The Impact of HIV on Teens and Young Adults

Any teenager who is sexually active should be aware of the risks of HIV and should use preventative strategies to avoid getting this life-altering infection. If you are old enough to have sex, you're old enough to know the facts and to protect yourself (and your partners).

The Impact of HIV in Young People

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 over 12,000 new infections annually—1,000 new infections every month.

Since 60% of infected youth are unaware of their status, they could be 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 prevention, and it starts by breaking down the numbers to understand the risks. In on-going surveillance by the CDC, researchers looked at youth HIV infections in America and were able to determine that:

• Approximately 85% of all youth infections are spread through sexual contact.
• Infections from intravenous drug use run between seven to 12%
• Young males represent around 60% of new infections.
• Of male infections, 75% are among men who have sex with men (MSM).
• Of MSM infections, 37% are African American and 30% 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.

Vulnerabilities That Place Youth at Risk

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 these factors:

• 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.
• 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.
• Among young MSM—whether they identify as gay, bisexual, or neither—there is a high risk of exposure through unprotected anal sex.
• 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 more protective, multi-layered cell structure.
• The social acceptability of young women having sex with older men further compounds the risk of HIV for young women 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 of HIV infection.
• Fear of stigma, abuse, and homophobia send many youths 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 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

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 believes 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.

Practical Approaches to HIV Prevention in Youth

Given the complex, interconnected issues related to HIV and youth, it's clear that a coordinated response is imperative—from a public health standpoint and on 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 that addresses the concerns and issues of each individual.

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. If you have made risky mistakes, carefully try to understand how and why the mistake occurred (alcohol, peer pressure?) and explore strategies to avoid repeating it again.
• Focus on incremental change. It's not about "turning over a whole new leaf," but rather identifying realistic changes you can make to reduce your personal risk and that of your partners'.
• Try to avoid statistics and percentages when discussing HIV, especially when someone has an attitude that differs from yours. To some, a 30% risk of something going wrong is the same thing as a 70% chance that it won't.
• If you have a problem with drugs, alcohol, or depression, deal with that first. Bottom line: there is no real way to make an 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 your kids.
• Remove taboo or any "unmentionable" labels from discussions about sex or drug use. It's better to have someone reach out to you if there's a problem than for them to be isolated because they 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 to 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.