HIV and Specific Populations

Yes. According to the Centers for Disease Control and Prevention, adolescents (13 to 19 years of age) and young adults (20 to 24 years of age) accounted for 19% of the 36,189 HIV diagnoses in the United States and dependent areas in 2021.

Some adolescents and young adults (AYA) with HIV in the United States acquired the virus as infants through perinatal transmission. Most people who acquire HIV during adolescence and young adulthood get it through sexual transmission. Almost half of AYA with HIV do not know they have it.

Several factors make it challenging to prevent AYA from getting HIV. Many AYA lack basic information about HIV and how to protect themselves from HIV.

The following are some factors that put AYA at risk of HIV:

• Low rates of condom use. Always using a condom correctly during sex reduces the risk of HIV and some other sexually transmitted infections (STIs).
• High rates of STIs among youth. An STI increases the risk of getting or spreading HIV.
• Alcohol or drug use. AYA under the influence of alcohol or drugs may engage in risky behaviors, such as having sex without a condom.

PrEP stands for pre-exposure prophylaxis. The word “prophylaxis” means to prevent or control the spread of an infection or disease. The U.S. Food and Drug Administration (FDA) approved an HIV medicine for use as PrEP for adults in 2012. Since then, recognition has been increasing that adolescents at risk for acquiring HIV can benefit from PrEP. In 2018, the FDA first approved an HIV PrEP medicine to include adolescents weighing at least 77 lb (35 kg) who are at risk of acquiring HIV.

PrEP is used by people without HIV who are at high risk of being exposed to HIV through sex or injection drug use. PrEP medicines are not for people that already have HIV.

Two HIV oral medicines (pills) are approved by the FDA for use as PrEP: Truvada and Descovy. To be effective, oral PrEP medicines must be taken consistently each day. The FDA has approved a new, long-acting injectable PrEP medicine: Apretude. It is delivered as an injection once every two months. Likewise, PrEP injections must be taken at the prescribed time to be effective.

To learn more, read the HIVinfo fact sheet Pre-exposure Prophylaxis.

PrEP medications can be prescribed by the pediatrician and are also available through many local health departments. PrEP medications are usually covered by most insurance companies, but uninsured individuals can find free or affordable PrEP through the CDC’s Paying for PrEP webpage.

Legal issues about consent for clinical care, status as a legal minor, and confidentiality are important considerations for providing PrEP medications to adolescents. The legal framework varies considerably by state.

For detailed information about the use of PrEP in adolescents see the CDC’s Preexposure Prophylaxis for Prevention of HIV Acquisition Among Adolescents: Clinical Considerations, 2020.

Treatment with HIV medicines (called antiretroviral therapy or ART) is recommended for everyone with HIV, including AYA. HIV medicines help people with HIV live long, healthy lives and reduce the risk of HIV transmission.

Several factors affect HIV treatment, including growth and development. For example, because adolescents grow at different rates, dosing of an HIV medicine may depend on their weight rather than their age.

Issues that make it difficult to take HIV medicines regularly and exactly as prescribed (called medication adherence) can affect HIV treatment in adolescents. Effective HIV treatment depends on good medication adherence.

Several factors can make medication adherence difficult for AYA with HIV. Negative beliefs and attitudes about HIV (called stigma) can make adherence especially difficult for AYA living with HIV. They may skip medicine doses to hide their HIV-positive status from others.

The following factors can also affect medication adherence:

• A busy schedule that makes it hard to take HIV medicines on time every day.
• Side effects from HIV medicines.
• Issues within a family, such as physical or mental illness, an unstable housing situation, or alcohol or drug abuse.
• Lack of health insurance to cover the cost of HIV medicines.
• Age and developmental stage.

The HIVinfo fact sheet, Following an HIV Treatment Regimen: Steps to Take Before and After Starting HIV Medicines, includes tips on adherence. Some of the tips may be useful to AYA with HIV and their parents or caregivers.

From CDC:

• HIV in the United States by Age
• HIV Surveillance Reports 
• Preexposure Prophylaxis for Prevention of HIV Acquisition Among Adolescents
• HIV Information and Youth

From the Department of Health and Human Services:

• 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 Living with HIV
• Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States:
  •  Introduction
• Pre-Exposure Prophylaxis (PrEP)

Also see the HIV Source collection of HIV links and resources.