What Parents and Providers Need to Know About HIV Risk and Teens

Table of Contents

• Risk Factors
• Teens and Sex
• Young Women of Color in the US
• Alcohol and Drug Use
• Talking to Your Teen about HIV

The average teenager feels as if she or he could not possibly get HIV. Most believe that HIV only happens to other people. However, teens represent a growing share of people getting and living with HIV worldwide. It is important that all teens take HIV seriously, get educated, and be tested if they have sex or use drugs.

Risk Factors

Teens and young adults make up the largest number of HIV cases reported in recent years, and young women account for the majority of young people living with HIV. In many countries, girls and young women have few or no privileges in the economic and social structures of their communities. As a result, they often have less access to HIV testing and treatment as well as to prevention measures, such as condoms and negotiating for safer sex. Moreover, many young women worldwide do not know enough correct information about HIV.

Let's face it – teens are having sex. One of the most common ways HIV is passed among teens is through unprotected sex.

Violence against girls and women also contributes to the number of young women who are living with HIV. In addition, early marriage is still common in many parts of the world. Adolescent girls who marry and become sexually active are more likely to drop out of school, are less able to get and understand important health information, and have greater chances of acquiring HIV. Adolescent girls who get married often marry against their will and marry older men; these older men are more likely to have been exposed to HIV through sexual activity or injection drug use and therefore expose their young brides to HIV.

In the US, young people living with HIV are the age group least likely to have an undetectable viral load. When a person living with HIV takes HIV drugs and their viral load drops to an undetectable level (too few copies of HIV in the blood for tests to measure) for more than six months, they are more likely to stay healthy and cannot transmit HIV to sexual partners.

One of the groups most at risk for acquiring HIV in the US is young gay and bisexual men. Gay and bisexual men who acquire HIV may transmit the virus to women as well as to men.

Gay and bisexual men are particularly at risk for several reasons:

• Larger numbers of gay and bisexual men live with HIV; therefore, they face a greater risk of being exposed to HIV each time they have sex without condoms or treatment-as-prevention methods
• Many gay and bisexual men do not know their HIV status
• Gay and bisexual men who have unprotected anal intercourse  are more likely to transmit HIV than men who have vaginal or oral sex
• Many gay and bisexual men use alcohol and street drugs, which increases their likelihood of sexual behaviors that put them at risk of acquiring HIV
• Young gay and bisexual men may incorrectly believe that HIV is no longer a serious health problem because of advances in treatment
• Social stigma and fear of homosexuality have deep and direct negative effects on the health of gay and bisexual men. Negative cultural messages can lead gay and bisexual men to think poorly about themselves and make unhealthy decisions, including those about sex and substance use. Stigma and discrimination may also make gay and bisexual men less willing to access HIV prevention and care, or may isolate them from family, friends, and other community support networks.

Teens and Sex

Let's face it – teens are having sex. One of the most common ways HIV is passed among teens is through unprotected sex. Teens are less likely to use a condom during vaginal or anal intercourse than adults. This is a key reason why so many new HIV acquisitions occur among youth and young adults.

Most teenagers believe that HIV only happens to other people. However, teens represent a growing share of people getting and living with HIV worldwide.

Not using condoms also puts teens at risk for other sexually transmitted infections or diseases (STIs or STDs). This is especially concerning because having an STI greatly increases a person's chance of getting or transmitting HIV during sex. Regularly using condoms significantly reduces the chances of getting STIs.

Another way to keep teens HIV-negative is Pre-Exposure Prophylaxis (PrEP). This means taking medicine before being exposed to something to prevent getting a disease or condition - in this case HIV. The only pill approved in the US for PrEP for cisgender women, Truvada (tenofovir disoproxil fumarate plus emtricitabine), must be taken regularly to be effective. Descovy (tenofovir alafenamide plus emtricitabine), another pill for PrEP, is approved in the US only for men and transgender women. It must also be taken regularly. Recently, an injectable PrEP medication, Apretude (cabotegravir), was approved in the US. After a start-up period, the shot is given every two months.

PEP stands for Post-Exposure Prophylaxis. It refers to taking HIV drugs for about a month immediately after possible exposure to HIV (e.g., needle-stick, sexual assault, unprotected sex). For PEP to be effective, it must be taken as soon as possible after exposure to HIV — within the first 72 hours if possible.

Young Women of Color in the US

Teens living with HIV come from all different backgrounds, but Black teens are acquiring HIV at much higher rates than white teens. This is especially true for young women. Unlike young men, the vast majority of young women get HIV through heterosexual sex (sex between a male and a female).

Certain factors may put young women at greater risk for sexually transmitted HIV:

• Not being aware of their partners' risk factors
• Lack of power in relationships
• Having sex with older men who are more likely to be living with HIV
• HIV is transmitted from men to women much more easily than from women to men
• Younger women have a less mature genital tract that may be more likely to get tears or abrasions during vaginal intercourse, which put them at risk for acquiring HIV
• A younger woman's cervix (entrance to the womb) is still developing until age 18. A young woman's "immature cervix" has thinner cells that provide less of a barrier to HIV than the cervix of an older, mature woman.

Alcohol and Drug Use

Young people may also use alcohol and drugs. Many teens are curious about drugs and feel pressure from peers to try them. Teens are more likely to engage in high-risk behaviors, such as unprotected sex, when they are under the influence of drugs or alcohol. Young people who run away or are otherwise homeless are at high risk for HIV if they trade sex for drugs or money.

Drug use can also increase the risk of HIV acquisition if needles are shared. This includes using needles for injecting drugs, injecting steroids, piercing the ears and body, and tattooing. For information on how to stay safe while injecting drugs, see our fact sheet on Cleaning Equipment for Injecting Drugs.

Talking to Your Teen about HIV

Teens hear about HIV at school, from friends, and on TV, radio, and the Internet. They generally know some basic information. However, what they know may be incorrect and many teens would like to know more. Teens need accurate, age-appropriate information that includes the following:

• What HIV is and how it is spread
• How to protect themselves
• How and where to get tested for HIV
• Myths about HIV vs. facts
• How to talk with their parents and partners about HIV/AIDS
• How to use a condom correctly
• How to make healthy choices about abstinence or sexual activity

Parents can make a difference. CDC research has shown that it is important for parents to talk early and clearly with their children about sex and values. Ongoing conversations about sex, HIV, STIs, and pregnancy prevention can help teens wait until they are ready to have sex and make responsible decisions about sexual behaviors when they do start having sex. Awareness, education, and communication can reduce the risk of teens acquiring HIV.

So, let's start talking! (See our fact sheet on Talking with Your Children about HIV)

If your teen is living with HIV, see our fact sheet Teens and HIV: The Transition into Adulthood.