HIV and Specific Populations

HIV and Children

  • Key Points

    • Perinatal transmission: 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.
    • HIV treatment: 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.
    • Treatment adherence: HIV medication adherence can be difficult for children. For example, a child may refuse to take HIV medicine because it tastes unpleasant.
  • HIV youth

  • Does HIV affect children and adolescents?

    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.

  • How do most children get 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.

  • What factors affect HIV treatment in children?

    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.

  • Why can medication adherence be difficult for children?

    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.

  • This fact sheet is based on information from the following sources:

    From CDC:

    From the NIH Office of AIDS Research:

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

HIV and Adolescents and Young Adults

  • Key Points

    • Adolescents and young adults (AYA) account for 19% of new HIV diagnoses in the United States.
    • Sexual transmission: Most youth who acquire HIV during adolescence get it through sexual transmission.
    • Preexposure prophylaxis (PrEP): Use of PrEP in AYA at risk for HIV is an important component of HIV prevention, especially considering that 19% of new infections annually occur in people younger than 24 years.
    • Treatment: HIV medicines (known as antiretroviral therapy) is recommended for everyone with HIV, including AYA. HIV medication adherence can be difficult for AYA. For example, they may skip HIV medicine doses to hide their HIV-positive status from others.
  • HIV youth

  • Does HIV affect adolescents and young adults?

    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.

  • How do adolescents and young adults get HIV?

    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.

  • What factors increase the risk of HIV in AYA?

    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.
  • Preexposure prophylaxis (PrEP) for prevention of HIV acquisition among AYA

    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.

  • Can adolescents get PrEP medications?

    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.

  • What factors affect HIV treatment in AYA?

    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.

  • Why can medication adherence be difficult for AYA?

    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.

  • This fact sheet is based on information from the following sources:

    From CDC:

    From the Department of Health and Human Services:

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

HIV and Women (Based on Assigned Sex at Birth)

  • Key Points

    • 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.
    • The most common way that women get HIV is through sex with a male partner who has HIV.
    • Several factors can increase the risk of HIV in women. 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.
    • Women with HIV take HIV medicines during pregnancy and childbirth to prevent perinatal transmission of HIV and to protect their own health.
  • Does HIV affect women?

    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.

  • What factors put women at risk for HIV?

    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.

  • Are there any issues that affect HIV treatment in women?

    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 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.

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

  • This fact sheet is based on information from the following sources:

    From CDC:

    From the Department of Health and Human Services:

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

HIV and Gay and Bisexual Men

  • Key Points

    • In the United States, gay and bisexual men are the population most affected by HIV.
    • The Centers for Disease Control and Prevention (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 may benefit from getting tested more often, for example, every 3 to 6 months.
    • Gay and bisexual men who are HIV negative but at risk of getting HIV should consider pre-exposure prophylaxis (PrEP). 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.
  • Does HIV affect gay and bisexual men?

    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.

    In the United States, gay and bisexual men are the population
    most affected by HIV.
    Ribbons in the red color for HIV awareness and rainbow LGBT colors.
  • What factors put gay and bisexual men at risk for HIV infection?

    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.
  • What steps can gay and bisexual men take to prevent HIV infection?

    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.

  • How often is HIV testing recommended for gay and bisexual men?

    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.

  • How should a gay man living with HIV protect his partner from HIV?

    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.

HIV and Older People

  • Key Points

    • 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.
    • Many HIV risk factors are the same for people of any age, but older people are less likely to get tested for HIV.
    • Treatment with HIV medicines (called antiretroviral therapy or ART) 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.
    • Many older people have conditions, such as heart disease or cancer, that can complicate HIV treatment.
  • Does HIV affect older people?

    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.

      Older adults are living longer with HIV
  • Do older people have the same risk factors for HIV as younger people?

    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.

  • Should older people get tested for HIV?

    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.

  • Are there any issues that affect HIV treatment in older people?

    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.