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HIV and Youth

In 2017, youth aged 13 to 24a made up 21% (8,164) of the 38,739 new HIV diagnosesb in the United States and dependent areas.c Youth with HIV are the least likely of any age group to be linked to care in a timely manner and have a suppressed viral load. Addressing HIV in youth requires that young people have access to information and tools they need to reduce their risk, make healthy decisions, and get treatment and care if they have HIV.

The Numbers

HIV Diagnoses

In 2017:

  • Eighty-seven percent (7,125) of youth who received an HIV diagnosis were young men and 13% (1,039) were young women.
  • Less than 1% (25) of youth who received an HIV diagnosis were aged 13 to 14, 21% (1,723) were aged 15 to 19, and 79% (6,416) were aged 20 to 24.

New HIV Diagnoses Among Youth by Transmission Category and Sex
in the US and Dependent Areas, 2017

This pie chart shows the number of new HIV diagnoses in the United States and dependent areas among youth by transmission category and sex in 2017. Young women, Heterosexual contact = 86percent; Young women, Injection drug use = 11percent; Young women, Other = 3percent; Young men, Male-to-male sexual contact = 93percent; Young men, Heterosexual contact = 3percent; Young men, Injection drug use = 1percent; Young men, Male-to-male sexual contact and injection drug use = 3percent; Young men, Other = or less than 1percent.
This pie chart shows the number of new HIV diagnoses in the United States and dependent areas among youth by transmission category and sex in 2017. Young women, Heterosexual contact = 86percent; Young women, Injection drug use = 11percent; Young women, Other = 3percent; Young men, Male-to-male sexual contact = 93percent; Young men, Heterosexual contact = 3percent; Young men, Injection drug use = 1percent; Young men, Male-to-male sexual contact and injection drug use = 3percent; Young men, Other = or less than 1percent.

Source: CDC. Adolescents and young adults (slides).

New HIV Diagnoses Among Young Gay and Bisexual Mend by Race/Ethnicity
in the US and Dependent Areas, 2017

This pie chart shows the number of new HIV diagnoses in the United States and dependent areas among young gay and bisexual men by race/ethnicity in 2017. Black/African American = 51percent; Hispanic/Latino = 25percent; White = 18percent; other races/ethnicities = 6percent.

Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2017. HIV Surveillance Report 2018;29

From 2010 to 2016, HIV diagnoses decreased 6% among youth overall in the 50 states and the District of Columbia. But trends varied for different groups of youth.

HIV Diagnoses Among Youth in the 50 States
and District of Columbia, 2010-2016

This chart shows HIV diagnoses trends for youth from 2010 to 2016. HIV diagnoses among young women decreased 32%, young men remained stable, young Black/African American gay and bisexual men decreased 5%, young Hispanic/Latino gay and bisexual men decreased 17%, and young white gay and bisexual men decreased 6%.

Source: CDC. NCHHSTP AtlasPlus. Accessed April 9, 2019.

Living With HIV

In the 50 states and the District of Columbia:

An estimated 50,900 youth had HIV in 2016, representing 4% of all people with HIV.g Of those, an estimated 56% were aware of their infection. Young people were the least likely to be aware of their infection compared to any other age group. Overall, 86% of people with HIV were aware of their infection at the end of 2016.

For every 100 youth with HIV in 2015, 36 received some HIV care, 27 were retained in care, and 25 were virally suppressed.

The lowest rate of viral suppression overall. For all age groups, for every 100 people with HIV, 51 were virally suppressed.
Source: CDC. Selected national HIV prevention and care outcomes (slides).

graphic of a bottle of pills
A person with HIV who takes HIV medicine as prescribed and gets and stays virally suppressed or undetectable can stay healthy and has effectively no risk of sexually transmitting HIV to HIV-negative partners.

Deaths

In 2016, there were 162 deaths among youth with diagnosed HIV in the US and dependent areas. These deaths may be due to any cause.

Prevention Challenges

Inadequate Sex Education. The status of sexual health education varies throughout the United States and is insufficient in many areas according to CDC’s 2016 School Health Profiles. In most states, fewer than half of high schools teach all 19 sexual health topics recommended by CDC. In addition, sex education is not starting early enough: in no state did more than half of middle schools teach all 19 sexual health topics recommended by CDC. Finally, sex education has been declining over time. The percentage of US schools in which students are required to receive instruction on HIV prevention decreased from 64% in 2000 to 41% in 2014, according to the School Health Policies and Practices Study.

Health-related behaviors. 2017 data from the Youth Risk Behavior Surveillance System (YRBS), which monitors health behaviors that contribute to the leading causes of death and disability among youth, reveal:

  • Low rates of testing. Only 9% of high school students have been tested for HIV. Among male students who had sexual contact with other males, only 15% have ever been tested for HIV. Low rates of testing mean more young people have undiagnosed HIV. People who do not know they have HIV cannot take advantage of HIV care and treatment and may unknowingly pass HIV to others.
  • Substance use. Nationwide, 19% of all students who are currently sexually active (had sexual intercourse during the previous 3 months) and 20% of male students who had sexual contact with other males drank alcohol or used drugs before their most recent sexual intercourse. Young people may engage in high-risk behaviors, such as sex without a condom or medicine to prevent or treat HIV, when under the influence of drugs or alcohol.
  • Low rates of condom use. Nationwide, 46% of all sexually active high school students and 48% of male students who had sexual contact with other males did not use a condom the last time they had sexual intercourse. Using condoms the right way can protect from HIV and some sexually transmitted diseases (STDs).
  • Number of partners. Nearly one-quarter (24%) of male students who had sexual contact with other males reported sexual intercourse with 4 or more persons during their life, compared to 10% of all students. The more sexual partners you have, the more likely you are to have sex with someone who has HIV and doesn’t know it.

Research has also shown that young gay and bisexual men who have sex with older partners are at a greater risk for HIV infection. This is because an older partner is more likely to have had more sexual partners or other risks, and is more likely to have HIV.

Low rates of pre-exposure prophylaxis (PrEP) use. A 2018 study found that young people are less likely than adults to use medicine to prevent HIV. Barriers include cost, access, perceived stigma, and privacy concerns.

Socioeconomic challenges for young people living with HIV. Among people with HIV who are receiving medical care, young people aged 18 to 24 are more likely than older people to be living in households with low income levels, to have been recently homeless, recently incarcerated, or uninsured. All of these factors pose barriers to achieving viral suppression.

High rates of STDs. Some of the highest STD rates are among youth aged 20 to 24, especially youth of color. The presence of another STD greatly increases the likelihood that a person exposed to HIV will become infected.

Stigma and misperceptions about HIV. In a 2017 Kaiser Family Foundation survey, 51% of young adults aged 18 to 30 said they would be uncomfortable having a roommate with HIV, and 58% said they would be uncomfortable having their food prepared by someone with HIV. More than half of young people incorrectly believe that HIV can be transmitted by spitting or kissing. Stigma and misperceptions about HIV negatively affect the health and well-being of young people, and may prevent them from testing, disclosing their HIV status, and seeking HIV care.

Feelings of isolation. High school students may engage in risky sexual behaviors and substance abuse because they feel isolated from family or peers and lack support. This is especially true for gay and bisexual students who are more likely than heterosexual youth to experience bullying and other forms of violence, which also can lead to mental distress and engagement in risk behaviors that are associated with getting HIV. In the 2017 YRBS, 33% of gay, lesbian, or bisexual students reported being bullied on school property in the previous 12 months, compared to 19% of all students.

What CDC Is Doing

CDC funds state and local health departments and community-based organizations (CBOs) to deliver effective HIV prevention services for youth. For example:

  • In 2019, CDC awarded a new cooperative agreement to strengthen the capacity and improve the performance of the nation’s HIV prevention workforce. New elements include dedicated providers for web-based and classroom-based national training and technical assistance tailored within four geographic regions.
  • Under the new integrated HIV surveillance and prevention cooperative agreement, CDC awarded around $400 million per year to health departments for surveillance and prevention efforts. This award will direct resources to the populations and geographic areas of greatest need, while supporting core HIV surveillance and prevention efforts across the United States.
  • In 2017, CDC awarded nearly $11 million per year for 5 years to 30 CBOs to provide HIV testing to young gay and bisexual men of color and transgender youth of color, with the goals of identifying undiagnosed HIV infections and linking those who have HIV to care and prevention services.
  • CDC collects and reports data on youth health risk behaviors and funds education agencies and nongovernmental organizations to help schools deliver health education emphasizing HIV/STD prevention, increase access to health services, and establish safe and supportive environments for students. For example:
  • Through its Let’s Stop HIV Together (formerly Act Against AIDS) campaigns and partnerships, CDC provides youth with effective and culturally appropriate messages aimed at stopping HIV stigma and promoting HIV testing, prevention, and treatment. The stigma materials include stories and issues relevant to youth, as do the following:
    • Doing It encourages all people to know their HIV status and protect themselves and their community by making HIV testing a part of their regular health routine.
    • Start Talking. Stop HIV. helps gay and bisexual men communicate about testing and a range of HIV prevention strategies.
    • HIV Treatment Works shows how people living with HIV have overcome barriers to stay in care and provides resources on how to live well with HIV.
    • Partnering and Communicating Together (PACT) to Act Against AIDS, a 5-year partnership with organizations such as the ASPIRA Association and AIDS United, is raising awareness about testing, prevention, and retention in care among populations disproportionately affected by HIV, including youth.

a Unless otherwise noted, persons aged 13 to 24 are referred to as youth or young in this fact sheet.
b HIV diagnoses refers to the number of people who received a diagnosis of HIV during a given period of time, not when the people got HIV infection.
c Unless otherwise noted, the term United States (US) includes the 50 states, the District of Columbia, and the 6 dependent areas of American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the US Virgin Islands.
d Includes infections attributed to male-to-male sexual contact and injection drug use (men who reported both risk factors).
e Black refers to people having origins in any of the black racial groups of Africa, including immigrants from the Caribbean, and South and Latin America. African American is a term often used for Americans of African descent with ancestry in North America. Individuals may self-identify as either, both, or choose another identity altogether.
f Hispanics/Latinos can be of any race.
g Includes diagnosed and undiagnosed HIV infections among adolescents.

Bibliography

  1. CDC. Diagnoses of HIV infection in the United States and dependent areas, 2017. HIV Surveillance Report 2018;29.
  2. CDC. Estimated HIV incidence and prevalence in the United States 2010-2016. HIV Surveillance Supplemental Report 2019;24(1).
  3. CDC. Sexually transmitted disease surveillance, 2017. Accessed April 9, 2019.
  4. CDC. NCHHSTP AtlasPlus. Accessed April 9, 2019.
  5. CDC. Selected national HIV prevention and care outcomes (slides).
  6. CDC. School health profiles 2016: Characteristics of health programs among secondary schools.
  7. CDC. Results from the school health policies and practices study 2014.
  8. Beer L, Mattson CL, Bradley H, Shouse R. Trends in ART prescription and viral suppression among HIV-positive young adults in care in the United States, 2009-2013. J Acquir Immune Defic Syndr 2017;76(1):1-6. PubMed abstract.
  9. Beer L, Mattson CL, Shouse RL, Prejean J. Receipt of clinical and prevention services, clinical outcomes, and sexual risk behaviors among HIV-infected young adults in care in the United States. AIDS Care 2016;28(9):1166-70. PubMed abstract.
  10. Committee on Pediatric AIDS. Policy statement: reducing the risk of HIV infection associated with illicit drug use. Pediatrics 2006;117(2):566-71.
  11. Just the Facts Coalition. Just the facts about sexual orientation and youth: A primer for principals, educators, and school personnel.
  12. Kaiser Family Foundation. National survey of young adults on HIV/AIDS.
  13. Kann L, McManus T, Harris W, et al. Youth risk behavior surveillance—United States, 2017. MMWR 2018;67(8):1-114. PubMed abstract.
  14. Siegler AJ, Mouhanna F, Giler RM, et al. The prevalence of pre-exposure prophylaxis use and the pre-exposure prophylaxis-to-need ratio in the fourth quarter of 2017, United States. Ann Epidemiol 2018; 28(12):841-9. PubMed abstract

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