Risk Factors

Men Who Have Sex with Men (MSM) of all races and ethnicities remain the population most severely affected by HIV. CDC estimates that MSM account for just 2% of the US population, but accounted for 61% of all new HIV infections in 2009. MSM accounted for 49% of people living with HIV infection in 2008 (the most recent year prevalence data are available).

Socioeconomic factors have been shown to influence the incidence of sexually transmitted disease (STD). Age, gender, sexuality, education, poverty, race, unequal access to quality healthcare and prevalence of infection within a community all can affect the risk of contracting an STD.

Black and hispanic Americans are disproportionately affected by HIV. Blacks represent approximately 14% of the US population, but accounted for an estimated 44% of new HIV infections in 2009. Latinos represented 16% of the population but accounted for 20% of new HIV infections in 2009. In the same year, the estimated rate of new HIV infections among black women was 15 times that of white women and over three times that of
Latina women.

Instant Feedback:
Race is a risk factor for HIV infection.

Risk factors are related to the following:

Poverty/socioeconomic factors:
"Poverty is the single most important demographic factor associated with HIV infection among inner-city heterosexuals."* Demming and DiNenno found that the HIV prevalence rates in urban poverty areas are inversely related to annual household income; the lower the income,the greater the HIV prevalence rate. They also found that "the inverse relationship between HIV prevalence and socioeconomic status (SES) was observed for all SES metrics examined (education, annual household income, poverty level, employment, and homeless status)."

Young people continue to be at risk for HIV infection and are becoming HIV infected in increasing numbers. This risk is more pronounced for minority and ethnic youth in the US.
According to CDC’s Youth Risk Behavioral Survey (YRBS), many young people begin having sexual intercourse at early ages: 47% of high school students have had sexual intercourse, and 7.4% of them reported first sexual intercourse before age 13. HIV/AIDS education needs to take place at correspondingly young ages, before young people engage in sexual behaviors that put them at risk for HIV infection.*

Heterosexual transmission:
Heterosexual contact poses a significant risk for women.
Females are at increased risk due to amplified socioeconomic disparities combined with physiologic factors: *

Male circumcision has been shown to significantly reduce the risk of HIV acquisition by men during penile-vaginal sex.

Men having sex with other men (MSM):
MSM represents about 2% of the population but accounted for about 61% of new HIV infections among U.S. males in 2009. Risky behaviors are higher among young MSM than among older MSM. *

Sexually transmitted diseases:
Individuals who are infected with STDs are three to five times more likely than non-infected individuals to acquire HIV, if exposed to the virus through sexual contact. In addition, if an HIV-infected individual is also infected with another STD, that person is 3 to 5 times more likely than other HIV-infected persons, to transmit HIV through sexual contact. In the United States, over 12 million people develop STDs each year, and most of these people are under age 25.

Young people who are homeless or runaways, often engage in substance abuse, which can increase the risk for HIV infection. They may exchange sex for drugs or money, believing this is their only chance of survival on the streets. Homelessness is not just a problem of young people. Studies indicate that between 3-20% of homeless people are infected with HIV, with some subgroups having much higher rates. Also, surveys have indicated that homeless rates for those with HIV/AIDS are increasing. Because people with HIV/AIDS often lose their jobs or are unable to work, many will become homeless at some point.

Substance abuse:
Young people (18-24) who use alcohol, tobacco, or other drugs are more likely to engage in high-risk behaviors, such as unprotected sex, when they are under the influence of drugs or alcohol. Substance abuse is also a risk factor for other age groups. People infected through injection drug use accounted for 19% of all people living with HIV . Sixteen percent of men and 26% of women living with HIV were infected through injection drug use.

Medical procedures/Needlestick injuries:
Medical practices associated with HIV transmission include:

Needlestick injuries are a major concern for people in the healthcare industry. While the risk for HIV transmission from needlestick is low, it is still a significant danger. A study of syringes used to administer medications to people with HIV showed 3.8% had detectable HIV RNA. Moreover, in a study of the viability of the virus in needles, viable HIV was found in 8% at 21 days, when the needles had been stored at room temperature.

HIV positive children becoming adults:
Many children who were infected through perinatal transmission are now becoming young adults, and making decisions about sexual behavior.

Perinatal Transmission:
The number of new perinatal infections each year has steadily declined since 1994. At that time, a zidovudine regimen given prenatally, intrapartum, and to the newborn, was shown to reduce the risk of mother-to-child transmission by two thirds. However, the CDC estimates that between 280-370 neonates continue to be infected every year. Of those infected, 40% were born to mothers whose HIV status at delivery was unknown. CDC recommends universal HIV testing of pregnant women and routine rapid HIV testing using the opt-out approach for all women in labor whose HIV status is unknown.

Instant Feedback:
Women in labor, whose HIV status is unknown, may opt-out of HIV testing.

Severe mental illness:
Adults with severe mental illness have been disproportionately affected by the HIV/AIDS epidemic. Studies have shown that the majority of adults with severe mental disorders are sexually active and many engage in high-risk behaviors, such as unprotected sex, multiple sexual partners, and IV drug use.

Older adults engaging in unsafe sex:
With improvement in health care, and the availability of drugs like Viagra, many older adults are remaining sexually active. Some older males have contact with prostitutes, as well as multiple sexual partners. About 10% of those with AIDS are over age 55 and 1 in 25 cases of AIDS in the U.S. are people 65 years old and older.


Estimated per-act risk for acquisition of HIV

Exposure route
Risk per 10,000 Exposures
Transfusion 1 unit infected blood
Needle-sharing during injection drug use
Percutaneous (needle-stick)
Receptive anal intercourse
Receptive penile-vaginal intercourse
Insertive anal intercourse 6.5
Insertive penile-vaginal intercourse 5
Receptive oral intercourse low
Insertive oral intercourse low
Biting negligible
Spitting negligible
Throwing body fluids (including semen or saliva) negligible
Sharing sex toys negligible

Instant Feedback:
The highest estimated per-act risk for acquisition of HIV involves needle sharing for drug use.

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