HIV and Youth: Prevention Challenges

Stigma, rejection, and bullying negatively affect the health and well-being of young people, and may prevent them from testing, disclosing their HIV status, and seeking HIV care or prevention services. Young people are also more likely than older people to be living in households with low income levels, to have been recently homeless, recently incarcerated, or uninsured. Furthermore, lesbian, gay, bisexual, and transgender (LGBT) youth experience homelessness at higher ratesexternal icon than non-LGBT youth for various reasons, including family rejection; physical, emotional, or sexual abuse; aging out of the foster care system; and financial and emotional neglect. Addressing these issues and encouraging safe and supportive environments at home and in school can help improve health outcomes for young people.

In addition to the social and economic issues that affect some young people, other factors can increase the chances of getting or transmitting HIV:

A computer monitor with pencils and books next to it.

Inadequate sex education. The status of sexual health education varies throughout the United States and is insufficient in many areas according to CDC’s 2018 School Health Profilespdf icon. Sex education is not starting early enough: in no state did more than half of middle schools teach all 20 sexual health topics recommended by CDC. Comprehensive sexual health is not reaching most high school students either: in most states, fewer than half of high schools teach all 20 sexual health topics recommended by CDC. Finally, sex education has been declining over time. The percentage of US middle schools in which students are required to receive instruction on HIV prevention decreased from 82% in 2000 to 71% in 2016, according to the School Health Policies and Practices Study.

An older man in a yellow shirt next to a young man in a purple shirt.

Older partners. Research has also shown that young gay and bisexual men who have sex with older partners are at greater risk for HIV. 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.

A blue PrEP pill.

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

A hand holding a blue doctor bag.

High rates of other STDs. Some of the highest STD rates are among youth aged 20 to 24 years. Having another STD can greatly increase the chance of getting or transmitting HIV.

  1. CDC. Diagnoses of HIV infection in the United States and dependent areas, 2018 pdf icon[PDF – 7 MB]. HIV Surveillance Report 2020;31.
  2. CDC. Estimated HIV incidence and prevalence in the United States, 2014-2018 pdf icon[PDF – 3 MB]. HIV Surveillance Supplemental Report 2020;25(1).
  3. CDC. HIV infection risk, prevention, and testing behaviors among men who have sex with men—National HIV Behavioral Surveillance, 23 U.S. Cities, 2017 pdf icon[PDF – 1 MB]. HIV Surveillance Special Report 2019; 22.
  4. CDC. HIV infection risk, prevention, and testing behaviors among persons who inject drugs–National HIV Behavioral Surveillance: injection drug use – 23 U.S. Cities, 2018 pdf icon[PDF – 2 MB]. HIV Surveillance Special Report 2020; 24.
  5. CDC. HIV risk behaviors. Accessed March 18, 2021.
  6. CDC. Behavioral and clinical characteristics of persons with diagnosed HIV infection—Medical Monitoring Project, United States, 2018 cycle (June 2018–May 2019) pdf icon[PDF – 905 KB]. HIV Surveillance Special Report 2020;25.
  7. CDC. Selected national HIV prevention and care outcomes pdf icon[PDF – 2 MB][slides].
  8. CDC. Sexually transmitted disease surveillance, 2018. Accessed March 18, 2021.
  9. National youth risk behavior survey (YRBS). Accessed March 18, 2021.
  10. CDC. School health profiles 2018: Characteristics of health programs among secondary schoolspdf icon.
  11. CDC. Results from the school health policies and practices study, 2016pdf icon.
  12. Kann L, McManus T, Harris W, et al. Youth risk behavior surveillance—United States, 2017. MMWR 2018;67(8):1-114. PubMed abstractexternal icon.
  13. 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 abstractexternal icon.