HIV and Specific Populations

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HIV and Children and Adolescents

Last Reviewed: April 5, 2019

Key Points

  • HIV can pass from a mother with HIV to her child during pregnancy, childbirth, or breastfeeding (called mother-to-child transmission of HIV). In the United States, the most common way children under 13 years of age get HIV is through mother-to-child transmission of HIV.
  • Most youth who get HIV during adolescence are infected through sex.
  • Because children and adolescents grow and develop differently, dosing of HIV medicines is often based on weight or stage of development instead of age.
  • Medication adherence can be especially difficult for children and adolescents. For example, adolescents may skip HIV medicine doses to hide their HIV-positive status from others.

Does HIV affect children and adolescents?

Yes, children and adolescents are among the people living with HIV in the United States.

  • According to the Centers for Disease Control and Prevention (CDC), 130 cases of HIV in children younger than 13 years of age were reported in the United States in 2016.
  • CDC reports that youth 13 to 24 years of age accounted for 21% of all new HIV diagnoses in the United States in 2016. Most new HIV infections among youth occur among gay and bisexual men, with young black/African American and Hispanic/Latino gay and bisexual men especially affected.

How do most children become infected with HIV?

HIV can pass from a mother with HIV to her child during pregnancy, childbirth, or breastfeeding (called mother-to-child transmission of HIV). In the United States, the most common way children under 13 years of age get HIV is through mother-to-child transmission of HIV.

Fortunately, the use of HIV medicines and other strategies have helped to lower the risk of mother-to-child transmission of HIV to 1% or less in the United States and Europe. The risk of transmission is low when:

  • HIV is detected as early as possible during pregnancy (or before a woman gets pregnant).
  • Women with HIV receive HIV medicines during pregnancy and childbirth and, in certain situations, have a scheduled cesarean delivery (sometimes called a C-section).
  • Babies born to women with HIV receive HIV medicines for 4 to 6 weeks after birth and are not breastfed.

To learn more, read the AIDSinfo Preventing Mother-to-Child Transmission of HIV fact sheet.  

How do adolescents become infected with HIV?

Some of the adolescents with HIV in the United States acquired the virus as infants through mother-to-child transmission. Most youth who get HIV during adolescence are infected through sex. Many adolescents with HIV were recently infected and don’t know that they are HIV positive.

What factors increase the risk of HIV infection in adolescents?

Several factors make it challenging to prevent HIV infection in adolescents. Many adolescents lack basic information about HIV and how to protect themselves from HIV infection.

The following are some factors that put adolescents at risk of HIV infection:

  • Low rates of condom use. Always using a condom correctly during vaginal, anal, or oral sex reduces the risk of HIV infection.
  • High rates of sexually transmitted diseases (STDs) among youth. An STD increases the risk of getting or spreading HIV.
  • Alcohol or drug use. Adolescents under the influence of alcohol or drugs are more likely to engage in risky behaviors, such as having sex without a condom.

Is HIV treatment the same for children and adolescents living with HIV as it is for adults?

The use of HIV medicines to treat HIV infection is called antiretroviral therapy (ART). ART is recommended for everyone with HIV, including children and adolescents. Children and adolescents with HIV are living longer, healthier lives because of HIV medicines.

Many factors influence when someone should start ART and which HIV medicines should be included in a treatment regimen. Growth and development and medication adherence are issues that affect HIV treatment in children and adolescents.

How does growth and development affect the use of ART?

Because children and adolescents grow and develop differently, dosing of HIV medicines is not always based on age. Instead, weight or stage of development is usually used to determine the appropriate dose of an HIV medicine.

Children with HIV may use different forms of HIV medicines than adolescents or adults. For example, some HIV medicines come in a liquid form, which can make it easier for infants and young children to take their medicines.

Why can medication adherence be difficult for children and adolescents?

Medication adherence means taking HIV medicines every day and exactly as prescribed. Effective ART depends on good adherence.

Several factors can make adherence difficult for children and adolescents with HIV. For example, a child may refuse to take an HIV medicine because it tastes unpleasant.

Negative beliefs and attitudes about HIV (called stigma) can make adherence especially difficult for adolescents living with HIV. They may skip medicine doses to hide their HIV-positive status from others.

The following factors can also affect medication adherence in children and adolescents:

  • A busy schedule that makes it hard to take HIV medicines on time every day
  • Side effects from HIV medicines
  • Issues within a family, such as physical or mental illness, an unstable housing situation, or alcohol or drug abuse
  • Lack of health insurance to cover the cost of HIV medicines

The AIDSinfo fact sheet Following an HIV Regimen: Steps to Take Before and After Starting HIV Medicines includes tips on adherence. Some of the tips may be useful to children and adolescents with HIV and their parents or caregivers.

This fact sheet is based on information from the following sources:

From CDC:

From the Department of Health and Human Services:

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