name and help with pronunciation. Again, that's star one to ask a question, and star two to withdraw your question, and one moment please.  Our first question comes from Donald McNeil from “New York Times”; your line is open sir. 

DONALD MCNEIL:  Hi, this situation is terrible, unbelievably bad, is there a plan, is there a plan that has a prayer of working, of doing anything about this?  If 13 percent  of all high school students are getting routinely tested for HIV, and the CDC put out those recommendations five or six years ago that testing ought to be routine, it's clearly not working.  Many of the kids who are not being tested were children when the recommendation were made.  Is there anything you can do, can you make it mandatory to have a test when you graduate from high school, can you advocate that? Can you o anything to increase the testing rate? 

KEVIN FENTON: Well Kevin Fenton here, thank you so much for your question.  We agree with you that this is really not an ideal situation.  This is exactly the reason why we're focusing on youth for this World’s AIDS Day as we focus on an AIDS free generation. The national HIV/AIDS strategy for the first time really gives us a road map to think strategically, to act nationally, and have bold targets for addressing HIV in the United States, and dealing with HIV among young people is certainly a key priority of the national HIV/AIDS strategy.  And in the strategy, some of the key elements for addressing HIV among youth include scaling up HIV testing, getting more young people tested for sexually transmitting diseases…

DONALD MCNEIL:  But none of this working.

KEVIN FENTON:  … linking young people to  effective HIV and treatment care services and of course addressing  health disparities.  But clearly the data suggests that we need to do more and we need to do more faster, and that's one of reasons why we're focusing on this issue today.  Your point about whether or not we should be doing more in terms of scaling up screening and testing in schools is actually a very good one, and CDC has partnered with state and local health department  colleagues to look at very innovative ways of scaling up STD screening and access to HIV testing either within schools or through referral programs, but again, more needs to be done on this area. 

THOMAS FRIEDEN: This is Dr.  Frieden, just to add to what Dr. Fenton said.  We agree with you that these are unacceptable outcomes.  This is the future generation, and this is the future of the HIV epidemic in this country.  It's about people being infected with a life-long infection that is both incurable and expensive to care for.  I don't think there is a quick and simple answer to this.  We're not in support of mandatory testing, but we do think that there are ways to make significant advances, and I would outline four that are interrelated and important. The first is improving the treatment cascade so there are fewer people out there who have uncontrolled infections, a lower force of infection, burden of the virus in the community.  That will mean even if  the same rates of risky behavior, which I’ll get to in a minute, even in the same rate there will be fewer HIV infections, so getting people tested, linked to care, on care, in care and viral load suppressed will help in a major way. Second, educational efforts to reduce risky behavior are very important. This is the first time we’ve presented data that in table 1 or the MMWR and really provides shocking data on both the higher rate of risky behaviors and the lower rate of condom use.  So we need to do education to reduce the rate of multiple sexual partners, illegal drugs, alcohol and drug use before the last sexual intercourse, and to increase the availability of condoms, condoms work.  And fourth to increase testing and linkage to care. 

Testing is not -- finding someone who is positive is very important because it helps them reduce their risky behavior and get into care. Ultimately, you want to prevent people from becoming infected.  So we think that each of these four aspects response are essential to driving down the problem.  There is no quick, simple easy solution, but it’s a problem that we can make significant progress against by addressing all of these issued and working with health care providers to increase the awareness of where we are with viral load suppression and drive that number up is critically important. Currently, it’s less than 30 percent  of all people living with HIV in this country. SO we have a long way to go, and making progress on that, and each of these four areas, will drive these numbers down. 

DONALD MCNEIL:  Even if you double your numbers, these are all things you have been doing for years, education, even if you double your numbers you will still be about 26 percent , and still many kids would not know they're infected.  Something new needs to happen.

THOMAS FRIEDEN:  If we double treatment effectiveness, we'll cut in half, roughly, the number of new infections that occur.  If we can knock risky behavior down by even 10 or 20 percent , if we identify the highest risk groups and intervene there with services, with condom availability, with testing linked to care, I think one of the real lessons we have in recent years is the importance of focusing, and the MMWR also provides some specifics about geography, by focusing where the epidemic is hitting hardest we can make the biggest difference. 

TOM SKINNER: Next question, please? 

OPERATOR:  Next question comes from Liz Szabo from "USA Today," your line is open. 

LIZ SZABO: Hi, I was wondering if, this rate of the newly infected—have you seen this before or is this new data? 

THOMAS FRIEDEN:  The question was what was new data from this?  And as we mentioned, some of this is updated, some of it is new, the table one from the MMWR—this is Dr. Frieden—that shows that men who have sex with males and females, MSM population, has a much higher level of risk than their heterosexual peers is new. Dr. Fenton do you have anything you want to…

KEVIN FENTON: And we wanted to highlight the new HIV incidence data.  Which as you said indicates that nearly 12,000 young people become HIV infected each year, that on average is about 1,000 young persons per month, so these data are really bringing the focus to young people in the run-up to World AIDS Day as well as focusing on an AIDS free generation. 

LIZ SZABO: One follow-up question—how is the rate of HIV infections been changing?  Is it going up and down, or is only in specific populations? 

THOMAS FRIEDEN: This is Dr. Frieden. In general, what we're seeing is HIV infections increasing in young people while they’re decreasing or stable in older people. So it really is young people particularly young men who have sex with men, especially African Americans, who are now being hardest hit by and driving the epidemic. 

KEVIN FENTON: Yes, so just I agree entirely with what Dr. Frieden just said, the increase that we're seeing and published previously are really being driven by the very significant increases that are occurring in gay and bisexual men, especially young men who have sex with men.  And over the past few years, we have been very concerned about the significant increases we have seen in young, black men who have sex with men.  So part of what we are hoping to achieve today is not only to focus on youth, but the importance of being honest about some of the factors driving these health disparities, and why young black and Latino men who have sex with men are at such a great risk.  As we mentioned earlier, high background prevalence of disease—factors such as stigma, discrimination, homophobia and then many of the social and economic disadvantage that these young people face can place them at high risk of acquiring HIV.  So any success we're going to have with dealing with this epidemic among young people must not only include some of the individual level interventions of testing and linkage to care and getting people on treatment, but we need to ensure that we're working with partners to provide supportive context to these young people to help them reduce or avoid risk. 

OPERATOR: The next question is from Daniel DeNoon from “Web MD.” Your line is open.

DANIEL DENOON: Thanks for taking my question, Dr. Frieden and Dr. Fenton you both stressed the importance of treatment as prevention, and yet I'm pretty sure that many states have waiting lists for their AIDS drugs assistance programs.  Can you talk about how once people are tested and found to be positive, especially those who are economically disadvantaged that we're speaking about are going to have access to these treatments? 

KEVIN FENTON: Thank you for that question.  I'm going to add Dr.  Jonathan Mermin who is here with me from our Division of HIV/AIDS Prevention to respond to that. 

JONATHAN MERMIN: First, there has been remarkable progress in the waiting lists for the AIDS drug assistance programs, and last assessed, it's fewer than 100 people. From peaks over 10,000 about a year ago, and that's because there have been efforts at the federal level to increase resources as well as the state levels to focus efforts to try to help people who have been diagnosed with HIV to access the care they need.  It's true as we do better and better diagnosing people with HIV and linking them to the care and prevention services they need, that the burden on the health care system will increase, but the good news is that the effective HIV prevention is actually cost saving to the nation.  That you don't just save lives, but you can ultimately save money because of the costs for care that Dr. Frieden has highlighted earlier.

TOM SKINNER: That was Dr.  Jonathan Mermin whose last name is spelled M-E-R-M-I-N from our Division of HIV/AIDS.  Next question, Ed? 

OPERATOR: It comes from Eben Brown from “Fox News Radio.” Your line is open. 

EBEN BROWN: Good afternoon, thank you for taking the call. Dr. Frieden, you’ve been talking about increased education for young people.  These numbers for young people are really quite alarming to me, we've been pursuing AIDS and HIV education for what seems like some 20 years for high school students. Do you think these numbers might make people rethink that perhaps maybe abstinence should be pushed a little bit more than it has been? You keep talking about condoms, and screening, and education, and curbing risky behavior like illegal drug use and multiple partners, but barring some type of bad blood transfusion, I would think that if kids don't have sex they just simply won't get AIDS. Do you think this is something that should be more openly talked about and perhaps more offered or pushed towards students, or kids I should say, as a real option in their sex lives? 

THOMAS FRIEDEN: We want kids to get the facts about HIV and understand their risk.  The programs that work best are multicomponent, comprehensive school-based interventions.  Those can include classroom-based work, school-wide interventions that have been shown to decrease unprotected sex, and to increase condom use.  We also see from the MMWR data, that for whatever reason, kids who are gay or bisexual were less likely to say they received sex education in schools.  Decisions about specific curricula are made locally and have to address local needs and realities.  We believe that it's important that programs be comprehensive and multicomponent.  Data show that while a focus on abstinence is essential since, as you point out, abstinence is essentially the only way to make sure that you do not become infected.  We also need to prepare all youth with the skills and information they are going to need to protect their health, not only in high school, but throughout their life.  We have an obligation, also, to protect the health of the substantial proportion of youth who are sexually active.  Half of all high school students have had sex and more than a third are currently sexually active.  It’s also crucial that curricula be medically accurate, and we have to correct a lot of myths and misconceptions, and I can tell you from having visited middle schools and high schools, it is astonishing the level of ignorance about basic physiology that high school students and middle school students have.  So providing factual information on how to protect yourself is something that we can certainly all agree on.  I think I would just say that what we advocate for are comprehensive, multicomponent programs and rigorously evaluating them to see how we can continue to improve them as we continue to improve all of our programs. 

TOM SKINNER: Next question, Ed, please. 

OPERATOR: Next question comes from Mike Stobbe from "AP news."  Your line is open.

MIKE STOBBE: Hi, thanks for taking my question. Actually I guess my question was covered.  I'm curious, though, have you selected a successor for Dr. Fenton? 

THOMAS FRIEDEN: Dr.  Fenton is irreplaceable. Dr. Fenton has done a wonderful job leading the national center for HIV, hepatitis, STD, TB Prevention for the last seven years.  We're very sad to see him go, but understand that he will be joining his family in the United Kingdom, and will be taking a leadership position in a new CDC-like organization there for health protection England, so we're beginning a national search.  Dr.  Rima Khabbaz who is the Deputy Director of CDC for Infectious Diseases will be acting center director in addition to her current role while we conduct a national research. 

TOM SKINNER: Mike, do you have a question other than that one? 

MIKE STOBBE: No, my other question was already covered. 

TOM SKINNER: Next question, Ed, please.

OPERATOR: Next question comes from Heidi Splete from "Pediatric News."  Your line is open.

HEIDI SPLETE: Hi thank you for taking my call. just following up on, so—you're not advocating that testing be mandatory, but what tips do you have for clinicians who are seeing—obviously if maybe some of the higher risk kids are not seeing doctors very much, but the ones who might make it in there or even just the ones who aren't, what tips do you have for clinicians on how to introduce if they’re not actually testing, just introduce, some more of the safety and prevention information?

THOMAS FRIEDEN: The key here for clinicians is to make it routine. It is routine screening just as we screen adults for high cholesterol; we screen people for HIV infection. And I think we have taken awhile to adapt to the fact that we have treatment for HIV and that people who test positive need to be linked to care and followed up. But it should be routine, not so much—gee, let’s have a long discussion about whether or not you like this, but this is what we do.  If someone refuses, that's their right, but this is what we do. 

TOM SKINNER: Next question Ed.

OPERATOR:  Next question comes from Cheryl Wetzstein from “Washington Times” Your line is open.

CHERYL WETZSTEIN: Thank you so much. At world AIDS day coming up, I’m wondering will there be a specific goal or a specific campaign aimed at United States young people to reduce AIDS, and also over in Africa, there's a voluntary medical male circumcision program aimed at primarily young men and teens, and I’d like you to just explain why is that not going to be pursued here in America. Thank you.

THOMAS FRIEDEN: Let me take the second one of your questions. This is Dr. Frieden, I’ll ask Dr. Fenton to address the first. In Africa, studies by CDC and others have shown that voluntary male medical circumcision can reduce the rate of female to male transmission by between 60-70 percent.  A number of countries in Africa, led by Kenya, and joined more recently by South Africa, have done a terrific job of scaling up of voluntary medical male circumcision. Interestingly when we began this, we thought there would not be much demand; there’s in fact been quite good demand, and what we have seen is very safe and effective services widely scaled up. The epidemic Africa is very different from the epidemic in the United States.  It is primarily a heterosexual epidemic in Africa. The efficacy of circumcision in reducing the risk among men who have sex with men is unproven and does not seem to be anywhere near, if at all—if it's protected at all, it is not anywhere near the level of efficacy in preventing female to male transmission. Dr. Fenton?

KEVIN FENTON: So your first question was related to World AIDS Day and the theme of an AIDS free generation.  And yes, across the country, there are going to be both high level events in Washington DC and of course across the states which will really reflect on where we have come as a nation in the fight against HIV/AIDS.  And using the theme of an AIDS free generation to talk not only about what we need to do for people infected with or affected by HIV/AIDS  today, but protecting our youth from acquiring HIV. So this focus on youth that we're having her today will be cascaded and reflected across the country for World AIDS Day.  I think there is a lot of  excitement here because we have effective tools, we have a good grasp of what some of the issues and the drivers are so what we need to do is to continue to press forward, continue to scale up the interventions that we know are most effective—HIV testing, linkage to care, education and awareness and of course, insuring that we're working both with young people where young people are –schools, community organizations—as well as parents to have new, open, and honest conversations about HIV and ending HIV in our lifetime.  So that's what we’re hoping to achieve on World AIDs Day and why this theme of an AIDS free generation is so critical to the US epidemic. 

CHERYL WETZSTEIN: Excuse me but you’re not at liberty or is there no actual goal by five years we’ll do this, or we're going to target this particular issue?  It's all more general? 

KEVIN FENTON:  There is no goal that will be released for this World AIDS Day specifically related to youth, but the national HIV/AIDS strategy which was released two years ago has very specific overarching goals for what we’re wanting to achieve in the United States with respect to reducing HIV incidence and increasing linkage to care for all Americans affected by HIV. 

CHERYL WETZSTEIN: Very good. Thank you so much.

TOM SKINNER: We'll take two more questions, Ed. 

OPERATOR: The next one comes from Jon Cohen from “Science Magazine.” Your line is open

JON COHEN: Thanks for taking my call. I have two quick questions.  One is there’s a 6.7 prevalence in youth and a  26 percent  incidence, is the trend showing there is an increasing prevalence in youth given the high incidence? And my second question is just about the treatment cascade in the youth.  Do you know what the full viral suppression rate is in youth as compared to adults? 

THOMAS FRIEDEN: First off, yes we're seeing an increase among youth, and for the rest, this is Dr. Frieden, for the rest, I will turn to Dr. Jonathan Mermin. 

KEVIN FENTON: Dr. Mermin will answer the question on the proportion of youth people who are virally suppressed.

JONATHAN MERMIN: You highlighted that the proportion of all new infections that are in youth is greater than the proportion of longstanding infections that are in youth.  That makes sense epidemiologically, but also from a population standpoint because youth are -- because there is a -- because people are living a lot longer with HIV infection than they used to.  The second question you asked was do we have data on the treatment continuum of care stratified by age ranges, and we do. We had a presentation at the International AIDS conference and we'll be able to follow up with you after this with those data, stratified by some age groups it won’t be the details that we would probably like at this time, but we'll have some stratification. 

KEVIN FENTON: But I think, Dr. Mermin, it is correct to say that young people fare less well with the treatment cascade in the United States. They are less likely to be tested, less likely to be linked to care, less likely to maintain in care, and less likely to be virally suppressed. And that really underscores the point that Dr.  Frieden made earlier today that a key strategy for getting ahead of the epidemic with young people is improving the entire system.  Improving the treatment cascade and ensuring that we're doing a better job at each level in that cascade for young people. 

TOM SKINNER: The next question, Ed, and we'll make this the last question, please. 

OPERATOR: Our next one comes from Lawrence Divizio at "Examiner Health."  Your line is open, sir. 

LAWRENCE DIVIZIO: Thank you for taking my question, this is for Dr.  Frieden, obviously you know there are social issues involved with requesting testing, and would it not be easier, since there are mandatory testing required for other diseases out there, for the CDC to request that it be made mandatory?  Do you have a position on this? 

THOMAS FRIEDEN: You know, what we have seen with things like premarital syphilis testing, which was mandatory in many states was that it just didn't work.  We also have seen real concerns in how mandatory testing programs can proceed.  But that doesn't mean it can't be done a whole lot better than it is now.  We think it should be absolutely routine in all doctor's offices.  You know, for many important health tests, the largest risk factor for not getting it is that someone's doctor did not recommend it.  And here you have a very, very small proportion of people who refuse testing.  But unfortunately, a relatively large portion of doctors that don't make it routine, so on thing we need to do is to ensure that testing is routine for all age groups, 13-65. 
Now in closing, I would like to reiterate a couple key findings from today’s report, 1,000 young Americans a month are being infected by HIV, that's 12,000 a year at a cost for the lifetime of their care of about $400 million per month, $5 billion more per year.  One in four new infections in this country occur among people age 13 to 24.  And far fewer are being tested so that more than half of all young people living with HIV, 60 percent don’t know they're infected.  Young, gay, and bisexual men are at much higher risk with more partners, more drugs, more alcohol, and less condoms. It's critical that we reach young people, especially young African American, gay, and bisexual men with HIV prevention and testing. We have to do so to see a generation free of AIDS.  We’re doing a lot at CDC programmatically with testing and proven prevention programs that are targeting the youth in communities, in schools, for Latino and African American youth, for gay and bisexual youth.  We're doing research to better understand health behavior and better evaluate what works in prevention.  We're doing funding of community based organizations.  We have funded, in the past year more than $55 million in five years for 34 community based organizations to expand HIV prevention services for young gay and bisexual men of color and others at highest risk. This expands on a previous program to reach these populations.  And we're working with a broad range of public and private partners with health care professionals to improve the treatment cascade, so that more people living with HIV know their status.  More of them who are positive, more people who are positive are engaged in care, and a greater proportion of those engaged in care are on treatment and have their viral load suppressed.  That's the win-win of HIV prevention and care, that protects individuals and it protects the community, and that's what we're focused on at CDC.  Thank you all very much for your interest. 

TOM SKINNER: This concludes our call, thank you all for joining us.  If you need further information or would like to request an interview or transcript, please call CDC’S HIV media office.  404-639-8895, or you can also call the main CDC press office at 404-639-3286.  Once again, thank you for joining us. 

OPERATOR: At this time, you may disconnect.  Thank you for your attendance.  

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES