Uneven Burden of New HIV Infection in the United States Is Borne by 13–24-Year-Olds
Article first published online: 14 FEB 2013
Copyright © 2013 by the Guttmacher Institute
Perspectives on Sexual and Reproductive Health
Volume 45, Issue 1, pages 56–57, March 2013
How to Cite
(2013), Uneven Burden of New HIV Infection in the United States Is Borne by 13–24-Year-Olds. Perspectives on Sexual and Reproductive Health, 45: 56–57. doi: 10.1363/4505613_2
- Issue published online: 12 MAR 2013
- Article first published online: 14 FEB 2013
A disproportionate number of new HIV infections in the United States occur among young people, particularly those who are black and men who have sex with men, according to the Centers of Disease Control and Prevention (CDC). Nearly 50,000 new cases of HIV occurred in the United States in 2010, of which 26% were among individuals aged 13–24, even though that age-group accounted for only 21% of the U.S. population in 2009. Eighty-three percent of newly infected young people were male, and 57% were black. The vast majority of new infections among young males were attributed to homosexual transmission, whereas the vast majority among young females were attributed to heterosexual transmission. Only 13% of high school students and 35% of 18–24-year-olds have ever undergone HIV testing.
Researchers used data from the National HIV Surveillance System to estimate the prevalence of HIV infection among U.S. youth (defined as 13–24-year-olds) in 2009 and the incidence of new HIV infection among that age-group in 2010. In addition, 2009 and 2011 National Youth Risk Behavior Survey data were used to examine HIV risk behaviors among a sample of U.S. public high school students in 12 states and nine cities, and HIV testing among a nationally representative sample of public and private high school students; data from the 2012 National Health Interview Survey were used to examine HIV testing among a nationally representative sample of 18–24-year-olds.
According to the CDC's findings, an estimated 69.5 per 100,000 Americans aged 13–24 were living with HIV in 2009. HIV prevalence among young people varied by state, from 2.3 to 562.8 per 100,000; in general, rates were highest in the Northeast and South, and lowest in the Midwest and West. Youth accounted for 21% of the U.S. population in 2009 and for 7% of all Americans living with HIV that year.
In 2010, an estimated 48,000 individuals were newly infected with HIV in the United States. Of those, 26% were persons aged 13–24. Males accounted for 83% of new HIV cases among youth; 57% of new infections were among blacks, 20% among Hispanics and 20% among whites. Among young men, 87% of new infections occurred through homosexual contact, 6% heterosexual contact, 2% injection-drug use, and 4% homosexual contact and injection-drug use; among young women, 86% of new infections occurred through heterosexual contact, and 13% injection-drug use.
HIV risk behaviors were more common among young men who had had homosexual contact than among those who had had only heterosexual contact. In analyses of the sample of public high school students, men who had had sex with men were more likely to report having had four or more sexual partners in their lifetime, ever having injected illegal drugs and having used drugs or alcohol before last sex; they were less likely to have used condoms at last sex and to have learned about AIDS or HIV in school.
Overall, HIV testing among youth was uncommon. Only 13% of all U.S. high school students in 2011—15% of females and 13% of males—had ever been tested. Twenty-two percent of students who had ever had sex had been tested; the proportion was higher among females than among males (27% vs. 18%) and among blacks than among Hispanics and whites (32% vs. 20% each). In 2010, 35% of 18–24-year-olds had ever undergone HIV testing; again, testing was more common in females than in males (45% vs. 24%), and in blacks than in Hispanics and whites (53% vs. 36% and 30%, respectively).
The researchers suggest that the disproportionate levels of new HIV infection among blacks and men who have sex with men are at least in part the result of higher HIV prevalence and greater levels of risky behavior among these two groups. They conclude that better adherence to CDC guidelines that recommend routine HIV testing for all persons between the ages of 13 and 64 is needed, especially for males, to “increase early HIV diagnosis and facilitate treatment that improves health and reduces transmission.” In addition, they call for “multicomponent school- and community-based approaches that provide access to condoms, HIV testing and treatment, and behavioral interventions for those at highest risk.”—J. Rosenberg