Too many young people in the United States (US) are at risk for HIV infection. This risk is especially notable for young gay, bisexual, and other men who have sex with men (MSM),¹ especially young African American or Latino MSM, and all youth of minority races and ethnicities. Continual HIV prevention outreach and education efforts, including programs on abstinence, delaying the initiation of sex, and negotiating safer sex, are required as new generations replace the generations that benefited from earlier prevention strategies.

The Numbers

New HIV Infections (Ages 13-29 Years)

• In 2009, young persons accounted for 39% of all new HIV infections in the US. For comparison's sake, persons aged 15-29 comprised 21% of the US population in 2010.
• Young MSM, especially those of minority races and ethnicities, are at increased risk for HIV infection. In 2009, young MSM accounted for 27% of new HIV infections in the US and 69% of new HIV infections among persons aged 13-29. Among young black MSM, new HIV infections increased 48% from 2006 through 2009.

HIV and AIDS Diagnoses² (Ages 13-24 Years)

• An estimated 8,294 young persons were diagnosed with HIV infection in 2009 in the 40 states with long-term HIV reporting, representing about 20% of the persons diagnosed during that year.
  • Seventy-five percent (6,237) of these diagnoses occurred in young people aged 20-24 years. Indeed, those aged 20-24 had the highest number and rate of HIV diagnoses of any age group (36.9 new HIV diagnoses/100,000 people).
• In 2009, young blacks accounted for 65% (5,404) of diagnoses of HIV infection reported among persons aged 13-24 years.
• In 2008, an estimated 22% of persons aged 13-24 living with diagnosed HIV infection were infected through hemophilia, blood transfusion, birth, or unknown transmission mode, with the majority being infected perinatally.

Prevention Challenges

Sexual Risk Factors

Early age at sexual initiation; unprotected sex; older sex partners. According to CDC's 2009 National Youth Risk Behavior Survey (YRBS), many adolescents begin having sexual intercourse at early ages: 46.0% of high school students have had sexual intercourse, and 5.9% reported first sexual intercourse before the age of 13. Of the 34.2% of students reporting sexual intercourse during the 3 months before the survey, 38.9% did not use a condom. Young people with older sex partners may be at increased risk for HIV. HIV education needs to take place before young people engage in sexual behaviors that put them at risk. Parent communication and monitoring may play an important role in reaching youth early with prevention messages.

Male-to-male sex. CDC data have shown that young gay, bisexual, and other MSM, especially young African American and young Latino MSM, have high rates of new HIV infections. Another CDC study showed that young MSM and minority MSM were more likely to be unaware of their HIV infection, a situation that puts their health and the health of their partners at risk. Young MSM may be at risk because they have not always been reached by effective HIV interventions or prevention education -- especially because some sex education programs exclude information about sexual orientation. A CDC study of MSM in 15 cities found that 80% had not been reached in the past year by HIV interventions known to be most effective. Young MSM may also have increased risk factors for HIV (such as risky sexual behaviors) due to isolation and lack of support.

Sexual abuse. Young adults, both male and female, who have experienced sexual abuse are more likely to engage in sexual or drug-related risk behaviors that could put them at risk for HIV infection.

Sexually transmitted infections (STIs). The presence of an STI greatly increases a person's likelihood of acquiring or transmitting HIV. Some of the highest STI rates in the country are among young people, especially young people of minority races and ethnicities.

Substance Use

Young people in the US use alcohol, tobacco, and other drugs at high rates. CDC's 2009 National YRBS found that 24.2% of high school students had had five or more drinks of alcohol in a row on at least 1 day during the 30 days before the survey, and 20.8% had used marijuana at least one time during the 30 days before the survey. Both casual and chronic substance users are more likely to engage in high-risk behaviors, such as unprotected sex, when they are under the influence of drugs or alcohol. Runaways, homeless young people, and young persons who have become dependent on drugs are at high risk for HIV infection if they exchange sex for drugs, money, or shelter.

Lack of Awareness

Research has shown that a large proportion of young people are not concerned about becoming infected with HIV. This lack of awareness can translate into not taking measures that could protect their health.

Abstaining from sex and drug use is the most effective way to avoid HIV infection, but adolescents need accurate, age-appropriate information about HIV and AIDS, how to reduce or eliminate risk factors, how to talk with a potential partner about risk factors and how to negotiate safer sex, where to get tested for HIV, and how to use a condom correctly. Parents also need to reinforce health messages, including how to protect oneself from HIV infection.

What CDC Is Doing

CDC employs a multifaceted approach to addressing the high number of HIV infections occurring in young people in the US.

Programs: CDC provides effective interventions that can be carried out locally for the highest impact. Examples include Project AIM to reduce HIV risk behaviors among at-risk youth; Mpowerment for young gay and bisexual men of diverse backgrounds to reduce sexual risk-taking, encourage regular HIV testing, and build positive social connections; Choosing Life: Empowerment! Action! Results! for those older than 16 living with HIV infection or AIDS or at high risk for HIV; and Focus on Youth for African American young people aged 12-15.

Research: CDC is engaged in research to better understand certain populations and to create or adapt interventions to reduce their risk for HIV infection. For example,

• The Division of Adolescent and School Health collects and reports data on youth health risk behaviors and school-based health policies and practices, and develops guidelines for schools to promote health among young people, among other activities.
• The Youth Risk Behavioral Surveillance System is a CDC surveillance system that monitors six types of health-risk behaviors that contribute to the leading causes of death and disability among youth and adults, including alcohol and other drug use, and sexual risk behaviors.
• The Division of HIV/AIDS Prevention evaluates HIV prevention interventions, such as those for adolescent African American girls in juvenile detention facilities, young African American MSM, and Hispanic parents; adapts current interventions for transgender young adults; and explores new forms of media, such as motion comics, that can deliver stories and content with HIV prevention messages over mobile phones, gaming systems, websites, and social media.

Overall, a multifaceted approach to HIV prevention, which includes individual, peer, familial, school, church, and community programs, is necessary to reduce the incidence of HIV infection and AIDS in young people.

Footnotes

1. The term men who have sex with men (MSM) is used in CDC surveillance systems. It indicates the behaviors that transmit HIV infection, not how individuals self-identify in terms of their sexuality.
2. The category HIV and AIDS Diagnoses indicates when a person is diagnosed with HIV infection or AIDS but does not indicate when the person was infected.