An HIV test kit on display during a San Antonio AIDS Foundation event in September. Credit: Associated Press

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Six out of 10 young people with HIV don't even know they have the infection that leads to AIDS and early death, according to a new national study - an alarming rate considering young people account for a quarter of all new HIV cases each year.

The U.S. Centers for Disease Control and Prevention used data collected from several metro areas, including Milwaukee, to unveil a detailed picture of HIV among young people in the United States on Tuesday.

HIV infections are increasing in young people ages 13 to 24 - particularly among African-Americans - while decreasing among older people, the CDC said.

"This is our future generation and the bottom line is that every month, 1,000 youth are becoming infected with HIV," CDC Director Thomas Frieden told reporters during a national telebriefing. "Given 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."

HIV hits black youths at a far higher rate than whites. Nearly 60% of new infections in youths occur in African-Americans, about 20% in Hispanics/Latinos and about 20% in whites, according to the CDC.

Over half (54%) of new infections among young gay and bisexual males are in African-Americans.

Locally, the numbers are just as startling:

In the last decade, Milwaukee County has seen a 218% increase in the number of HIV cases among young, black males (ages 15 to 29) who have sex with other males.

Of all new cases, 82% are in men, and blacks are 10 times more likely to be infected than whites.

The incidence of HIV in Wisconsin is 3 per 100,000 - comparable to the national average - but Milwaukee County's rate is much higher: 22 per 100,000.

Of the new cases statewide in 2011, a little over half were in Milwaukee County. Of those, 90% were in the city of Milwaukee.

By risk group, nearly three-quarters (72%) of new HIV infections among youths occur through male-to-male sexual contact, while 20% are infected through heterosexual contact. Relatively few are infected through injection drug use.

Gay and bisexual men reported much higher levels of risky behavior than their heterosexual peers, according to the CDC's analysis of high school students in 12 states and nine large urban school districts, including Milwaukee Public Schools, who responded to Youth Risk Behavior Surveys.

Gay and bisexual males are much more likely to have multiple sex partners, to inject illegal drugs, to use alcohol or drugs before sex, and also are much less likely to use condoms, according to the survey results.

While it's preventable and treatable, HIV remains an incurable and costly infection. The estimated cost of medical care for a single HIV patient is $400,000 over a lifetime. HIV patients are living a lot longer with the infection than they used to, Frieden said.

With 12,000 new HIV infections among American youths each year, that's an additional $400 million in HIV-related health care costs per month, or about $5 billion per year.

Testing is critical to stemming the tide, public health officials said.

The CDC says the percentage of young people tested for HIV is far lower than other age groups. Just 13% of high school students overall have been tested for HIV, and only 22% of sexually active high school students nationwide have been tested, according to the CDC's study.

That means infected youths are unknowingly transmitting HIV to others.

HIV testing should be done routinely, just like cholesterol testing among adults, Frieden said.

The largest risk factor for not getting tested for HIV is doctors not recommending it, said Frieden, who does not support mandatory HIV testing.

Many young people don't regularly see health care providers, so schools and community organizations play key roles in health education, outreach and services, Frieden said.

"It's critical that we reach young people, especially young African-American gay and bisexual men, with HIV prevention and testing," Frieden said. "We have to do so to see a generation free of AIDS."

The CDC has partnered with state and local health departments to look for innovative ways to scale up access to HIV testing, either within schools or through referral programs, Frieden said.

"Testing has improved considerably in the last year in Milwaukee," said Gary Hollander, president and CEO of Diverse & Resilient Inc., a nonprofit organization whose mission is the healthy development of lesbian, gay, bisexual and transgender people in Wisconsin.

"We're working very aggressively to turn this epidemic around," Hollander said, referring to HIV infections among young people, and African-Americans and Latinos in particular.

Hollander attributed the rise in HIV among young blacks to lack of exposure to HIV prevention information, limited social networks, and racism and homophobia that contribute to feelings of lack of acceptance.

Diverse & Resilient just unveiled its latest billboard in an ongoing campaign to educate young people. The new "acceptance journey" billboard carries the message: "Who my son loves doesn't change my love for him." The campaign includes 50 billboards, plus ads on buses and bus shelters.

Until this year, many Milwaukee Public Schools didn't teach about same-sex HIV transmission - just HIV transmission among heterosexuals, Hollander said.

United Way funding helped broaden the curriculum and support other community-based programs that offer sexuality education, he said.

Young gay and bisexual men are often isolated in small social networks, so when one person is infected and engages in high-risk behavior, that increases the likelihood of transmission to others in the small network, Hollander said.

Diverse & Resilient offers social network HIV testing, as do the AIDS Resource Center and 16th Street Community Health Center, he said.

When a young person who engages in high-risk behavior is identified, social network testing connects their friends and sex partners for testing. Incentives are offered, such as a gift card to Walmart or Target, to encourage voluntary testing among a network of friends.

"We normally get 1 to 2% positives in testing," Hollander said. "If we get a network tested, it goes up to 10 to 15%."

Helping prevent HIV infections also requires making free condoms available to sexually active young people, Hollander said.

Free condoms are available by request from school nurses in MPS schools that have nurses, and at the AIDS Resource Center and 16th Street Community Health Center, Hollander said.

What you should know about HIV, and where to get tested

About 87% of young males who have HIV got it from male-to-male sex, 6% from heterosexual sex, 2% from injection drug use and about 5% from a combination of male-to-male sex and injection drug use.

Youths who are sexually active can reduce their risk of HIV infection by choosing to stop having sex. They can also limit their number of sex partners, not have sex with an older partner who may be more likely to already have HIV, and use a condom every time.

Most new HIV infections in youths (about 70%) occur in gay and bisexual males; more than half (54%) are African-Americans.

Sexually active young gay and bisexual males have a higher risk for getting HIV if they are having sex with older or multiple partners, using drugs or alcohol, or not using condoms during every sexual encounter.

Sexually active young gay and bisexual males should get an HIV test at least every year. Those at greater risk may benefit from testing every three to six months.

The Milwaukee Health Department offers free and confidential (name-associated) HIV counseling, testing and referral, and partner services at Keenan Central Health Clinic on a walk-in basis. The clinic is at 3200 N. 36th St., (414) 286-3631.

For more information on HIV prevention and for fee-based HIV testing in the Milwaukee area, go to: city.milwaukee.gov/STD-HIV-AIDS. Diverse & Resilient also offers free HIV testing.

For information about community and web-based programs that reduce risky behaviors among youths, see www.cdc.gov/hiv/topics/research/prs/rr_chapter.htm