Pediatricians in Minnesota have a large role to play in the prevention, diagnosis, and linkage to care for young people in regards to HIV infection. Each year, young people in the state are newly diagnosed with HIV. Furthermore, there are young people who are living with HIV in our state who need and deserve high-quality HIV-specific and general primary care.
The science of HIV prevention is advancing rapidly, and includes behavioral approaches such as condom use, structural approaches such as housing support and economic justice, and biomedical approaches such as the promotion of pre-exposure prophylaxis or “PrEP” medications. Pediatricians can work at all of these levels, for example by using motivational interviewing practices with young people to promote the use of condoms, advocating on a state level to improve the social drivers of health for young people, and for making the assessment of the need for PrEP and the prescribing of PrEP a routine part of clinical practice. For more information about the medications used as HIV prophylaxis, which are FDA approved for adults and adolescents weighing greater than 35 kg, and guidelines for prescribing, the CDC HIV Nexus Clinician Resources is open access and can be found here: https://www.cdc.gov/hiv/clinicians/prevention/prescribe-prep.html.
It is critical that young people diagnosed with HIV are quickly linked to HIV treatment services. The Youth and AIDS Projects (YAP) is a grant-funded organization based in the Twin Cities and affiliated with the Department of Pediatrics at the University of Minnesota. YAP has a thirty-year history of working with youth and young adults, and is a resource for pediatricians and pediatric service providers. YAP was established in 1989 as one of the first HIV-service organizations in the US to focus on young people, and continues to be guided by the principle that young people can and do make responsible health-related decisions when given appropriate resources and support. YAP staff are deeply invested in helping young people with intersectional barriers to health and are adept at working with other youth-centered agencies to address young peoples’ needs. YAP staff are also engaged in the training of the next generation of health care providers, including resident trainees. YAP’s current programs include comprehensive medical and non-medical case management for young people ages thirteen to thirty years old who are living with HIV, HIV treatment adherence, HIV testing, and health education/risk reduction for young people living with HIV. YAP also is engaged in Covid-19 vaccination education with a specific focus on vaccine education for young people who identify as LGBTQ+.
For pediatricians and other pediatric service providers who are seeing adolescent patients in a clinical setting, YAP staff are a resource on diverse topics such as PrEP, counseling around HIV testing, and linking young people who receive a reactive HIV test to care. YAP staff meet young people where they are, for example meeting with recently young people in clinical settings in collaboration with providers as the young people receive their results, in order to provide immediate support and education. To refer a patient for services, or to connect with YAP’s staff for other education and support, contact information can be found on YAP’s web page under “service referrals:” https://www.yapmn.org/service-referrals.html. Additionally, service providers can directly contact Val Crutcher, YAP’s Executive Director, at (651) 231-4849. Ms. Crutcher is one of the Twin Cities experts on services for young people, with 32 years of experience working with at-risk youth and 28 years working with youth living with HIV. She and the YAP team regularly assist providers in navigating next steps for enrollment in YAP’s programs and other referrals for young people. Ms. Crutcher has built an incredible YAP team to address HIV-related health disparities more effectively. Because YAP staff members have experienced many of the struggles that young people living with HIV face, they have a unique ability to connect with young people, a factor that facilitates engagement and ultimately improves health outcomes.
About the Author
Calla Brown, MD, MHR, FAAP, is an internist and pediatrician with clinical and research interests that include primary care, care of complex chronic medical conditions in children and adults, community health, and health justice. Her interest in these topics was cemented during her service as a Peace Corps Volunteer in Ecuador from 2003-2005. Dr. Brown is an assistant professor at the University of Minnesota Department of Pediatrics, she practices med/peds primary care at a local community health center and is the medical director of YAP [Youth and AIDS Projects] in the Twin Cities.
.
