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“AIDS is kind of like school violence. You’re like, ‘it can’t happen to me, it can’t happen at our school,’ and that’s the attitude….”37

Adolescent Health Clinic Client, Montefiore Hospital, New York City

Youth in High-Risk Situations

Youth who drop out of school, are sexually abused, run away from home, are incarcerated, are in other out-of-home residential placements, or are homeless, are at a higher risk for HIV infection.26 High rates of early sexual activity, higher incidence of sexual victimization and physical abuse, minimal condom use, and high rates of injection drug abuse all contribute to increased HIV risk for these young people.

Many homeless and runaway youth use injection and other drugs and exchange sex for money, food, or shelter, which lead to even higher rates of HIV infection.27 In fact, some studies of homeless youth have reported infection rates above 10%; and one study of the runaway youth population reported that these young people are 6 to 12 times more likely to become infected with HIV than other youth.28,29

Barriers to Care

Over the years, HIV care providers have struggled to engage and retain vulnerable youth in care. One of the biggest obstacles may be young people’s lack of awareness about the disease and the typical sense of invincibility that many youth have about their health and their exposure to risk. They also have difficulty accessing testing and are more likely to internalize HIV stigma.30,31

Photo of an African-American boy doing his homework at a table.

Young people may internalize HIV stigma more due to the typical feelings of self-consciousness and self-criticism associated with adolescence.

According to the CDC, almost 60% of HIV-positive youth ages 13–24 in 2010 did not even know they were infected, compared to 16% of the general HIV-positive population.32 Although HIV testing is widely available, self-reported rates of HIV testing have remained flat in recent years.33 Approximately 46% of high school students have had sex at least once, yet only 12.7% report ever having had an HIV test.34

There are many challenges that keep teens from getting tested for HIV and knowing their results. Near the top of the list have been issues around transportation to and from testing sites and hours of operation. Many high school students have to be resourceful in finding a testing facility that operates outside of school hours if they don’t want to involve their parents.

In the 1980s and beyond, youth younger than 18 years old had to have permission from their parents to get tested for HIV, which was a major obstacle to knowing their status. According to a report issued by the Guttmacher Institute, the laws have changed significantly around confidentiality of testing and treatment for youth. Now, all 50 states allow most minors to give their own legal consent for treatment of sexually transmitted diseases, with 31 states specifically including HIV.35

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