ADVOCATES FOR YOUTH

The Facts

Young People and HIV

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Young people in the United States continue to be at risk for HIV and AIDS. At the end of 2006, in 45 states with reporting, almost 46,000 young people ages 13-24 were living with HIV, comprising about sixteen percent of all HIV infections.[1] But experts believe young people may suffer from up to 30 percent of all cases of HIV in the United States.[2] Youth of color and young men who have sex with men continue to be most at risk. It is important to promote programs that seek to lessen risky sexual behaviors by encouraging condom use, delay in sexual initiation, partner reduction, and early HIV testing and treatment. But research has shown that even when risk factors are equal, minority youth are more at risk for HIV. Research and resources must be directed toward addressing the underlying social forces that contribute to these disparities.

HIV among Young People 13-24 in the United States: Racial and Sexual Minority Youth Are at Greatly Disproportionate Risk

• From 2001-2004, 62 percent of HIV/AIDS diagnoses in young people aged 13-24 were in males, and 32 percent were in females.[3]
• In 2005, blacks and Latinos accounted for 84 percent of all new HIV infections among 13- to 19-year-olds and 76 percent of HIV infections among 20- to 24-year-olds in the United States even though, together, they represent only about 32 percent of people these ages. Asian and Pacific Islanders (APIs) and American Indians and Alaska Natives account for about one percent of new HIV infections among women ages 13-24.
• Young women of color suffer disproportionate rates - in 2004, black women and Latinas accounted for 83 percent of new infections in 13- to 24-year-old women in the United States, even though, together, they represent only about 26 percent of U.S. women these ages. In addition, black women account for 62 percent and Latinas for 19 percent of cumulative AIDS cases among women ages 13-24.[4]
• Most young men who have HIV acquired it through male-to-male sexual contact, and the risk is increasing for young men who have sex with men. Between 2001 and 2005, HIV/AIDS cases among young men ages 13-24 who have sex with men increased across all ethnic groups, with young African American/Black men worst affected.[5]
  • Sixty-four percent of the HIV/AIDS cases in young men ages 13-24 through 2005 were transmitted through male-to-male contact.[5]
  • Fifty-seven percent of HIV/AIDS infections among young men who have sex with men were in African Americans/Blacks; 18 percent in Hispanics; and 23 percent in whites.[5]
  • From 2001-2005, cases of HIV/AIDS among young black men who have sex with men increased by 74 percent.[5]

Sexual Risk Behaviors Put Many Young People In Danger

• From 2001 to 2005, the percentage of high school students reporting that they had ever had sexual intercourse increased among black (61 percent to 68 percent) and Latino/Hispanic students (48 percent to 51 percent). There was no significant increase for white students.[6]
• In 2005, the percentage of high school students reporting that they had sexual intercourse with four or more people during their life was highest among black students (28 percent). Sixteen percent of Latino students reported having 4 or more partners, and 11 percent of white students.[6]
• Among sexually active high school students in 2005, 63 percent reported using a condom at most recent sex. Male students were significantly more likely to report condom use than female students (70 percent versus 56 percent, respectively). Black students (69 percent) were significantly more likely than white or Latino/Hispanic students (63 and 58 percent, respectively) to report condom use. This significant racial/ethnic difference held for both male and female students.[6]
• Research has shown that many young people are not concerned about becoming infected with HIV.[7] In addition, young people experience many barriers to HIV testing and are more likely than other population groups to not get tested for HIV.[8]
• In addition, many people are unaware of their HIV status. Nationwide, only 12 percent of students have been tested for HIV.[6] A study in 6 major cities found that among 15- to 22-year-old MSM in the United States,about three quarters of those testing positive for HIV were unaware they had the virus, and black MSM had nearly 7 times greater odds of having unrecognized HIV infection as white men.[9]
• Concurrent partnerships (multiple simultaneous sexual relationships or sexual relationships that overlap in time) put many young people at greater risk for HIV infection.[10]

Factors Which Contribute to Unequal Risk for HIV/AIDS

• Increasingly, scientists recognize sexual networks, or connections between people living in the same community, as a driving force behind the HIV epidemic, especially for African Americans. Young people living in communities with high HIV prevalence are more at risk for HIV even if risk behaviors are the same as young people living in a community with lower HIV prevalence.[11,12]
• Dating violence and sexual assault play a role in HIV transmission. Twenty percent of youth report experiencing dating violence. Women who experience dating violence are less likely to use condoms and feel more uncomfortable negotiating condom use. In one study, half of girls who reported HIV or STIs had been physically or sexually abused.[13,14,15]
• A recent study among black women in the South, a region with unusually high rates of HIV, concluded that socioeconomic factors, including financial dependence on male partners, feeling invincible, and low self-esteem, place young black women at risk for HIV/AIDS.[16]
• Having an STI (sexually transmitted infection) puts youth more at risk for HIV.[17] Almost half of the U.S.’s over 19 million STI infections each year occur in youth ages 15-24.[18] A recent study found that one in four young women ages 15-19 has an STI.[19]

Effective Strategies for HIV Prevention Among Young People

No single strategy will work to reduce HIV/AIDS infection among young people. However, research has shown that culturally competent, honest programs, that include information about abstinence, contraception, and condoms, can be effective in helping youth reduce risk behaviors.[20,21] In addition, open and honest parent-child communication about HIV and its prevention can aid youth in making good decisions.[22,23] Finally, resources must be directed at understanding the epidemic’s impact on youth; at remedying the socioeconomic disparities which contribute to the epidemic; and at developing and testing a vaccine.

References

1. HIV/AIDS Surveillance: General Epidemiology (Through 2006). Centers for Disease Control and Prevention, 2008. Accessed from http://www.cdc.gov/hiv/topics/surveillance/resources/slides/general/slides/general.pdf on 4/1/08.
2. Morris, M., Handcock, M.S., Miller W.C., Ford, C.A. Schmitz, J.L., Hobbs, M.M., Cohen, M.S., Harris K.M., Udry J.R. Prevalence of HIV Infection Among Young Adults in the United States: Results from the Add Health Study. American Journal of Public Health. 2006 June: 96(6): 1091-1097.
3. HIV/AIDS Surveillance in Adolescents and Young Adults (Through 2005). Cemters For Disease Control and Prevention, 2008.Accessed from http://www.cdc.gov/hiv/topics/surveillance/resources/slides/adolescents/slides/Adolescents.pdf on 4/1/08.
4. Cases of HIV Infection and AIDS in the United States, by Race/Ethnicity, 2000-2004. HIV/AIDS Surveillance Supplemental Report, 2006: 12(1). Accessed from http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2006supp_vol12no1/table2.htm on 4/1/08.
5. HIV/AIDS Surveillance in Men who have Sex with Men. Centers for Disease Control and Prevention, 2008. Accessed from http://www.cdc.gov/hiv/topics/surveillance/resources/slides/msm/slides/msm.pdf on 4/1/2008.
6. Eaton DK et al. Youth risk behavior surveillance, United States, 2005. Morbidity & Mortality Weekly Report 2006;55(SS-5):1–108.
7. Kaiser Family Foundation. National Survey of Teens on HIV/AIDS, 2000.
8. Henry-Reid, L.M., Rodriquez F, Bell, M.A. et al. Youth counseled for HIV testing in school-and hospital-based clinics. JAMA 1998; 90:287-92
9. MacKellar, D. et al, Unrecognized HIV infection, risk behaviors, and perception of risk among young men who have sex with me: opportunities for advancing HIV prevention in the third decade of HIV/AIDS. Journal of AIDS, Vol.38, No.5, 2005.
10. Gorback, P.M., Drumright L.N., Holmes K.K., Discord, discordance, and concurrency: comparing individual and partnership-level analyses of new partnerships of young adults at risk of sexually transmitted infections. Sexual Transmitted Diseases. 2005 January; 32(1):7-12.
11. Millett et al. Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors. AIDS 21 (15) 2083-2091.
12. Adimora et al. HIV and African Americans in the Southern United States: Sexual Networks and Social Context. Sexually Transmitted Diseases 2006: 33 (7 suppl): S39-45.
13. Roberts TA, Klein J. Intimate Partner Abuse and High-Risk Behavior in Adolescents. Archives of Pediatrics & Adolescent Medicine 2003; 157:375-380.
14. Silverman JG, Raj A, Clements K. Dating Violence and Associated Sexual Risk and Pregnancy Among Adolescent Girls in the United States. Pediatrics 2004;114(2):e220-e225.
15. Decker et al. Dating Violence and Sexually Transmitted Disease/HIV Testing and Diagnosis Among Adolescent Females. Pediatrics 2005; 116 (2): e272-276
16. CDC. HIV Transmission among Black Women – North Carolina, 2004. MMWR 2005; 54(4); 89-92.
17. The Role of STD Detection and Treatment in HIV Prevention – CDC Fact Sheet, Centers for Disease Control and Prevention. Accessed from http://www.cdc.gov/std/HIV/STDFact-STD&HIV.htm on 4/1/08.
18. Centers for Disease Control and Prevention. Trends in Reportable Sexually Transmitted Diseases in the United States, 2006. Accessed from http://www.cdc.gov/std/stats/trends2006.htm on 4/1/08.
19. Centers for Disease Control and Prevention. Oral Abstract D4a – Prevalence of Sexually Transmitted Infections and Bacterial Vaginosis among Female Adolescents in the United States: Data from the National Health and Nutritional Examination Survey (NHANES) 2003-2004. 2008 National STD Prevention Conference. Accessed from http://www.cdc.gov/stdconference/2008/media/summaries-11march2008.htm#tues1 on 4/1/08.
20. Kirby D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Infections. Washington, DC: National Campaign to Prevent Teen Pregnancy, 2007.
21. Alford S. Science and Success, Second Edition: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Washington, DC: Advocates for Youth, 2008.
22. Resnick MD et al. Protecting adolescents from harm: findings from the national longitudinal study on adolescent health. JAMA 1997; 278:823-32.
23. Miller KS et al. Patterns of condom use among adolescents: the impact of mother-adolescent communication. Am J Public Health 1998; 88:1542-44.
    

Written by Jennifer Augustine, MPH, and Emily Bridges, MLS
2008 © Advocates for Youth

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