Survey Results Point to Gaps in HIV Knowledge and Awareness Among Young Americans

World AIDS Day is right around the corner, but data from a new survey show insufficient knowledge of HIV transmission and general confusion about the virus among young people in the United States.

The data were collected from a first-of-its-kind survey that was performed as part of a new campaign called Owning HIV: Young Adults and the Fight Ahead, which was launched by Merck and the Prevention Access Campaign.

The survey was designed to provide more information on beliefs and perceptions toward HIV among Generation Z and millennials in the United States. These populations were selected because, although new diagnoses of HIV remained stable between 2012-16, incidence increased for individuals aged 25 to 29 years. At this point, young people now account for a majority of new HIV diagnoses.

Between June 17 and August 5, 2019, the Kantar Group conducted the 1-time online survey of Generation Z (18-22 years) and millennials (23-36 years). Respondents included 1596 individuals who self-reported as diagnosed (living with HIV) or HIV-negative. Participants included Black/African American, Hispanic/Latinx, gay, bisexual, transgender, and straight individuals.

When asked about awareness of HIV, 41% (42 of 103) HIV-negative Generation Z respondents said they were either not at all or only somewhat informed about the virus, compared with 23% (169 of 743) of HIV-negative millennials. Based on this, campaign organizers are concerned that younger generations could be generally less informed about HIV.

Respondents were also questioned about sexual health behaviors. According to the survey results, 67% (564 of 846) of HIV-negative participants reported HIV was more concerning than other sexually transmitted infections. However, 54% (456 of 846) of participants did not report using condoms or pre-exposure prophylaxis (PrEP).

This demonstrates a startling point, as 75% (482 of 623) of millennial respondents and 60% (76 of 127) of Generation Z participants living with HIV reported contracting HIV through sex without condoms or PrEP.

Survey results indicate that incidence of HIV acquisition from sex without condoms or PrEP use was higher among millennial Hispanic/Latinx (84%, 112 of 133), Black/African American (79%, 140 of 178), and men who have sex with men (80%, 289 of 362).

In addition to assessing HIV knowledge and sexual health behavior, the survey also explored the topics of HIV stigma and undetectable equals untransmittable (U=U). In general, the results indicate that stigma continues to persist among this population and impacts how young Americans living with HIV are being treated.

In fact, more than 28% (209 of 743) of HIV-negative millennials said they have avoided contact such as hugging or befriending an individual living with HIV and 30% (222 of 743) reported they would prefer to not interact with someone living with HIV.

Among participants living with HIV, many reported struggling with sexual relationships because of their HIV status. Results found that 39% (50 of 127) of Generation Z and 28% (176 of 623) of millennials encounter difficulty forming new romantic and/or sexual relationships. Additionally, 85% (58 of 69) of Generation Z participants and 65% (178 of 272) of millennials respondents abstain from sex because of their HIV status.

One reason for this could be lack of knowledge regarding U=U.

Only 31% (254 of 740) of respondents living with HIV identified that the term “undetectable” means that a person living with HIV cannot sexually transmit the virus. Additionally, nearly 50% (412 of 846) HIV-negative respondents believed HIV could still be transmitted in an individual who is undetectable. More than 30% of young adults living with HIV also incorrectly believed that antiretroviral therapy can be halted if a person living with HIV is feeling better.

"Understanding the problem is the first step in preventing a deepening of the HIV epidemic,” Peter Sklar, MD, director, clinical research, Merck Research Laboratories said in a statement. “We must continue to search for ways to better understand young people's perceptions of HIV, promote safer sex behaviors and drive education and action in this population.”