High-Risk HIV Behaviors in United States

United States

Human immunodeficiency virus (HIV) attacks the body’s immune system and if left untreated, can progress to the most severe stage of HIV infection known as acquired immunodeficiency syndrome (AIDS). HIV is spread when certain bodily fluids of an HIV-positive person who has a detectable viral load enter the bloodstream of someone without HIV.  

When AIDS occurs, a person’s immune system has been severely damaged and they are more likely to develop infections and cancers. While there is no vaccine or cure for HIV or AIDS, medical therapies can help manage the symptoms. 

People who are HIV-positive can also experience HIV-related stigma, which are negative attitudes or beliefs about people who are HIV-positive. HIV-related stigma can discourage people from getting tested and accessing services, and is also associated with negative health outcomes such as depression.

HIV can infect anyone regardless of age, gender, sexual orientation or race/ethnicity. However, certain behaviors like unprotected sex and needle/syringe sharing put some groups at higher risk than others. 

According to America’s Health Rankings analysis, populations with a higher prevalence of high-risk HIV behaviors include:

• Men compared with women.
• Adults ages 18-44 compared with adults ages 45 and older.
• Multiracial adults compared with Asian and white adults.
• Adults with annual household incomes less than $75,000 compared with adults with incomes of $75,000 or more.
• Adults living in metropolitan areas compared with adults in nonmetropolitan areas. 
• Lesbian, gay, bisexual and queer (LGBQ+) adults compared with straight adults.
• Adults who have difficulty with cognition compared with adults without a disability.
• Adults who have not served compared with those who have served in the U.S. armed forces. 

There are steps people can take to lower their risk of being infected with HIV, including: 

• Abstaining from sex or having fewer sexual partners.
• Using a condom (male or female condom) correctly every time they engage in sexual activity.
• Taking medications such as pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) if they are at high risk of getting HIV through sex or injection drug use. 

Not engaging in injection drug use is the best way to avoid HIV infection from drug use, but if that is not possible, the risk of infection can be lowered by using only clean, sterile needles and not sharing needles with anyone. Many communities have started implementing syringe service programs, such as needle exchanges. These programs provide access to sterile needles, safe disposal of used syringes and connections to other resources, such as treatment programs for substance use disorder and treatment care for HIV. Studies have indicated that needle and syringe programs have been effective at reducing new cases of HIV.

People who are diagnosed with HIV should start taking medicine to treat it as soon as possible. The treatment is called antiretroviral therapy (ART) which works by reducing the amount of HIV present in the body. ART can decrease the amount of HIV in the body so much that it becomes undetectable. At that point, the person has effectively no risk of transmitting HIV to someone who is HIV-negative through sex. 

The Centers for Disease Control and Prevention (CDC) has a tool to help people find HIV prevention services, including condoms, HIV testing, PrEP and PEP in their area.

Healthy People 2030 has several goals related to HIV, including reducing the number of new HIV infections and increasing the proportion of people living with HIV who know their status. 

Additionally, the U.S. Department of Health and Human Services is working on an initiative to reduce new HIV infections by 90% by 2030.

Abdul-Quader, Abu S., Jonathan Feelemyer, Shilpa Modi, Ellen S. Stein, Alya Briceno, Salaam Semaan, Tara Horvath, Gail E. Kennedy, and Don C. Des Jarlais. “Effectiveness of Structural-Level Needle/Syringe Programs to Reduce HCV and HIV Infection Among People Who Inject Drugs: A Systematic Review.” AIDS and Behavior 17, no. 9 (November 2013): 2878–92. https://doi.org/10.1007/s10461-013-0593-y.

Rueda, Sergio, Sanjana Mitra, Shiyi Chen, David Gogolishvili, Jason Globerman, Lori Chambers, Mike Wilson, et al. “Examining the Associations between HIV-Related Stigma and Health Outcomes in People Living with HIV/AIDS: A Series of Meta-Analyses.” BMJ Open 6, no. 7 (July 2016): e011453. https://doi.org/10.1136/bmjopen-2016-011453.