RISK FACTORS AND BARRIERS TO PREVENTION
Sexual Risk Factors
Early age at sexual initiation.
According to CDC’s Youth Risk Behavioral Survey (YRBS), many young people begin
having sexual intercourse at early ages: 47% of high school students have had
sexual intercourse, and 7.4% of them reported first sexual intercourse before
age 13 [4].
HIV/AIDS education needs to take place at correspondingly young ages, before
young people engage in sexual behaviors that put them at risk for HIV infection.
High school students reporting ever having had sexual intercourse, 2003
Source.
CDC’s Youth Risk Behavioral Survey, 2003 [4].
High school students reporting sexual intercourse for the first time before age
13, 2003
Source.
CDC’s Youth Risk Behavioral Survey, 2003 [4].
Heterosexual transmission.
Young women, especially those of minority races or ethnicities, are increasingly
at risk for HIV infection through heterosexual contact. According to data from a
CDC study of HIV prevalence among disadvantaged youth during the early to
mid-1990s, the rate of HIV prevalence among young women aged 16–21 was 50%
higher than the rate among young men in that age group [5].
African American women in this study were 7 times as likely as white women and 8
times as likely as Hispanic women to be HIV-positive. Young women are at risk
for sexually transmitted HIV for several reasons, including biologic
vulnerability, lack of recognition of their partners’ risk factors, inequality
in relationships, and having sex with older men who are more likely to be
infected with HIV.
MSM.
Young MSM are at high risk for HIV infection, but their risk factors and the
prevention barriers they face differ from those of persons who become infected
through heterosexual contact. According to a CDC study of 5,589 MSM, 55% of
young men (aged 15–22) did not let other people know they were sexually
attracted to men [6].
MSM who do not disclose their sexual orientation are less likely to seek HIV
testing, so if they become infected, they are less likely to know it. Further,
because MSM who do not disclose their sexual orientation are likely to have 1 or
more female sex partners, MSM who become infected may transmit the virus to
women as well as to men. In a small study of African American MSM college
students and nonstudents in North Carolina, the participants had sexual risk
factors for HIV infection, and 20% had a female sex partner during the preceding
12 months [7].
Sexually transmitted diseases (STDs).
The presence of an STD greatly increases a person’s likelihood of acquiring or
transmitting HIV [8].
Some of the highest STD rates in the country are those among young people,
especially young people of minority races and ethnicities [9].
Substance Abuse
Young people in the United States use alcohol, tobacco, and other drugs at high
rates [10].
Both casual and chronic substance users are more likely to engage in high-risk
behaviors, such as unprotected sex, when they are under the influence of drugs
or alcohol [11].
Runaways and other homeless young people are at high risk for HIV infection if
they are exchanging sex for drugs or money.
Lack of Awareness
Research has shown that a large proportion of young people are not concerned
about becoming infected with HIV [12].
Adolescents need accurate, age-appropriate information about HIV infection and
AIDS, including how to talk with their parents or other trusted adults about HIV
and AIDS, how to reduce or eliminate risk factors, how to talk with a potential
partner about risk factors, where to get tested for HIV, how to use a condom
correctly. Information should also include the concept that abstinence is the
only 100% effective way to avoid infection.
Poverty and Out-of-School Youth
Nearly 1 in 4 African Americans and 1 in 5 Hispanics live in poverty [13].
The socioeconomic problems associated with poverty, including lack of access to
high-quality health care, can directly or indirectly increase the risk for HIV
infection [14].
Young people who have dropped out of school are more likely to become sexually
active at younger ages and to fail to use contraception [15].
The Coming of Age of HIV-Positive Children
Many young people who contracted HIV through prenatal transmission are facing
decisions about becoming sexually active. They will require ongoing counseling
and prevention education to ensure that they do not transmit HIV.