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Sexual Behaviors and Health

 
The STD-HIV Connection
Having an STD increases the odds of acquiring HIV. STDs cause sores and inflammation, making it easier for HIV to enter the body. STD treatment will not prevent or treat HIV, but will make HIV transmission less likely.

HIV/AIDS

Rates of HIV infection have stabilized for many groups, and symptoms can now be managed effectively for those with access to care. However, in some communities the support youth need to stay healthy and free from infection is inadequate. Youth continue to bear a disproportionate burden of new HIV/AIDS infections.

On this page we provide a brief overview of HIV/AIDS with a focus on youth. For more detail, see the slide set HIV Basics for Health Educators and the presentation series HIV/AIDS and Young People.

What is HIV/AIDS?

Human Immunodeficiency Virus (HIV) is a virus that attacks and destroys cells that fight infection (CD4 cells). The virus rapidly copies itself, increasing the body's viral load and decreasing CD4 "helper" cells. If HIV treatment is not begun in time and maintained adequately, the immune system becomes so compromised that the body is not able to defend against other infectious diseases and cancers. These "opportunistic infections" signal Acquired Immunodeficiency Syndrome (AIDS), the late stage of HIV infection, which leads to death. High concentrations of HIV are found in blood, semen, vaginal secretions, breast milk, and amniotic fluid, among other internal body fluids. A person can contract HIV in a number of ways: Transmission does not occur through tears, nasal secretions, saliva, sputum, perspiration, urine, feces, or vomit.

Prevalence and Risk

In 2014, the rate of HIV infection among teens was estimated to be 6.3 per 100,000 (8.0 in New York State). Among adolescents and young adults, certain groups are at particularly high risk:
  • Young men who have sex with men are at higher risk than other groups. Male-to-male sexual contact is the highest transmission category among youth age 13-24, and accounted for 92% of diagnoses among teen boys in 2014.
     
  • Young black men and women are also disproportionately at risk. Compared to other racial/ethnic groups, most HIV diagnoses in 2014 were among black youth (55% of all infections among youth age 13-24).
     
  • Transgender youth are among the groups at highest risk for HIV infection. There are many reasons for this, most of which originate in stigma and discrimination. For example, trans youth may not have family support, leading to homelessness, limited access to health care, and in some cases survival sex work.
     
  • Homeless youth are at increased risk of HIV infection. Gay, bisexual, and transgender teens are more likely to be homeless, compounding their risk. Being homeless may also drive young people to exchange sex for money or shelter, making them especially vulnerable.
Prevalence is lower among women (with the exception of transgender women). Among teens with an HIV diagnosis, 81% are male and 19% are female. Most HIV-positive women were infected through heterosexual sex.

Prevention

Adolescents have increased susceptibility to HIV because of factors relating to poverty, lack of access to health care, lower levels of education, high rates of sexually transmitted diseases (STDs), and undeveloped prevention skills. Many youth are unaware of their level of risk: The CDC estimates that half of HIV-positive youth do not know they are infected. Some of these issues can be addressed through coordinated community efforts that attend to risk and protective factors for adolescent sexual health.

Individuals can lower their risk of acquiring or transmitting HIV by:

  • Using condoms correctly every time
  • Using condoms and dental dams for oral sex
  • Obtaining the HPV vaccination
  • Practicing mutual monogamy
  • Reducing the number of sex partners
  • Avoiding drugs and alcohol, which can impair sexual decision making
  • Using a water-based lubricant with condoms (to decrease the chance that the condom will break)
  • Avoiding sex with anyone who has symptoms of an STD
  • Avoiding sex with anyone who uses IV drugs
  • Regular STD screening for all partners
  • Pre-exposure prophylaxis for HIV (PrEP)
  • Post-exposure prophylaxis (PEP)
  • If HIV-positive, taking antiretroviral drugs during pregnancy, labor, and delivery
The preventive drug protocols PrEP and PEP may be appropriate in certain cases. For more information, visit CDC: HIV/AIDS - PrEP and CDC: HIV/AIDS - PEP, as well as HIV Basics for Educators, slides 36-45 (includes New York State information).

Screening

An HIV test is recommended for anyone who has:
  • Had sex with someone who is HIV-positive or whose status is unknown since their last HIV test
  • Injected drugs (including steroids, hormones, silicone) and shared needles and syringes with others
  • Exchanged sex for drugs, shelter, money
  • Been diagnosed with or sought treatment for a sexually transmitted disease
  • Been diagnosed with or sought treatment for hepatitis or tuberculosis
  • Had sex with someone who could answer "yes" to any of the above questions or someone whose history they don't know
Deciding when to get tested depends on when the exposure may have occurred and which test is used. Most tests look for antibodies against HIV in the blood. Because antibodies are not immediately detectable, there is a window period of about 3-8 weeks or more between infection and a positive test. Repeat testing is often recommended. For more information, visit CDC: HIV/AIDS - Testing.

Treatment

There is no cure for HIV. When started in time, medications extend the lives of people who are HIV-positive and may also decrease the chance that they will infect partners. HIV is treated using a combination of drugs that must be taken following a strict protocol. For more information, visit AIDS.gov: Overview of HIV Treatments.

Resources

AIDS.gov: HIV/AIDS Basics

Centers for Disease Control and Prevention: Get Tested (enter zip code to locate testing site)

New York State Department of Health: AIDS Institute

It's Your (Sex) Life: STDs & Testing - HIV/AIDS FAQs

References

Centers for Disease Control and Prevention. (2015, June 30). HIV Among Youth.

Centers for Disease Control and Prevention. (2016). Slide Sets: HIV Surveillance in Adolescents and Young Adults.

Starr, T. (2015). HIV Basics for Health Educators.

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