The Impact of HIV on Teens and Young Adults

Understanding the Risks, Why They Happen, and What You Can Do

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Photo Credit: Kelley Boone

Make no mistake about it, it is great to be young. It's a time in life to explore who you are and what you want to be. It's about taking risks, making mistakes and engaging in the rites of passage that are part of every generation's legacy. It's about grabbing life with both hands, fully and unafraid.

But in the shadow of HIV, have the rules suddenly changed?

The Impact of HIV/AIDS in Young People

On the face of things, the numbers seem to speak for themselves.

According to the Centers for Disease Control and Prevention (CDC), approximately 26% of the 50,000 Americans infected each year with HIV are under the age of 25. That's just over 12,000 new infections annually, or 1,000 new infections every month. Add to that the fact that 60% of infected youth are unaware of their status, and are unknowingly passing the virus on to others.

But the numbers alone barely reflect the true nature of the problem. Addressing the issue of HIV youth prevention is often akin to walking through a socioeconomic house of cards. It touches upon behavioral and sexual issues, biological factors, social influences and a multitude of other factors, each balanced precariously against the next. Tug one issue independently, and the entire structure suffers.

Breaking Down the Numbers

Building an informed strategy is key to overcoming this, and it starts by effectively breaking down the numbers to identify the areas of greatest risk.

In an on-going surveillance by the U.S. Centers for Disease Control, researchers looked at youth infections in America and were able to determine that:

  • approximately 85% of all youth infections are through sexual contact.
  • infections from intravenous drug use run anywhere from 7-12%.
  • young males represent around 60% of new infections.
  • of male infections, 75% are among "men who have sex with men" (or MSM).
  • of MSM infections, 14% are African American and 7% are Latino.
  • African American youth account for more than 50% of new infections.
  • Latinos and African Americans are twice as likely to be infected through IV drug use than whites.

Identifying External Vulnerabilities

But this is not where the issue stops. Underpinning these statistics are a number of other social and clinical factors that increase the likelihood of HIV infection—essentially the "external" forces over which we have little control as individuals. Chief among them:

  • Poverty remains an integral factor in the high rate of infection among poorer communities, where there is inadequate access to public healthcare, services, support, and outreach.
  • Yet while the rate of poverty is eight times greater for African Americans than for whites, it's important to note that the rate of infections among impoverished groups—whether white, Latino or African American—is pretty much the same. Ethnicity plays no part.
  • Mode of transmission plays a major role in the infection rate among young MSM, whether they identify as gay, bisexual or neither. This is due to a number of factors, including the fear of disclosure and the high-risk of exposure through unprotected anal sex.
  • Similarly, young females have greater vulnerability to HIV than older females due to the single-layer columnar cells that line the cervix. (After puberty, these cells are gradually replaced by a thicker, multi-layered cell structure.)
  • The social acceptability of sex with older men further compounds the issue in some cultures, since older men are more likely to be HIV-infected. Both this and biological susceptibility are two of the reasons that young women are often infected at an earlier age than young men.
  • In the U.S., approximately 25% of the reported cases of sexually transmitted diseases (STDs) occur among youth. STDs are directly associated with a higher risk for HIV infection.
  • Fear of stigma, abuse, and homophobia send many youth underground, preventing them from seeking the care and treatment they need. This often leads to depression and substance abuse, which can, in turn, lead to incidences of high-risk sexual behavior.
  • Alcohol and drug use remain a challenge across all groups, lowering inhibitions and blurring judgment. The prevalence of crystal methamphetamine in the gay community, in particular, has been linked to a 250% greater risk of infection.

Youth Attitudes About HIV/AIDS

Yet another challenge in the prevention of HIV is the very attitudes of our youth. In a far-reaching, national survey conducted by the Kaiser Family Foundation, researchers discovered that

  • three out of five respondents stated that delaying sex was "a nice idea, nobody does it."
  • one in six believe that having occasional unprotected sex is "not that big a deal."
  • three in five reported that either they or a partner have had a pregnancy scare.
  • 70% regard birth control methods other than condoms as "practicing safer sex."
  • 50% regard condoms as a sign of mistrust, infidelity or promiscuity.
  • 20% believe that you can tell someone has HIV by looking at them.

What was most telling, perhaps, was that few of the young people surveyed ever engaged in discussions about HIV/AIDS with their sexual partner, despite the fact that more than 75% said that they want more information.

Given the complex, interconnected issues related to HIV and youth, it's clear that a coordinated response is imperative—not only from a public health standpoint but from an individual and interpersonal level. What years of public awareness have taught us is that risk reduction goes well beyond a list of "what-to-do-and-what-not-do." It requires clarity, persistence and an individual-based approach as to the concerns and issues of that person and that person alone.

But let's be honest. There is no way that we, as individuals, can even pretend to overcome issues like poverty and access to care. And there's no guarantee that all the discussion in the world will prevent someone from avoiding every risk all of the time.

In truth, all any of us can really focus on is ourselves and those around us. And it's not so much about setting up warning signs. It's about understanding the nature of risk in all its forms; where it comes from and how it can make us vulnerable.

It's only by "connecting the dots"—discussing risk in relation to attitudes and social influences—that we can truly begin to make informed choice.

What You Can Do to Reduce Risk Now

  • Start by getting the facts about HIV/AIDS, safer sex, birth control, condom use, etc. Educate yourself first, seeking advice and references from trusted, reliable sources.
  • Be clear with yourself from the start that mistakes do happen. Use them to understand how and why the mistake occurred (e.g. alcohol, peer pressure) and explore strategies to avoid repeating it again.
  • Stress incremental change. It's not about "turning over a whole new leaf," but rather identifying realistic changes you can make to reduce personal risk.
  • Try to avoid statistics and percentages when discussing HIV. To some, a 30% risk of something going wrong is the same thing as a 70% chance that it won't.
  • If there is a problem with drugs, alcohol, or depression, deal with that first. Bottom line: there is no real way to make informed judgment until these issues are addressed.
  • As a parent, try to normalize discussions about sex at the earliest age possible. Always aim to be specific, and assess your personal discomfort levels to avoid passing them to you kids.
  • Remove taboo or any "unmentionable" labels from discussions about sex or drug use. It's better to have someone call upon you if there's a problem than fear your reaction if they're in trouble. This is particularly true when it comes to issues of gay or bisexual sex. Regardless of culture or beliefs, it is simply not possible to address risk reduction if anything is "taken off the table."
  • When having a discussion about HIV, try not to grill the person with questions like "Do you…?" or "Did you…?" Instead, keep the conversation open by asking, "What do you understand about…?" or "What are your feelings about…?"
  • When it comes to peer pressure, try to work together to formulate strategies. Young people often state that they succumb to peer pressure simply because "they don't know what to say."
  • Actively engage in HIV education programs at schools and youth centers. Be a "known" resource people can turn to.
  • And finally, the CDC recommends that at-risk youth between the ages of 13-24 be tested for HIV and STDs at least once during the course of a routine exam. Sexually active MSM should be tested at least once annually.


U.S. Centers for Disease Control and Prevention. "HIV incidence among young men who have sex with men - seven U.S. cities, 1994-2000." Morbidity and Mortality Weekly Report. June 1, 2001; 50(21):440-4.

Denning, P. and DiNenno, E. "Communities in Crisis: Is There a Generalized HIV Epidemic in Impoverished Urban Areas of the United States?" XVIII international AIDS Conference, Vienna, 2010.

Hader, S.,MD; Smith, D., MD; Moore, J., PhD, et al. "HIV Infection in Women in the United States." Journal of the American Medical Association. 2001; 285(9):1186-1192.

U.S. Centers for Disease Control and Prevention. "Tracking the hidden epidemics. Trends in STDs in the United States, 2000." Atlanta: US Department of Health and Human Services, CDC; 2000.

Buchacz, K.; McFarland, W.; Kellogg, T., et al. "Amphetamine use is associated with increased HIV incidence among men who have sex with men in San Francisco." AIDS. September 2001; 19(13):1423-1424.

Kaiser Family Foundation. "National Survey of Adolescents and Young Adults: Sexual Health, Knowledge, Attitudes and Experiences." May 19, 2003. Publication 3218

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