Dr. Kyzwana Caves is a specialist in adolescent medicine at Children’s Hospital of The King’s Daughters in Norfolk, VA and is credentialed as an HIV Specialist by the American Academy of HIV Medicine.
Q: You are currently a specialist in adolescent and young adult medicine at Children’s Hospital of The King’s Daughters. Why did you decide to focus specifically on HIV prevention and LGBTQ equality among youth?
One of the driving factors behind my pursuit of practicing medicine and my focus on serving these specific groups of people has a lot to do with health equity. For example, sexual and ethnic minority youth are underrepresented in the healthcare system as a whole and unfortunately, they also are disproportionately affected by the disease burden of HIV, as well as other sexually transmitted infections (STIs). My interest in HIV prevention and LGBTQ equality is based on my personal goals as a youth advocate to create nonjudgmental spaces that promote education, open communication, confidentiality, and continuity of care.
Q: Given your background researching HIV among youth and adolescents, what challenges do you see young people face when it comes to HIV?
Young people are the demographic with the most new HIV infections each year, and they account for over half of all new STIs annually. Additionally, among those living with HIV, they are the least likely out of any age group to be linked to care in a timely manner and to achieve viral suppression. There are several contributing factors, one has to do with stigma around sex and the barriers it can create toward effective communication between youth, their parents, and medical professionals. I also think stigma and the associated communication barriers promote risky sexual behaviors, including sex without condoms, and having multiple sexual partners.
Separately, there’s the issue of low condom use. Adolescents and young adults continue to use condoms less reliably than their older counterparts, and it contributes to the disease burden. Whether this is because there’s a lack of education around condom use or just the “invincibility” of puberty – both likely contribute to the inconsistent use of sexual protection.
Lastly, lack of testing is a problem. Some healthcare providers who care for adolescents are not comfortable having conversations about reproductive health with their patients, and as a result, youth are not reliably tested for STIs. Centers for Disease Control and Prevention (CDC) recommends annual gonorrhea and chlamydia testing for youth under age 25 and depending on other risk factors – annual HIV and syphilis testing. Additionally, CDC recommends people over the age of 13 should have had at least one HIV test in their lives, but not everybody is doing that. As I tell my teenagers, the only way to really know is to know. We have to make sure that youth are being reliably tested.
Q: Last year you published a research abstract, “A Clinic Based Survey of Urban Youth Knowledge of PrEP Use for HIV Prevention,” which explored the knowledge of and use of PrEP in urban youth populations. Can you describe what you found when examining the level of awareness about and willingness to take PrEP within this age group?
This study looked at levels of awareness of and willingness to take PrEP in similar populations of adolescents and young adults in the Washington, D.C. metropolitan area within one specific clinic location six years apart. The idea was to document the change in knowledge of PrEP and overall willingness to take PrEP. We found that over the course six years, more youth had heard about PrEP, more than half of our participants expressed an interest in taking PrEP and were willing to discuss it with their healthcare providers. However, what we didn’t expect to find is that a smaller percentage of the participants in the more recent data group, in 2018, actually thought that PrEP was a highly effective prevention method compared to the group in 2012.
This finding may suggest that even though knowledge of PrEP has increased, it doesn’t mean that it’s better knowledge. Just because they know about it doesn’t mean that they have an overall understanding of its use. We are not able to infer this, but it may be a driving factor behind the lack of greater PrEP use in this population of patients – which is something we should continue to explore.
Q: What has your research revealed about the current use of HIV prevention strategies by young people and how can they be improved?
This study highlighted a more concerning misnomer that a lot of the adolescents and young adults actually did not believe that they were at risk for HIV infection, despite inconsistent condom use and a gap in knowledge about the HIV status of their sexual partner. Although most of the youth we interviewed thought that PrEP would be beneficial and appeared willing to use it, PrEP use still remained low. I think this means that providers have to be consistent with their messaging and willingness to talk about PrEP as a prevention method for populations that may benefit from its use.
In addition, providers and public health workers must be diligent in our conversations and recommendations regarding condom use. If we work to try to de-stigmatize sex and help adolescents and young adults develop healthy, sex-positive ideals, we may facilitate youth seeking medical care for prevention services rather than treatment services after they’ve already been exposed.
Q: National Youth HIV & AIDS Awareness Day is April 10. What would be your message to young people at risk for HIV on this day?
I would encourage adolescents and young adults who are sexually active to get tested. It is the first step in knowing your status and taking control of your health. Also, be proactive – make sure to ask your partner questions about their status and communicate the need to use condoms consistently. Although condoms may not be the best prevention method, it remains one of the best options that we have right now. It is important for youth to ask healthcare providers if they may benefit from PrEP. If their provider is uncertain about what PrEP is and why is useful, ask them to refer you to someone who does.
If you’re HIV positive, find a provider who is committed to getting and keeping you healthy. People with undetectable viral levels are extremely unlikely to give the virus to their partner. Removing barriers and increasing access to care has to be something that, as a community, we need to focus on in order to keep our teenagers healthy.