Young People at Risk: HIV/AIDS Among America's Youth

In the United States, HIV-related death has the greatest impact on young and middle-aged adults, particularly racial and ethnic minorities. In 1999, HIV was the fifth leading cause of death for Americans between the ages of 25 and 44. Among African-American men in this age group, HIV infection has been the leading cause of death since 1991. In 1999, among black women 25-44 years old, HIV infection was the third leading cause of death. Many of these young adults likely were infected in their teens and twenties. It has been estimated that at least half of all new HIV infections in the United States are among people under 25, and the majority of young people are infected sexually (Rosenberg PS, Biggar RJ, Goedert JJ. Declining age at HIV infection in the United States [letter]. New Engl J Med 1994;330:789-90).

In 2000, 1,688 young people (ages 13 to 24) were reported with AIDS, bringing the cumulative total to 31,293 cases of AIDS in this age group. Among young men aged 13- to 24-years, 49% of all AIDS cases reported in 2000 were among men who have sex with men (MSM); 10% were among injection drug users (IDUs); and 9% were among young men infected heterosexually. In 2000, among young women the same age, 45% of all AIDS cases reported were acquired heterosexually and 11% were acquired through injection drug use. Among both males and females in this age group, the proportion of cases with exposure risk not reported or identified (26% for males and 43% for females) will decrease and the proportion of cases attributed to sexual contact and injection drug use will increase as follow-up investigations are completed and cases are reclassified into these categories.

Surveillance data analyzed from 25 states with integrated HIV and AIDS reporting systems for the period between January 1996 and June 1999 indicate that young people (aged 13 to 24) accounted for a much greater proportion of HIV (13%) than AIDS cases (3%). These data also show that even though AIDS incidence (the number of new cases diagnosed during a given time period, usually a year) is declining, there has not been a comparable decline in the number of newly diagnosed HIV cases among youth.

Scientists believe that cases of HIV infection diagnosed among 13- to 24-year-olds are indicative of overall trends in HIV incidence (the number of new infections in a given time period, usually a year) because this age group has more recently initiated high-risk behaviors. Females made up nearly half (47%) of HIV cases in this age group reported from the 34 areas with confidential HIV reporting for adults and adolescents in 2000—and in young people between the ages of 13 and 19, a much greater proportion of HIV infections was reported among females (61%) than among males (39%). Cumulatively, young African-Americans are most heavily affected, accounting for 56% of all HIV cases ever reported among 13- to 24-year-olds in these 34 areas.