November 30, 2012
Background: In 2009, 6.7% of the estimated 1.1 million persons living with human immunodeficiency virus (HIV) infection in the United States were youths (defined in this report as persons aged 13-24 years); more than half of youths with HIV (59.5%) were unaware of their infection.
Methods: CDC used National HIV Surveillance System data to estimate, among youths, prevalence rates of diagnosed HIV infection in 2009 and the number of new infections (incidence) in 2010. To assess the prevalence of risk factors and HIV testing among youths, CDC used the 2009 and 2011 Youth Risk Behavior Surveillance System for 9th-12th grade students and the 2010 National Health Interview Survey (NHIS) for persons 18-24 years.
Results: Prevalence of diagnosed HIV was 69.5 per 100,000 youths at the end of 2009. Youths accounted for 12,200 (25.7%) new HIV infections in 2010. Of these, 7,000 (57.4%) were among blacks/African Americans, 2,390 (19.6%) among Hispanics/Latinos, and 2,380 (19.5%) among whites; 8,800 (72.1%) were attributed to male-to-male sexual contact. The percentage of youths tested for HIV overall was 12.9% among high school students and 34.5% among those aged 18-24 years; it was lower among males than females, and lower among whites and Hispanics/Latinos than blacks/African Americans.
Conclusions: A disproportionate number of new HIV infections occurs among youths, especially blacks/African Americans, Hispanics/Latinos, and men who have sex with men (MSM). The percentage of youths tested for HIV, however, was low, particularly among males.
Implications for Public Health: More effort is needed to provide effective school- and community-based interventions to ensure all youths, particularly MSM, have the knowledge, skills, resources, and support necessary to avoid HIV infection. Health-care providers and public health agencies should ensure that youths are tested for HIV and have access to sexual health services, and that HIV-positive youths receive ongoing health-care and prevention services.
The risk for acquiring human immunodeficiency virus (HIV) infection during adolescence and early adulthood starts with initiation of sexual behavior or injection drug use, and initiation of contributing behaviors such as use of alcohol and other drugs. The prevalence of HIV in potential sex partners, the percentage of HIV-infected persons unaware of their status, and the frequency of risky sexual behaviors and injection drug use contribute to the level of risk. In 2009, youths (defined in this report as persons aged 13-24 years), who represented 21% of the U.S. population, comprised 6.7% of persons living with HIV. More than half (59.5%) were unaware of their infection, the highest for any age group.1 All persons need to understand the threat of HIV and how to prevent it.2 Youths, particularly those at highest risk, need effective school-based, school-linked, and community-based interventions3 that make them aware of their risk for HIV and help delay initiation of sexual activity, increase condom use for those who are sexually active, and decrease other behaviors, such as alcohol and drug use, that contribute to HIV risk. This report describes, among youths, 1) rates of those living with a diagnosis of HIV infection at the end of 2009, 2) the estimated number of new HIV infections in 2010, 3) the percentage that have been tested for HIV, and 4) the percentage that engage in selected risk behaviors.
To calculate prevalence per 100,000 by state among persons aged 13-24 years living with diagnosed HIV infection at the end of 2009, and the number of new HIV infections among youths by sex, race/ethnicity, and transmission category* in 2010, data from the National HIV Surveillance System were used.† To describe HIV testing and risk behaviors for persons aged 13-24 years, two data sources were required. First, two components of the Youth Risk Behavior Surveillance System were analyzed. The 2011 National Youth Risk Behavior Survey (YRBS)4 was used to estimate percentages of 9th-12th grade students (predominantly aged 14-17 years) who had ever been tested for HIV (excluding tests performed for blood donations), overall and by sex, race/ethnicity, and sexual behavior.§ To describe HIV risk behaviors among male and female students in grades 9-12 based on the sex of their sexual contacts, CDC combined additional YRBS data from 2009 and 2011 collected by 12 states and nine large urban school districts.¶ Approximately half (48.9%) of all persons aged 13-24 years living with an HIV diagnosis and reported to the National HIV Surveillance System live in these 12 states and nine cities. T-tests were used to test for statistically significant differences (p<0.05) between subgroups. Second, 2010 National Health Interview Survey (NHIS) data were used to calculate the percentages of persons aged 18-24 years who had ever been tested for HIV (excluding tests performed for blood donations) overall and by sex, race/ethnicity, and HIV risk factor.**
At the end of 2009, the prevalence of persons aged 13-24 years living with an HIV diagnosis was 69.5 per 100,000, ranging by state from 2.3 to 562.8 per 100,000 population (Figure 1). Rates were higher in the South and Northeast compared with the West and Midwest.
In 2010, of the estimated 47,500 new HIV infections, 12,200 (25.7%) were among youths (10,100 [82.8%] among males and 2,100 [17.2%] among females). An estimated 7,000 (57.4%) newly infected youths were blacks/African Americans (5,600 males and 1,400 females), 2,390 (19.6%) were Hispanics/Latinos (2,100 males and 290 females), and 2,380 (19.5%) were whites (2,100 males and 280 females) (Figure 2). By transmission category, 72.1% of all new HIV infections among youths were attributed to male-to-male sexual contact, 19.8% to heterosexual contact,†† 4.0% to injection drug use, and 3.7% to male-to-male sexual contact and injection drug use. Among females, 85.7% of infections were attributed to heterosexual contact and 12.9% to injection drug use. Among males, 87.1% of infections were attributed to male-to-male sexual contact, 6.0% to heterosexual contact, 2.2% to injection drug use, and 4.5% to male-to-male sexual contact and injection drug use. Of the 8,800 new infections among youths attributed to male-to-male sexual contact, 4,800 (54.4%) were among blacks/African Americans, 1,900 (21.6%) among Hispanics/Latinos, and 1,800 (20.5%) among whites.
In the 12 states and nine large urban school districts, more risk behaviors were reported by male high school students who had sexual contact with males (i.e., males who had sexual contact with males only or with both males and females [MSM]) compared with males who had sexual contact only with females (Table 1). Among high school students who had had sexual contact, MSM were significantly more likely than other males to have had sexual intercourse with four or more persons during their lifetime (39.4% compared with 26.9%), and to have ever injected any illegal drug (20.4% compared with 2.9%), and were significantly less likely to report having ever been taught in school about acquired immunodeficiency syndrome (AIDS) or HIV infection (74.6% compared with 86.3%). Currently sexually active§§ MSM were significantly more likely than currently sexually active males who had sexual contact only with females to have drunk alcohol or used drugs before last sexual intercourse (38.5% compared with 24.3%) and were significantly less likely to have used a condom during last sexual intercourse (44.3% compared with 70.2%).
In 2011, 12.9% of all 9th-12th grade students had been tested for HIV (Table 2). Of those who ever had sexual intercourse (49.2% of male and 45.6% of female high school students), 22.2% had been tested for HIV. Female students (27.2%) were significantly more likely than male students (17.6%), and black/African American students (32.0%) were significantly more likely than Hispanic/Latino (20.1%) or white (19.6%) students to have been tested for HIV. In 2010, 34.5% of persons aged 18-24 years had ever been tested for HIV (Table 3). Testing among this age group also was higher among females (45.0%) compared with males (24.1%), and higher among blacks/African Americans (53.3%) compared with Hispanics/Latinos (36.2%) or whites (29.8%).
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