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Alwyn T. Cohall, MD, Director

Harlem Health Promotion Center Director Project Stay

Miah, my 3-year-old daughter, recently complained of discomfort in her ears. "Daddy, my ears are crying!" Fortunately, after a hug and a good night's sleep, she pronounced herself cured. But her malapropism stayed with me. As a health care provider who works primarily with adolescents and young adults, I have left the clinic many nights with "crying ears," stunned by the atrocities inflicted upon this vulnerable segment of our population.

Stephen Nicholas—featured on the cover with a young patient at Incarnation Children's Center—and his colleague Elaine Abrams devote their lead editorial to recounting the struggle to save the "boarder babies" with AIDS (page 163). While HIV-infected infants were rescued from institutionalized hospitalization by creating humane transitional living quarters and facilitating their adoption, they grew into adolescents who were rejected by their adoptive parents because they "didn’t foresee such longevity, complexity of care needs, or behaviors they couldn’t control." To survive physically only to have the quality of their lives undermined by deficiencies in our society's educational, social welfare, and mental health systems, is particularly cruel.

There is, however, another chapter in the story. Through advances in HIV screening, early diagnosis, and prenatal care, the former legions of HIV-infected infants in the US are diminishing over time, and eventually the numbers of perinatally infected adolescents will also decrease. The numbers of behaviorally infected adolescents, however, may not. According to recent estimates by the Centers for Disease Control and Prevention, young people under the age of 25 are responsible for 25% of new cases of HIV infection.

Some of these young people have found their way through the doors at Project STAY (Services to Assist Youth), a program that provides comprehensive medical and psychosocial services to youth living with HIV. Like storm tossed passengers, they wash up on our shores, traumatized and exhausted. Once stabilized, they relate horrific tales of abuse, violence, and rejection, often perpetrated by the key adults in their lives. In this context, numbing their pain with sex and drugs appears to be a rational response.

As a society, we have failed to provide proper safeguards to ensure that our young people have an opportunity to live their lives free of infection and despair. Carol Goodenow and her colleagues report in this issue on the strong protective effects of school AIDS education and condom use instruction for sexually active adolescents (page 203). Yet, ". . . condom instruction remains one of the more controversial and least taught topics within school-based AIDS education. . . . Nationally, school condom use instruction has declined in recent years."^(p208)

In addition to inconsistent and sporadic school-based and community-based AIDS education programs, access to quality, adolescent-friendly medical and mental health services is rare. Child protective services, hampered by insufficient resources, often fail in their primary mission to protect children. Why do we devote exorbitant funds to build youth detention facilities, but give short shrift to youth development programs?

The public health practitioners and researchers featured in this issue are leading the way in providing rational and theoretically sound approaches to improving adolescent health. Our youth are screaming collectively in pain. Are your ears crying? It's time to listen and act.

This Article Extract Full Text (PDF) Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cohall, A. T. Search for Related Content PubMed PubMed Citation Articles by Cohall, A. T.