Only 1 in 5 sexually experienced U.S. students ever tested for HIV

Progress on decreasing sexual risk behaviors differs by race and gender

Only 22 percent of sexually experienced U.S. high school students have ever been tested for HIV, even though young people account for a disproportionate share of new infections, researchers for the Centers for Disease Control and Prevention will report at the 2014 International AIDS Conference.

Female and black students were more likely to be tested than male students and other racial/ethnic groups, but HIV testing among all groups of adolescents remains low, the CDC analysis found.

“This analysis offers a mixed progress report on sexual risk among U.S. high school students – we’ve seen substantial progress in some areas, but risk persists in others,” said Jonathan Mermin, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention. “It is clear that HIV testing is not reaching everyone who needs it.”

The new analysis provides an in-depth look at trends in sexual risk behaviors among students by race and gender from 1991 to 2013, building upon data released last month on trends in sexual risk behaviors among all U.S. students. Data indicate that areas of progress in reducing sexual risk differ among various groups.

The proportion of black, Hispanic, and female students who have ever had sexual intercourse has declined throughout the 22-year time period, but progress has stalled in this area for white and male students.

Similarly, the analysis noted consistent declines in the proportion of black and Hispanic students who had multiple sexual partners, but found increases among white students since 2009. And following years of increases, condom use has now declined among sexually active female and black students, and stabilized among male, white, and Hispanic students, the researchers found.

“Protecting the health of America’s youth will require action not just from CDC, but also from parents, schools, health care providers, and communities,” Dr. Mermin said.

The new analysis will be presented on July 23 by Laura Kann, Ph.D., at the 20th International AIDS Conference in Melbourne, Australia. It is based on data from CDC’s National Youth Risk Behavior Survey (YRBS), a nationally representative survey, done every other year, of public and private school students in grades 9-12.

Key findings include:

• HIV testing: Since 2005, the proportion of students who had ever had sexual intercourse and had been tested for HIV has remained stable (22 percent in 2013). During 2013, among those who had sexual intercourse, female students were more likely than male students to have been tested (27 percent vs. 18 percent), and black students (28 percent) were more likely to have been tested than white (20 percent) or Hispanic (21 percent) students. CDC recommends that adolescents and adults ages 13-64 years in the United States get tested for HIV at least once as part of routine medical care.
• Ever had sexual intercourse: Overall, the proportion of U.S. high school students who ever had sexual intercourse declined from 1991 (54 percent) to 2001 (46 percent) and has stabilized since that time (47 percent in 2013). The proportion of male students who ever had sexual intercourse declined from 1991 (57 percent) to 1997 (49 percent), and has stabilized since that time (48 percent in 2013), while this percentage has consistently declined among female students since 1991 (from 51 percent to 46 percent). By race/ethnicity, the proportion of black and Hispanic students who ever had sexual intercourse has declined since 1991 (among black students, from 82 to 61 percent and among Hispanic students, from 53 to 49 percent); and, after an initial decline from 1991 to 2003, has stabilized since that time among white students (50 percent in 1991, 42 percent in 2003, and 44 percent in 2013).
• Multiple partners: Overall, the proportion of students who had sexual intercourse with four or more partners during their lifetime decreased from 1991 (19 percent) to 2003 (14 percent) and has stabilized since that time (15 percent in 2013). The proportion who had multiple partners declined among male students from 1991 (23 percent) to 1997 (18 percent), and has since stabilized (17 percent in 2013), while this percentage has declined among female students since 1991 (from 14 percent to 13 percent in 2013). By race/ethnicity, the proportion who had multiple partners declined from 1991 to 2013 among black students (from 43 to 26 percent) and Hispanic students (from 17 to 13 percent); and after an initial decline from 1991 to 2009 among white students (from 15 percent to 10 percent), has increased since that time (to 13 percent in 2013).
• Condom use: Overall, the proportion of sexually active students (students who had sexual intercourse during the three months before the survey) who reported that they or their partner used a condom the last time they had sexual intercourse increased from 1991 (46 percent) to 2003 (63 percent), but has declined since then (to 59 percent in 2013). Condom use among male students increased from 1991 (54 percent) to 2005 (70 percent), but has stabilized (66 percent in 2013). Among female students, condom use increased from 1991 to 2003 (from 38 percent to 57 percent), but has since declined (to 53 percent in 2013). Among black students, condom use increased from 1991 (48 percent) to 1999 (70 percent) but has declined to 65 percent in 2013. After an initial increase, condom use has stabilized among Hispanic and white students (among Hispanic students, from 37 percent in 1991 to 57 percent in 2003 and 58 percent in 2013; among white students, from 46 percent in 1991 to 63 percent in 2005 and 57 percent in 2013).

Despite substantial progress in reducing sexual risk behaviors among black students, including decreases in the proportion of black students who have ever had sex, risk remains higher among these students than among their white and Hispanic counterparts.

“African-American youth have made tremendous strides in protecting themselves. However, they continue to shoulder a disproportionate burden of HIV and STD infections,” said Stephanie Zaza, M.D., M.P.H., director of CDC’s Divis ion of Adolescent and School Health. “It’s important that we build on progress in reducing sexual risk behaviors among African-American students, while working to provide all young people with essential information, skills, and services to protect themselves from HIV and STDs.”

The YRBS does not measure some of the known social and economic determinants of risk behaviors, such as family income and education, so researchers cannot assess the degree to which these factors may account for the higher levels of risk behaviors among African-American youth in this study.

More information is available at www.cdc.gov/nchhstp/newsroom.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES