Patient X is a 17-year-old girl, previously healthy, who visited a clinic for routine care. She is sexually active — as are nearly half of Missouri high school students. Her nurse practitioner ordered a battery of blood tests, but a lab technician misread the form. Instead of screening for hepatitis C, he ran a test for HIV. It came back positive.
The number of HIV-infected teenagers and young adults in the St. Louis region, while still relatively low, increased sharply in the past 10 years. Just 20 cases were reported in 1998. By 2006, there were 54. The girl above, being treated at St. Louis Children’s Hospital pediatric HIV clinic, is among them.
With the help of newer medications, doctors are able to manage HIV as they do many chronic diseases. That’s the good news. But such careful management is possible only if the infection is found. Too many teenagers and young adults don’t get tested.
Why not? Some are afraid a parent will find out they’re having sex. Others don’t think HIV is a problem anymore. Some just don’t want to know.
But if their HIV goes undetected, these young people will become casualties of a persistent epidemic that has disappeared from the headlines but that continues to claim lives.

St. Louis Children’s Hospital this week becomes the nation’s first pediatric hospital to offer universal, confidential HIV testing to everyone 15 or older who comes to the emergency room.
“Confidential” is key. Before the test is offered, parents or guardians will be asked to step out of the room. The decision to be tested rests with the young people themselves. So does the decision to tell a parent or guardian that the test has been performed and what it found. Hospital staff will counsel and encourage the young patients to share the information.
That will be difficult for some parents to accept — understandably. Although 15-year-olds try hard to assert their independence, most are still very much kids.
But early diagnosis is the key here, and not everyone who becomes infected will be lucky enough to be tested by accident. What matters most is getting information that can save lives.

Dr. Ericka V. Hayes of St. Louis Children’s Hospital specializes in pediatric infectious diseases. She helped design the confidential testing program. She also helps run the hospital’s pediatric HIV clinic.
Biology makes young women more vulnerable to sexually transmitted diseases than young men, she notes. STDs, in turn, make them even more vulnerable to HIV.
Teenagers and young adults in their early 20s have the highest rates of STD infection. St. Louis has the nation’s highest rates of chlamydia and gonorrhea. She says the prevalence of those diseases “makes me wonder how many cases of HIV we’re missing.”
If Dr. Hayes and her colleagues start treatment before the virus has begun to overwhelm a young person’s immune system, the patient can expect to live for decades. If treatment begins after the first symptoms of AIDS have appeared, the outlook isn’t nearly as good.

Arthur Kinnard was 15 when he was diagnosed with HIV. Now 19, he remembers the moment as if it happened yesterday.
“Everything slowed down. It kind of felt like a dream,” he said last week. “It seemed like something that would never happen to me.”
Most HIV-positive teenagers here are gay adolescents. But the fastest-growing group with the virus are African-American girls who have been infected by a male sex partner. Many never knew they were at risk.
Mr. Kinnard regularly talks to teenagers about HIV. “It’s better to know and get the treatment you need than be worried and not get it,” he tells them. “Not knowing is what’s killing us.”

Photo of Dr. Ericka V. Hayes by Christian Gooden/Post-Dispatch