HIV and Youth

In 2018, youth aged 13 to 24^a made up 21% of the 37,832 new HIV diagnoses^b in the United States (US) and dependent areas.^c Youth with HIV are the least likely of any age group to be retained in care and have a suppressed viral load. Addressing HIV in youth requires that young people have access to the information and tools they need to make healthy decisions and reduce their risk for getting HIV, and to get treatment and stay in care if they have HIV.

The Numbers

HIV Diagnoses

New HIV Diagnoses Among Youth by Transmission Category and Sex in the US and Dependent Areas, 2018

*Includes hemophilia, blood transfusion, perinatal exposure, and risk factors not reported or not identified.
Totals may not equal 100% due to rounding.
Source: CDC. HIV surveillance – adolescents and young adults (preliminary) pdf icon[PDF – 2 MB] (slides).

* Black refers to people having origins in any of the black racial groups of Africa. African American is a term often used for Americans of African descent with ancestry in North America.
† Hispanics/Latinos can be of any race.
Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2018 (Preliminary) pdf icon[PDF – 10 MB]. HIV Surveillance Report 2019;30.

From 2010 to 2017, HIV diagnoses decreased 10% among youth overall in the 50 states and the District of Columbia. Although trends varied for different groups of youth, HIV diagnoses declined for groups most affected by HIV, including young black/African American gay and bisexual men.

HIV Diagnoses Among Youth in the 50 States and District of Columbia, 2010-2017

* Includes infections attributed to male-to-male sexual contact and injection drug use (men who reported both risk factors).
† Changes in subpopulations with fewer HIV diagnoses can lead to a large percentage increase or decrease.
‡ Hispanics/Latinos can be of any race.
** Black refers to people having origins in any of the black racial groups of Africa. African American is a term often used for Americans of African descent with ancestry in North America.
Source: CDC. NCHHSTP AtlasPlus. Accessed April 3, 2020.

Living With HIV

Youth With HIV in the 50 States and District of Columbia

Deaths

 In 2017, there were 149 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 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 Studypdf icon.

Health-related behaviors. 2017 data from the Youth Risk Behavior Surveillance System (YRBSS), 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 transmit 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 have sex without protection (such as using a condom or taking medicine to prevent 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.

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

Socioeconomic challenges for young people 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 and highlight the need for youth-specific support for HIV care retention and medication adherence.

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.

Feelings of isolation. High school students may engage in risky sexual behaviors and substance misuse 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 rejection, 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 YRBSS, 33% of gay, lesbian, or bisexual students reported being bullied on school property in the previous 12 months, compared to 19% of all students.

Stigma and misperceptions about HIV. In a 2017 Kaiser Family Foundation surveyexternal icon, 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.

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

What CDC Is Doing

CDC is pursuing a high-impact HIV prevention approach to maximize the effectiveness of HIV prevention interventions and strategies. Funding state, territorial, and local health departments and community-based organizations (CBOs) to develop and implement tailored programs is CDC’s largest investment in HIV prevention. This includes longstanding successful programs and new efforts funded through the Ending the HIV Epidemic initiative. In addition to funding health departments and CBOs, CDC is also strengthening the HIV prevention workforce and developing HIV communication resources for consumers and health care providers.

• Under the integrated HIV surveillance and prevention cooperative agreement, CDC awards around $400 million per year to health departments for HIV data collection and prevention efforts. This award directs resources to the populations and geographic areas of greatest need, while supporting core HIV surveillance and prevention efforts across the US.

• In 2019, CDC awarded $12 million to support the development of state and local Ending the HIV Epidemic plans in 57 of the nation’s priority areas. To further enhance capacity building efforts, CDC uses HIV prevention resources to fund the National Alliance of State and Territorial AIDS Directors (NASTAD) $1.5 million per year to support strategic partnerships, community engagement, peer-to-peer technical assistance, and planning efforts.
• In 2020, CDC will award around $109 million per year to support the implementation of state and local Ending the HIV Epidemic plans with a five-year funding program.
• Under the flagship community-based organization cooperative agreement, CDC awards about $42 million per year to community organizations. This award directs resources to support the delivery of effective HIV prevention strategies to key populations.

• In 2017, CDC awarded nearly $11 million per year for five years to 30 CBOs to provide HIV testing to young gay and bisexual men of color and transgender youth of color, with the goal of identifying undiagnosed HIV infections and linking those who have HIV to care and prevention services.
• In 2019, CDC awarded a 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.

• CDC collects and reports data on youth health risk behaviors and funds education agencies and non-governmental organizations to help schools deliver health education emphasizing HIV and STD prevention, increase access to health services, and establish safe and supportive environments for students. For example,

• • Advocates for Youthexternal icon and the American Academy of Pediatricsexternal icon provide training, follow-up support, and technical assistance to local education agencies to build their ability to strengthen the effectiveness of sexual health education instructional materials and sexual health services, emphasizing HIV and STD prevention.
  • The National Coalition of STD Directorsexternal icon and Child Trends Incorporatedexternal icon works with state-level leadership teams to assess and coordinate model policy development and implementation at the state and local levels.
  • The American Psychological Associationexternal icon and Children’s Hospital Los Angelesexternal icon work with local education agencies to establish and maintain safe and supportive school environments in schools, especially for youth at highest risk of HIV and STD infections.

• Through its Let’s Stop HIV Together campaign, CDC offers resources about HIV stigma, testing, prevention, and treatment and care. This campaign is part of the Ending the HIV Epidemic initiative.

^a Unless otherwise noted, persons aged 13 to 24 are referred to as youth or young in this web content.
^b HIV diagnoses refers to the number of people who received an HIV diagnosis during a given time period, 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 The term male-to-male sexual contact is used in CDC surveillance systems. It indicates a behavior that transmits HIV infection, not how individuals self-identify in terms of their sexuality. This web content uses the term gay and bisexual men.
^e Includes infections attributed to male-to-male sexual contact and injection drug use (men who reported both risk factors).