Positively Risky: Are Young People Under Threat Of HIV Infection, Without Even Knowing It?

Who gets infected with HIV — human immunodeficiency virus?

The "HIV risk lists" you've seen might, like this one, prominently feature men who have sex with men, IV drug users, women, older people, young people, ethnic minority groups, and people in the criminal justice system, but you've got to admit that the first two groups immediately come to mind for many, and it's easy to miss the fact that youth are especially vulnerable to HIV at all. 

Ignorance isn't bliss! Common misconceptions about HIV among young people that need to die now.

A 2017 Kaiser Family Foundation survey picked the brains of a nationally-representative sample of just under 2,000 young people to find out how today's youth sees HIV/AIDS. The results were concerning. 

• White youth are among the most ignorant groups in the US, when it comes to HIV knowledge. While around half of both Black and Latinx youth report that they're personally concerned about HIV, a grand total of 81 percent of Caucasian young people just aren't worried that they may get HIV. 
• It may not be a surprise that most young people wouldn't feel comfortable with having a HIV+ sexual partner, but a majority also don't want a roommate with HIV, and would feel uncomfortable if someone with the virus prepared food for them. 
• The fact that over a third of young people also (wrongly!) believe that HIV can be spread through contact with common household items like plates, glasses, and toilet seats after they were touched by someone living with HIV explains why many are so concerned about contact with HIV+ people.
• Many young people have heard of antiretroviral treatment, but few know that ART can help prevent the transmission of HIV when someone living with HIV takes the drugs consistently.
• Only 13 percent of youth is informed about PrEP​, a regimen that can go a long way toward preventing HIV transmission when taken by people whose (sex) partners have HIV. 
• Many young people never talk about HIV with anyone, ever. 
• Certainly among the most concerning findings was that more than half of young adults said they had never, ever, been tested for HIV — even though HIV testing is recommended as part of routine healthcare checkups. 

Why are US young people so at risk of HIV?

A dance of different factors makes young people in the United States vulnerable to HIV infection. 

Lacking sex education is an important one — according to the CDC, fewer than half of middle and high schools teach the sex education topics they recommend, leaving young people woefully uniformed about sex, unless they actively seek the information beyond the school gates. The fact that only 46 percent of sexually-active high school students (including a slightly higher 48 percent of gay and bisexual boys) use condoms probably has a lot to do with that lacking sex ed. Skipping condoms definitely has a lot to do with that increased risk of contracting HIV.

So, too, might the fact that a mere nine percent of high school students have ever been tested for HIV (while gay and bisexual male high school students do slightly better, with a rate of 15 percent). Testing doesn't save you from a preexisting HIV infection, of course, but if you already have HIV, knowing about it can certainly prevent you from spreading it to others — both through the use of antiretroviral therapy for you and PrEP for your partner, and through safer sexual practices. 

Drug and alcohol abuse also play a role in increasing HIV rates among young people. While IV drug use, specifically sharing needles, can directly cause HIV through exposure to infected blood, both drug and alcohol use can also create an environment in which unsafe sexual practices thrive. 

Then, there's the fact that many young people who are just discovering their sexuality are... doing a lot of discovering, with a lot of different people. Nearly a quarter of male high school students in the US who had sex with other males had sex with more than four people. The same was estimated to be true for 10 percent of all students across the board. Your risk of HIV goes up with the number of partners you have.

Having older sexual partners, facing social and financial struggles, and being so scared of HIV that you stick your proverbial head in the sand by not getting tested are all factors that facilitate the transmission of HIV among young people, too. 

Basic HIV facts everyone should be aware of

HIV is complex, but the things young people should know to reduce their risk of becoming infected with HIV aren't. Here are some basics everyone should be aware of:

• HIV is spread via contact with very specific bodily fluids — blood, semen and pre-ejaculate, rectal and vaginal fluids, and breast milk. For HIV transmission to occur, there has to be contact with either a mucus membrane (basically your genitals, anus, and mouth) or an open wound (which can be small). 
• Sex is the most common way to get infected with HIV in the US. Receptive anal sex (without a condom) is riskier, but vaginal sex and penetrative anal sex can certainly transmit HIV just fine as well. Sharing needles and syringes is the second most common way to transmit HIV. IV drug use is the most common route here, but sharing things like insulin isn't a good idea, either.
• You may read that HIV cannot be spread through oral sex or French kissing. That's not completely true. This mode of transmission is "only" highly unlikely, but not impossible. HIV is not spread through saliva (spit), but if both partners have small wounds in their mouths, like if they bit their cheeks or have gum disease, blood-to-blood contact and resulting HIV transmission from kissing is theoretically possible. 
• Using condoms greatly reduces your risk of HIV!
• Taking antiretroviral therapy correctly and continuously reduces a HIV+ person's viral load, even sometimes to the point that it's undetectable. When a person's viral load is undetectable, HIV cannot be transmitted. Taking HIV meds properly doesn't just serve the person's health, but also reduces the risk that their sexual partners will be exposed to HIV!
• If you want to have sex with someone living with HIV, talk to your doctor about getting on PrEP​ (pre-exposure prophylaxis) to greatly reduce your risk. 

In conclusion

The rates of HIV in young people are alarming. So are the facts that young people are among the groups least likely to get tested and treated. The good news is that information can arm you against HIV, by allowing you to take important steps to stay safe. The first step is realizing that HIV isn't something that "only happens to other people". By taking it seriously, you can stay ahead of HIV.