HIV and Specific Populations

Yes, children and adolescents are among the people living with HIV in the United States.

• According to the Centers for Disease Control and Prevention (CDC), 87 cases of HIV in children younger than 13 years of age were diagnosed in the United States in 2018.
• CDC reports that youth 13 to 24 years of age accounted for 21% of all new HIV diagnoses in the United States and dependent areas in 2018.

HIV can pass from a mother with HIV to her child during pregnancy, childbirth, or breastfeeding, called perinatal transmission of HIV. In the United States, this is the most common way children under 13 years of age get HIV. Perinatal transmission of HIV is also called mother-to-child transmission of HIV.

The use of HIV medicines and other strategies have helped to lower the rate of perinatal transmission of HIV to 1% or less in the United States and Europe.

To learn more, read the HIVinfo fact sheet Preventing Perinatal Transmission of HIV.

Some adolescents, 13 to 19 years of age, with HIV in the United States acquired the virus as infants through perinatal transmission. But most youth who acquire HIV during adolescence get it through sexual transmission. Many adolescents with HIV do not know they are HIV positive.

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

The following are some factors that put adolescents 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 diseases (STDs).
• High rates of STDs among youth. An STD increases the risk of getting or spreading HIV.
• Alcohol or drug use. Adolescents under the influence of alcohol or drugs may engage in risky behaviors, such as having sex without a condom.

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

Several factors affect HIV treatment in children and adolescents, including a child’s growth and development. For example, because children grow at different rates, dosing of an HIV medicine may depend on a child’s weight rather than their age. Children who are too young to swallow a pill may use HIV medicines that come in liquid form.

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

Several factors can make medication adherence difficult for children and adolescents with HIV. For example, a child may refuse to take an HIV medicine because it tastes unpleasant.

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

The following factors can also affect medication adherence in children and adolescents:

• 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
• A child’s 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 children and adolescents with HIV and their parents or caregivers.

From CDC:

• HIV and Youth
• HIV Surveillance Report, 2018 

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 in During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States:
  • Introduction

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

Yes. According to the Centers for Disease Control and Prevention (CDC), in 2018, 19% of the new HIV diagnoses in the United States and dependent areas were among women. In addition, 57% of women with HIV were Black/African American.

The most common way that women get HIV is through sex with a male partner who has HIV without using a condom. Most women who have HIV know that they are HIV positive, but some women are not getting the HIV care and treatment they need.

HIV is spread through blood, pre-seminal fluids, semen, vaginal fluids, rectal fluids, and breast milk. In the United States, the main risk factors for HIV transmission are the following:

• Having anal or vaginal sex with a person who has HIV without using a condom or taking medicines to prevent or treat HIV. Anal sex is the riskiest type of sex for getting HIV, because the rectum’s lining is thin and may allow HIV to enter the body during anal sex.
• Sharing injection drug equipment (works), such as needles, with a person who has HIV.

In women, several factors can increase the risk of HIV transmission. For example, during vaginal or anal sex, a woman has a greater risk for getting HIV because, in general, receptive sex is riskier than insertive sex. Age-related thinning and dryness of the vagina may also increase the risk of HIV in older women, because these can cause a tear in the vagina during sex and lead to HIV transmission. A woman's risk of HIV can also increase if her partner engages in high-risk behaviors, such as injection drug use or having sex with other partners without using condoms.

Treatment with HIV medicines (called antiretroviral therapy or ART) is recommended for everyone with HIV. Treatment with HIV medicines helps people with HIV live longer, healthier lives. ART also reduces the risk of HIV transmission.

People should start taking HIV medicines as soon as possible after HIV is diagnosed. However, birth control and pregnancy are two issues that can affect HIV treatment in women.

Birth control

Some HIV medicines may reduce the effectiveness of hormonal contraceptives, such as birth control pills, patches, rings, or implants. Women taking certain HIV medicines may have to use an additional or different form of birth control. For more information, view the HIV and Birth Control infographic from HIVinfo.

Pregnancy

Women with HIV take HIV medicines during pregnancy and childbirth to reduce the risk of perinatal transmission of HIV and to protect their own health.

The choice of an HIV treatment regimen to use during pregnancy depends on several factors, including a woman’s current or past use of HIV medicines, other medical conditions she may have, and the results of drug-resistance testing. In general, pregnant women with HIV can use the same HIV treatment regimens recommended for non-pregnant adults—unless the risk of any known side effects to a pregnant woman or her baby outweighs the benefits of a regimen.

Sometimes a woman’s HIV treatment regimen may change during pregnancy. Women and their health care providers should discuss whether any changes need to be made to an HIV treatment regimen during pregnancy.

From CDC:

• HIV and Women
• HIV Transmission
• Ways HIV can be Transmitted

From the Department of Health and Human Services:

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV:
  • HIV and the Older Person
  • Women with HIV
• Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States:
  • General Principles Regarding Use of Antiretroviral Drugs During Pregnancy: Overview
  • Recommendations for Use of Antiretroviral Drugs During Pregnancy: Overview

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

In the United States, gay and bisexual men are the population most affected by HIV. According to the Centers for Disease Control and Prevention (CDC), in 2019, adult and adolescent gay and bisexual men accounted for 69% of the new HIV diagnoses in the United States and dependent areas.

The high percentage of gay and bisexual men who are living with HIV means that, as a group, they have a greater risk of being exposed to HIV.

Other factors may also put gay and bisexual men at risk for HIV infection:

• Anal sex. Most gay and bisexual men get HIV from having anal sex without using condoms or without taking medicines to prevent or treat HIV. Anal sex is the riskiest type of sex for getting HIV or passing it on to others (called HIV transmission).
• Homophobia, stigma, and discrimination. Negative attitudes about homosexuality may discourage gay and bisexual men from getting tested for HIV and finding health care to prevent and treat HIV.

Gay and bisexual men can take the following steps to reduce their risk of HIV infection:

Choose less risky sexual behaviors.
Receptive anal sex is the riskiest type of sex for getting HIV. Insertive anal sex (topping) is less risky for getting HIV than receptive anal sex (bottoming). In general, there is little to no risk of getting or transmitting HIV from oral sex.

Limit your number of sex partners.
The more partners you have, the more likely you are to have a partner with poorly controlled HIV or to have a partner with a sexually transmitted disease (STD). Both factors can increase the risk of HIV transmission.

Use condoms correctly every time you have sex.
Read this CDC fact sheet: External (sometimes called Male) Condom Use.

Consider pre-exposure prophylaxis (PrEP).
Pre-exposure prophylaxis (PrEP) is when people who do not have HIV but who are at risk of getting HIV take HIV medicine every day to reduce their chances of HIV infection. PrEP can be combined with other prevention methods, such as condoms, to reduce the risk of HIV even further. To learn more, read the HIVinfo fact sheet on Pre-Exposure Prophylaxis (PrEP).

Consider post-exposure prophylaxis (PEP).
Post-exposure prophylaxis (PEP) is the use of HIV medicines soon after a possible exposure to HIV to prevent becoming infected with HIV. For example, a person who is HIV negative may use PEP after having sex without a condom with a person who is HIV positive. To be effective, PEP must be started within 72 hours after the possible exposure to HIV. To learn more, read the HIVinfo fact sheet on Post-Exposure Prophylaxis (PEP).

Get tested for HIV.
Whether you test HIV positive or HIV negative, you can take action to protect your health and prevent HIV transmission.

CDC recommends that all sexually active gay and bisexual men get tested for HIV at least once a year. Some sexually active gay and bisexual men (including those who have more than one partner or have had casual sex with people they do not know) may benefit from getting tested more often, for example, every 3 to 6 months.

Visit this CDC webpage to learn more about HIV testing and to find a testing location near you: Let’s Stop HIV Together.

Take HIV medicines every day. Treatment with HIV medicines (called antiretroviral therapy or ART) is recommended for everyone who has HIV. ART cannot cure HIV infection, but it can reduce the amount of HIV in the body (called the viral load).

A main goal of ART is to reduce a person’s viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test. People with HIV whose viral load stays undetectable have effectively no risk of transmitting HIV to an HIV-negative partner through sex. Maintaining an undetectable viral load is also the best way to stay healthy.

Other steps you can take include using condoms during sex and talking to your partner about taking PrEP.

From CDC:

• Gay and Bisexual Men's Health: For Your Health: Recommendations for a Healthier You
• HIV and Gay and Bisexual Men 
• Pre-Exposure Prophylaxis (PrEP)
• Post-Exposure Prophylaxis (PEP)
• HIV Prevention

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

Yes. Anyone can get HIV, including older people. According to the Centers for Disease Control and Prevention (CDC), in 2018, over half of the people in the United States diagnosed with HIV were aged 50 and older.

The number of older people living with HIV is increasing for the following reasons:

• Life-long treatment with HIV medicines (called antiretroviral therapy or ART) is helping people with HIV live longer, healthier lives. Because of effective HIV medicines, there is an increasing number of older people who are living with HIV.
• HIV is newly diagnosed in thousands of people aged 50 and older every year.
  
  

Many risk factors for HIV are the same for people of any age. But like many younger people, older people may not be aware of their HIV risk factors.

In the United States, HIV is spread mainly by:

• Having anal or vaginal sex with someone who has HIV without using a condom or taking medicines to prevent or treat HIV
• Sharing injection drug equipment (works), such as needles, with someone who has HIV

Some age-related factors can put older people at risk for HIV. For example, age-related thinning and dryness of the vagina may increase the risk of HIV in older women. Thinning and dryness of the vagina can cause tear in the vagina during sex and lead to HIV transmission. Older people may also be less likely to use condoms during sex, because they are less concerned about pregnancy.

Talk to your health care provider about your risk of HIV and ways to reduce your risk.

CDC recommends that everyone 13 to 64 years old get tested for HIV, at least once, as part of routine health care, and that people at higher risk of HIV get tested more often. Your health care provider may recommend HIV testing if you are over 64 and at risk for HIV.

For several reasons, older people are less likely to get tested for HIV:

• In general, older people are often considered at low risk of getting HIV. For this reason, health care providers may not always think to test older people for HIV.
• Some older people may be embarrassed or afraid to be tested for HIV.
• In older people, signs of HIV may be mistaken for symptoms of aging or of age-related conditions. Consequently, testing to diagnose the condition may not include HIV testing.

For these reasons, HIV is more likely to be diagnosed at an advanced stage in many older people. Diagnosing HIV at a late stage also means a late start to treatment with HIV medicines and possibly more damage to the immune system.

Ask your health care provider whether HIV testing is right for you. Use these questions from Health.gov to start the conversation: HIV Testing: Questions for the doctor.

Treatment with HIV medicines is recommended for everyone with HIV. As for anyone with HIV, the choice of an HIV treatment regimen for an older person is based on the person’s individual needs.

However, the following factors can complicate HIV treatment in older people.

• Conditions, such as heart disease or cancer, that are more common in older people and require additional medical care.
• Side effects from HIV medicines and other medicines may occur more frequently in older people with HIV than in younger people with HIV.
• The increased risk of drug interactions in an older person taking HIV medicines and medicines for another condition.
• Age-related changes that can affect an older person’s ability to think or remember, which can make it harder to stick to an HIV treatment regimen.

From CDC:

• HIV and Older Americans
• HIV Surveillance Report, 2018
• HIV Testing

From the Department of Health and Human Services:

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV:
  • HIV and the Older Person

From the National Institute on Aging (NIA):

• HIV, AIDS, and Older People

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