HIV Risk Factors [1]
Many youth initiate sexual activity in their adolescence and engage in sexual risk behaviors that can result in getting HIV, sexually transmitted infections (STIs), and/or becoming pregnant. In addition to risk behaviors, there are a number of environmental and structural factors that put youth at higher risk for getting HIV.
What Puts Youth at Risk for HIV?
Youth who engage in specific behaviors are at higher risk for getting HIV. The following are ways that youth are currently engaging in high-risk behaviors in the United States, according to the Centers for Disease Control and Prevention (CDC) 2015 Youth Risk Behavior Survey (YRBS) [2] and 2014 School Health Policies and Practices Study (SHPPS) [3]:
- Low rates of condom use. Almost half (43%) of high school students reporting sexual intercourse in the previous 3 months (30%) did not use a condom.
- Substance use/abuse and sex. One in five (20%) of sexually active students across the U.S. drank alcohol or used drugs before their last sexual intercourse. Students who were not sure of their sexual identity (45%) were more likely to have drunk alcohol or used drugs before sex, compared to heterosexual students (20%) and gay, lesbian, and bisexual students (22%).
- Multiple sexual partners. Most teenagers do not have multiple sexual partners at one time. Instead they may have multiple sequential partners which can, in turn, put them at higher risk for getting HIV.
- Low perception of risk. Youth have a low perception of risk for getting HIV and therefore may not feel the need to protect themselves.
- Older partners. Young gay and bisexual men are more likely to choose older sex partners than those of their own age, and older partners are more likely to be infected with HIV.
- High rates of STIs. Having an STI puts youth at higher risk of getting and transmitting HIV. [4] In the U.S., there are high rates of STIs among youth, especially among young people of color.
What Contributes to Youth HIV?
In addition to individual behaviors that put youth at higher risk for HIV infection, there are a number of contributing environmental and structural factors that increase the risk of youth getting HIV. According to the 2015 YRBS [5] and 2014 SHPPS [6], these include:
- Inadequate HIV prevention education. Three quarters of health education [7] programs reported teaching how to prevent HIV infection (75%) and STDs (76%), while fewer taught how to find valid information or services related to HIV or HIV testing (65%). Three-quarters (76%) reported teaching abstinence as the most effective method to avoid pregnancy, HIV, and other STIs.
- Limited access to and education about condoms. Fifty percent of high school health education [7]programs taught students how to get condoms. Only 35% taught how to correctly use a condom [8] and, among health services in high schools, only 7% provided free condoms to students.
- Low HIV testing rates. Only 10% of high school students reported ever being tested for HIV [9]. Students who were not sure of their sexual identity (13%) were less likely than gay, lesbian, or bisexual students (18%) to be tested for HIV. This is especially concerning as they were more likely to report sex behaviors that may place them at greater risk (i.e., substance use before sex). Among male students, gay and bisexual students (17%) were more likely to have been tested for HIV than heterosexual students (9%).
- Limited access to HIV counseling, testing, and referral services. Less than half (40%) of schools provided HIV counseling, testing, and referral services at school.
- Feelings of isolation. Gay and bisexual youth may lack support and/or a safe space to seek medical advice in their school environments. A little over a third (38%) of high schools reported having a gay/straight alliance and few (35%) high school health programs provided services specifically for gay, lesbian and bisexual students. Also, some don't tailor their curricula to include information about sexual orientation as it relates to sexual health.
There are other risks associated with youth becoming infected with HIV, including:
- Dating violence and sexual assault can increase the risk of getting HIV. Youth who experience dating violence will have more difficulty negotiating condom use and are not as likely to use condoms and other forms of protection.
- Homelessness. Runaways and homeless youth lack the means to earn enough money to cover their basic needs. It is estimated that there are 320,000 to 400,000 gay and transgender youth who experience homelessness each year. To survive, many homeless youth exchange sex for drugs, money, or shelter, putting them at higher risk of getting HIV.
There are many ways youth can reduce their risk [10] for getting HIV, such as:
- talking with their partner about STIs and HIV
- getting tested with their partner before initiating sexual activity
- using condoms before engaging in sexual activity
- becoming informed about the risks associated with different types of sexual activity and how to use protection
