HIV and Specific Populations

Yes. According to the Centers for Disease Control and Prevention (CDC), 53 cases of HIV in children younger than 13 years of age were diagnosed in the United States and 6 dependent areas in 2021. This is less than half of the 105 cases of HIV reported in this age group in 2017. From 2017 through 2020 in the United States and Puerto Rico, 12,569 children born were exposed but did not perinatally acquire HIV.

HIV can pass from a birthing parent with HIV to their 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 sheets Preventing Perinatal Transmission of HIV and Preventing Perinatal Transmission of HIV After Birth.

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

Several factors affect HIV treatment in children, 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. Effective HIV treatment depends on good medication adherence.

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

The following factors can also affect medication adherence in children:

• A busy parental 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 with HIV and their parents or caregivers.

From CDC:

• HIV in the United States by Age
• HIV Surveillance Reports 

From the NIH Office of AIDS Research:

• Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection: 
  • Adherence to Antiretroviral Therapy in Children and Adolescents with HIV
• Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States:
  •  Introduction
• Preventing Perinatal Transmission of HIV
• Preventing Perinatal Transmission of HIV After Birth.

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

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.

Yes. According to the Centers for Disease Control and Prevention (CDC), in 2021, 18% of the new HIV diagnoses in the United States and dependent areas were among women. In addition, 54% of women with HIV are Black/African American.

The most common way that women get HIV is through sex with a male partner who has HIV without using 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 can be transmitted from one person to another through bodily fluids such as 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 long, healthy 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. See the Preventing Perinatal Transmission fact sheet for more information.

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.

PrEP and PEP for women

Pre-exposure prophylaxis (PrEP) is HIV medicine taken to reduce the chances of getting HIV infection. PrEP is used by people who do not have HIV but are at high risk of being exposed to HIV through sex or injection drug use.

There are two PrEP medications approved for use by women and other people who may have receptive vaginal sex (such as some transgender men or nonbinary people):

• Truvada (or a generic equivalent), a pill that is taken by mouth every day.
• Apretude, a shot that is taken every 2 months.

In emergency situations, people can also take post-exposure prophylaxis (PEP). PEP is HIV medicine taken within 72 hours (3 days) to reduce the chances of getting HIV infection after a possible exposure to HIV.

Women should speak with their health care provider to learn about PrEP and PEP and how to protect themselves from HIV. See the Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) fact sheets for more detailed information about PrEP and PEP.

From CDC:

• HIV and Women
• How HIV Spreads
• PrEP Is for Women (PDF)

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:
  • Antepartum Care for Individuals with HIV
  • 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 2021, adult and adolescent gay, bisexual and other men who reported male-to-male sexual contact accounted for 71% of the new HIV diagnoses in the United States and dependent areas.

Factors that put gay and bisexual men at risk for HIV infection:

•  Male-to-male sexual contact. Of all new HIV diagnoses in the United States, 67% were among gay, bisexual, and other men who reported male-to-male sexual contact. This high percentage of all men who have male-to-male sexual contact and have HIV means that, as a group, they have a greater likelihood of being exposed to HIV.
• Having sex without using an HIV prevention strategy. Most gay and bisexual men get HIV from having anal sex without using condoms or without taking medicines to prevent or treat HIV (see PrEP below). 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.
Anal sex is the riskiest type of sex for getting or transmitting HIV. Receptive anal sex (bottoming) is 13 times riskier for getting HIV than insertive anal sex (topping).

In general, oral sex has a low risk of transmitting HIV. However, it is hard to know the exact risk because a lot of people who have oral sex also have anal or vaginal sex. Other sexually transmitted infections (STIs), such as syphilis, herpes, gonorrhea, and chlamydia, can be transmitted during 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 an STI. Both factors can increase the likelihood of HIV transmission. Having an STI may create inflammation or open sores that make it easier for HIV to penetrate your skin. Syphilis, which is especially prevalent among men who have sex with men, can put you at high risk for HIV in the future.

Use condoms correctly every time you have sex.
Read this CDC fact sheet on the proper way to use condoms: Male (External) Condom Use.

Consider pre-exposure prophylaxis (PrEP).
Pre-exposure prophylaxis (PrEP) is HIV medicine taken to reduce the chances of getting HIV infection. PrEP is used by people who do not have HIV but are at high risk of being exposed to HIV. PrEP can be taken as an oral medicine (pills) or delivered as a long-acting injection once every two months. 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 a possible exposure to HIV.

PEP is for emergency situations. It is not a substitute for PrEP or the regular use of other HIV prevention methods.

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, in both cases you can take action to protect your health and prevent HIV transmission.

The CDC recommends that all sexually active gay, bisexual, and other men who have male-to-male sexual contact get tested for HIV at least once a year. However, some sexually active gay and bisexual men (such as 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 as prescribed by your health care provider. 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. Recent studies have shown that delaying treatment can increase the chances that people living with HIV will develop AIDS and other serious illnesses.

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

From CDC:

• HIV Surveillance Report, 2021
• Oral Sex and HIV Risk (PDF)
• HIV and Gay and Bisexual Men 
• Pre-Exposure Prophylaxis (PrEP)
• Post-Exposure Prophylaxis (PEP)
• Preventing HIV

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 2021, roughly 41% of the people in the United States with HIV were at least 55 years old.

As a group, people aged 55 years and older in the United States have the lowest incidence of estimated new HIV infections. Life-long treatment with HIV medicines (called antiretroviral therapy or ART) is helping people with HIV live long, healthy lives. Effective HIV medicines are increasing the number of older people who are living with HIV.

Many risk factors for HIV are the same for people of any age. But like many younger people, older people may not have the knowledge, understanding, or awareness 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 and syringes, 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 small tears 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.

The 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 (for example, every 3 to 6 months). 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 perceived as being at low risk of getting HIV. For this reason, health care providers may not always recommend testing for 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. According to an HIV Surveillance Supplemental Report from CDC, in 2021, 34% of people aged 55 and older in the U.S. already had late-stage HIV (AIDS) when they received a diagnosis. That is, they received a diagnosis later in the course of their disease.

Diagnosing HIV at a late stage also means a late start to treatment with HIV medicines and their benefits and possibly leads to more damage to the immune system. Studies have shown that delaying treatment can increase the chances that people with HIV will develop AIDS and other serious illnesses. Late start to HIV treatment also increases the chance of getting immune reconstitution syndrome, which can cause worsening of some infections when people with HIV and low CD4 cell counts begin taking HIV medicines.

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 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 (cognitive impairment), which can make it harder to stick to an HIV treatment regimen.

From CDC:

• HIV Surveillance Report, 2021
• HIV Surveillance Supplemental Report, 2022
• Getting Tested for HIV

From the NIH Office of AIDS Research:

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

From the NIH National Institute on Aging:

• HIV, AIDS, and Older People

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