HIV and Adolescents and Young Adults

HIV Statistics in the United States

According to the Centers for Disease Control and Prevention (CDC):

·       Adolescents (13–19 years) and young adults (20–24 years) accounted for 28,087 people (3%) of all individuals living with HIV in the United States.

·       In 2022, adolescents and young adults represented 7,099 (19%) of the 37,981 new HIV diagnoses in the U.S. and dependent areas.

·       This means nearly 1 in 5 new HIV diagnoses occurred among individuals aged 13 to 24 years.

How Do Adolescents and Young Adults Get HIV?

·       Some AYA acquired HIV at birth through perinatal transmission.

·       However, most AYA acquire HIV through sexual transmission.

By gender and exposure type:

·       Most male AYA diagnosed with HIV acquired it through male-to-male sexual contact.

·       Most female AYA diagnosed with HIV acquired it through heterosexual contact.

Factors That Increase HIV Risk in AYA

Several factors contribute to higher HIV risk among adolescents and young adults:

·       Limited knowledge about HIV
Understanding prevention, testing, and treatment helps reduce transmission.

·       Low condom use
Consistent and correct condom use lowers the risk of HIV and other STIs.

·       High rates of sexually transmitted infections (STIs)
Having an STI increases the risk of acquiring or transmitting HIV.

·       Alcohol or drug use
Substance use may lead to unsafe sexual behaviors.

·       Injection drug use
Sharing needles or drug equipment can transmit HIV through blood exposure.

About 44% of AYA with HIV are unaware of their status, and 34% of diagnosed AYA are not virally suppressed, creating additional prevention challenges.

How Can PrEP Benefit Adolescents and Young Adults?

Pre-Exposure Prophylaxis (PrEP) is a powerful HIV prevention option for adolescents and young adults at risk.

·       PrEP is used by HIV-negative individuals who are at high risk through sex or injection drug use.

·       It is not for people who already have HIV.

·       In 2018, the FDA approved PrEP for adolescents weighing at least 77 lb (35 kg).

PrEP use trends:

·       PrEP use among eligible AYA increased from 8% in 2017 to 20% in 2021.

·       However, Black and Hispanic individuals were less likely to use PrEP compared to White individuals.

Currently, three HIV medicines are FDA-approved for PrEP.

Can Adolescents Access PrEP?

Yes. PrEP can be accessed through:

·       Pediatricians

·       Local health departments

·       Community health clinics

Cost and coverage:

·       Most insurance plans cover PrEP.

·       Uninsured individuals may access free or low-cost PrEP through CDC-supported programs.

Important considerations:

·       Consent, confidentiality, and legal status vary by state for individuals under 18.

·       Providers must follow state-specific laws when prescribing PrEP to minors.

HIV Treatment for Adolescents and Young Adults

·       Antiretroviral therapy (ART) is recommended for everyone with HIV, including AYA.

·       ART helps individuals live long, healthy lives and reduces HIV transmission.

Treatment considerations for AYA:

·       Medication dosing may depend on body weight, not age.

·       Growth and development affect treatment planning.

·       Medication adherence is critical for successful treatment.

Why Is Medication Adherence Challenging for AYA?

Several factors may make it difficult for adolescents and young adults to take HIV medicines consistently:

·       HIV-related stigma and fear of disclosure

·       Busy daily schedules

·       Medication side effects

·       Family challenges (housing instability, illness, substance use)

·       Lack of health insurance

·       Dependence on caregivers for medications and appointments

Support, education, and counseling can significantly improve adherence and outcomes.

This fact sheet is based on information from the following sources:

From CDC:

• Estimated HIV Incidence and Prevalence
• HIV Incidence and Prevalence
• HIV Surveillance Reports
• Preexposure Prophylaxis for Prevention of HIV Acquisition Among Adolescents

From the HIV Clinical Practice Guidelines at Clinicalinfo.HIV.gov:

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV:
  • Adolescents and Young Adults With HIV
• Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection:
  • Adherence to Antiretroviral Therapy in Children and Adolescents With HIV

This article and accompanying image are adapted from the NIH HIVinfo fact sheet “HIV and Adolescents and Young Adults” published on HIVinfo.nih.gov, a U.S. government resource providing trusted information about HIV.