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HIV Among Youth in the United States

April 20, 2018

In 2016, youth aged 13 to 241 made up 21% of all new HIV diagnoses in the United States. Most (81%) of those new diagnoses occurred among young gay and bisexual men. Young black/African American2 and Hispanic/Latino3 gay and bisexual men were especially affected.

Having a very low level of virus in the body (suppressed viral load) helps a person stay healthy and reduces the risk of transmitting HIV to others. 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 needed.


The Numbers

New HIV Infections4

From 2010 to 2015, estimated annual HIV infections declined 24% among youth.


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HIV and AIDS Diagnoses5

In 2016:

  • 8,451 youth received an HIV diagnosis in the United States. Eighty percent (6,776) of those diagnoses occurred in young people aged 20 to 24.
  • Eighty-one percent (6,848) of HIV diagnoses were among youth with infections attributed to male-to-male sexual contact. African Americans accounted for 54% (3,719) of infections attributed to male-to-male sexual contact, Hispanics/Latinos accounted for 25% (1,687), whites accounted for 16% (1,094), and other races/ethnicities accounted for 5%.
  • Four percent (274) of infections among young men were attributed to heterosexual contact, 3% (228) were attributed to male-to-male sexual contact and injection drug use, and 1% (98) to injection drug use alone.
  • 992 young women received an HIV diagnosis. Eighty-seven percent (865) of those infections were attributed to heterosexual contact and 9% (92) were attributed to injection drug use.
  • 1,473 youth received an AIDS diagnosis, representing 8% of total AIDS diagnoses that year.

From 2011 to 2015:

  • HIV diagnoses among youth remained stable overall. Stable diagnoses with decreasing incidence may be due to increased HIV testing efforts among youth.
  • HIV diagnoses remained stable among young African American and white gay and bisexual men. Diagnoses increased 19% among young Hispanic/Latino gay and bisexual men.
  • HIV diagnoses decreased 25% among young women.
  • HIV diagnoses remained stable among young people who inject drugs.6


New HIV Diagnoses Among Youth in the United States, by Race/Ethnicity and Sex, 2016

New HIV Diagnoses Among Youth in the United States, by Race/Ethnicity and Sex, 2016

Source: CDC. NCHHSTP AtlasPlus. Accessed February 2, 2018.


Living With HIV and Deaths

  • At the end of 2015, an estimated 60,300 youth were living with HIV in the United States. Of these, 51% (31,000) were living with undiagnosed HIV -- the highest rate of undiagnosed HIV in any age group.
  • Among youth living with HIV in 2014, 41% received HIV medical care in 2014, 31% were retained in HIV care, and 27% had a suppressed viral load -- the lowest rate of viral suppression for any age group. A person living with HIV who gets and stays virally suppressed can stay healthy and has effectively no risk of sexually transmitting HIV to HIV-negative partners.
  • In 2015, 100 youth aged 15 to 24 died from HIV disease.


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.

Risk behaviors. 2015 data from the Youth Risk Behavior Surveillance System (YRBS), which monitors health risk behaviors that contribute to the leading causes of death and disability among youth, reveal:

  • Low rates of testing. Only 10% of high school students have been tested for HIV. Among male students who had sexual contact with other males, only 21% have ever been tested for HIV.
  • Substance use. Nationwide, 21% of all students who are currently sexually active (had sexual intercourse during the previous 3 months) and 32% of male students who had sexual contact with other males drank alcohol or used drugs before their most recent sexual intercourse.
  • Low rates of condom use. Nationwide, 43% of all sexually active high school students and 49% of male students who had sexual contact with other males did not use a condom the last time they had sexual intercourse.
  • Number of partners. One-third (33%) of male students who had sexual contact with other males reported sexual intercourse with 4 or more persons during their life, compared to 12% of all students who had ever had sexual contact.

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 be infected with HIV.

According to the Medical Monitoring Project, which collects data about the experiences and needs of people living with HIV, 38% of young people aged 18 to 24 living with HIV and receiving medical care reported sex without a condom in the past 12 months.

Socioeconomic challenges for young people living with HIV. Among people living with HIV and 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, and uninsured or to have only Ryan White Program-funded health care. All of these factors pose barriers to achieving viral suppression.

High rates of sexually transmitted diseases (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 disclosing their HIV status and seeking HIV care.

Feelings of isolation. Gay and bisexual high school students may engage in risky sexual behaviors and substance abuse because they feel isolated and lack support. They 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 2015 YRBS, 34% of gay, lesbian, or bisexual students reported being bullied on school property in the previous 12 months, compared to 20% of all students.


What CDC Is Doing

CDC funds state and local health departments and community-based organizations (CBOs) to develop and implement HIV prevention programs in the communities most affected by HIV. For example:

  • Under the current funding opportunity, CDC will award around $400 million per year to health departments for surveillance and prevention efforts. This funding opportunity 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 and transgender youth of color, with the goals of identifying previously undiagnosed HIV infections and linking those who have HIV to care and prevention services.
  • CDC's Division of Adolescent and School Health collects and reports data on youth health risk behaviors and funds state and local education agencies and nongovernmental organizations to help schools deliver health education emphasizing HIV/STD prevention, increase teen access to health services, and establish safe and supportive environments for students. For example:
  • CDC's Act Against AIDS initiative focuses on raising awareness about HIV, fighting stigma, and reducing the risk of HIV infection among at-risk populations through campaigns such as Doing It, which motivates individuals to get tested for HIV and know their status.


Bibliography

  1. CDC. Estimated incidence and prevalence in the United States 2010-2015. HIV Surveillance Supplemental Report 2018;23(1).
  2. CDC. Diagnoses of HIV infection in the United States and dependent areas, 2016. HIV Surveillance Report 2017;28.
  3. CDC. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data -- United States and 6 dependent areas, 2015. HIV Surveillance Supplemental Report 2017;22(2).
  4. CDC. Sexually transmitted disease surveillance 2016.
  5. CDC. School health profiles 2016: Characteristics of health programs among secondary schools.
  6. CDC. Results from the school health policies and practices study 2014.
  7. CDC. Vital Signs: HIV infection, testing, and risk behaviors among youths -- United States. MMWR 2012;61(47):971-6.
  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. Kann L, McManus T, Harris WA, et al. Youth risk behavior surveillance -- United States, 2015. MMWR 2016;65(6):1-174. PubMed abstract.
  11. Kann L, Olsen EO, McManus T, et al. Sexual identity, sex of sexual contacts, and health-risk behaviors among students in grades 9-12 -- youth risk behavior surveillance, selected sites, United States, 2001-2009. MMWR 2011;60(7):1-133. PubMed abstract.
  12. Committee on Pediatric AIDS. Policy statement: reducing the risk of HIV infection associated with illicit drug use. Pediatrics 2006;117(2):566-71.
  13. Kaiser Family Foundation. National survey of young adults on HIV/AIDS. Accessed March 8, 2018.
  14. Just the Facts Coalition. Just the facts about sexual orientation and youth: A primer for principals, educators, and school personnel.
  15. Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. Accessed March 8, 2018.


Additional Resources

CDC DASH Website

CDC-INFO 1-800-CDC-INFO (232-4636)

CDC HIV Website

CDC Act Against AIDS Campaign

CDC HIV Risk Reduction Tool (BETA)


Footnotes

  1. Unless otherwise noted, persons aged 13 to 24 are referred to as youth or young in this fact sheet.
  2. Referred to as African Americans in this fact sheet.
  3. Hispanics/Latinos can be of any race.
  4. Estimated annual HIV infections are the estimated number of new infections (HIV incidence) that occurred in a particular year, regardless of when those infections were diagnosed.
  5. HIV and AIDS diagnoses indicate when a person is diagnosed with HIV or AIDS, not when the person was infected.
  6. Includes diagnoses attributed to injection drug use as well as those attributed to injection drug use and male-to-male sexual contact.

[Note from TheBody.com: This article was created by the Centers for Disease Control and Prevention, who last updated it on Apr. 20, 2018. We have cross-posted it with their permission.]


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This article was provided by U.S. Centers for Disease Control and Prevention. Visit the CDC's website to find out more about their activities, publications and services.
 

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