Continuum of HIV care needed on college campuses

March 4, 2020

An estimated 3% to 6% of U.S. college students are HIV positive, but those numbers could be higher and indicate a need for campuses to provide a range of HIV health care services, Dr. Sinead Younge, Danforth Endowed Professor in the Department of Psychology at Morehouse College, said at a February lecture at the College of Community Health Sciences.

“We don’t have good numbers, and it has to do with reporting,” Younge said in her lecture, “Implementing an Expanded HIV Continuum of Care on a College Campus.” Dr. Sinead Younge

She said for many young adults, college years are a time of exploration, identity development and risk taking. “We see high rates of binge drinking, not wearing seat belts, unprotected sex. This is the time when young people are initiating unhealthy behaviors, so it’s an opportune time to intervene.”

According numbers Younge provided, half of all sexually transmitted infections, or STIs, occur in people 25 years of age and younger. People ages 15 to 24 years old have five times the rate of chlamydia, four time the rate of gonorrhea, and three times the rate of syphilis compared to the total U.S. population. She said in 2006, an estimated 5,260 people between the ages of 13 and 24 in the 33 states reporting to the U.S. Centers for Disease Control and Prevention were diagnosed with HIV/AIDS, representing approximately 14% of the total number of people diagnosed that year.

Younge said a number of factors likely contribute to HIV cases on college campuses: low rates of STI (including HIV) screening and testing; confidentiality concerns; intersections of sex and substance use; lack of health insurance and transportation to screening and care sites; and multiple sex partners, if the sex is unprotected. Younge said while college students these days know more about HIV, they underestimate their own risk of contracting the virus.

She said a continuum of HIV care requires a multi-faceted approach. Student health clinics must have convenient hours and locations, safeguard privacy, coordinate care and provide “wraparound services,” such as combining medical care with counseling. College and universities should consider including health care costs in students’ tuition and integrating HIV/AIDS education into the curriculum.

The Atlanta-based Morehouse College recently created “Healthy Relationships Intervention,” adapted from a CDC program. Younge said the intervention begins at new student orientation sessions, where students learn about healthy relationships, understanding risks and consent. So-called “booster” sessions are held in dormitories and special programs are offered in classes to further reinforce the information provided at the orientation sessions.

In addition, Morehouse also provides pre-exposure prophylaxis, or PrEP, at no cost to students, and even partners with pharmacies to deliver PreEP directly and individually to students, further reducing potential stigma students might feel if they have to go into a clinic to get the medication, Younge said. PrEP has been shown to be effective at reducing the risk of getting HIV from sex or injection drug use, according to the CDC.