Youth at Disproportionate Risk

The Safe and Supportive Schools project increases the capacity of state education agencies to help school districts create safe and supportive school environments for all students and staff and for groups of youth at disproportionate risk. See our capacity building services for more information.

Young people who share certain demographic characteristics are disproportionately affected by HIV infection and other STDs. Black and Hispanic/Latino young men who have sex with men (YMSM), homeless youth and youth enrolled in alternative schools are affected at particularly high rates.

Regardless of income level, Black and Latino adolescents are disproportionately affected by HIV infection and other STDs and have higher rates of pregnancy than white adolescents. Although Blacks comprised only 15 percent of all adolescents aged 13–19 in the United States in 2010, they accounted for 69 percent of all diagnoses of HIV infection among adolescents. Also in 2010, more Hispanic/Latino adolescents were diagnosed with HIV infection than White adolescents even though there are nearly three times as many White adolescents as Hispanic/Latino adolescents living in the United States.

Given the disproportionate risk faced by certain subpopulations of youth, the Centers for Disease Control and Prevention, Division of Adolescent and School Health (CDC-DASH) asked sites funded by this cooperative agreement to develop or strengthen efforts for addressing the needs of lesbian, gay, bisexual and transgender (LGBT) youth, with an emphasis on young men who have sex with men (YMSM); homeless youth; and youth enrolled in alternative schools.

CDC-DASH has also funded four partners to address the HIV/STD prevention needs of Black and Hispanic/Latino YMSM through The Young Men Who Have Sex with Men Projectopens in new window.

Learn more about each of these groups of youth and resources to help support them below.

Among adolescent males aged 13–19 years, approximately 91 percent of diagnosed HIV infections in 2010 were among YMSM.¹ Youth who identify as lesbian, gay, bisexual or transgender (LGBT) are more likely than their heterosexual peers to engage in sexual risk-taking behaviors, including earlier age at first sexual intercourse, more lifetime and recent sex partners, and drinking alcohol or using other drugs prior to last sexual intercourse; and are less likely to use a condom during intercourse.^{2, 3} Additionally, LGBT students are frequently bullied and harassed and are more likely than heterosexual students to experience a higher prevalence of dating violence and forced sexual intercourse.⁴ As a result, LGBT youth are more likely to have suicidal thoughts or attempts, personal safety issues and lower academic achievement than their heterosexual peers.^{2, 5}

Homeless youth are a vulnerable population with high rates of sexual risk-taking behaviors, substance use and mental health problems. It is estimated that 1.5 to 2 million youths per year are homeless or have run away from home.⁶ Homeless youth are highly likely to experience early sexual debut, have multiple sex partners, engage in unprotected sexual intercourse and use alcohol or other drugs prior to sex, resulting in a high risk of acquiring HIV.^{7, 8} Although there are no national data available on HIV among homeless youth, community studies have demonstrated a higher seroprevalence among homeless youth than among the general U.S. youth population.¹⁰ Some homeless youth may be at additional risk because of a history of childhood sexual abuse and a lack of connectedness to trusted adults and family.⁸

National Network for Youthopens in new window
This organization advocates at the federal level to educate the public and policymakers about the needs of homeless and disconnected youth.

True Colors Fundopens in new window
This organization is raising awareness about and helping bring an end to gay, lesbian, bisexual and transgender youth homelessness.

Students in alternative school settings are more likely than students in mainstream schools to engage in sexual risk-taking behaviors. Students in alternative high schools are nearly twice as likely to report ever having sexual intercourse, compared with students in mainstream high schools and are three times as likely to report having four or more sexual partners during their lifetime.^{10, 11} Among students who are sexually active, alternative school students are less likely to have used a condom during sexual intercourse and are nearly twice as likely to use alcohol or drugs prior to sexual intercourse compared to mainstream high school students.¹² This pattern of sexual behavior contributes to a greater risk for HIV infection, other STDs and unplanned pregnancy.

National Alternative Education Association (NAEA)opens in new window
NAEA provides advocacy and support for professionals who work on behalf of children and youth receiving alternative education services.

All4You! opens in new window
This curriculum is designed to reduce sexual risk behaviors associated with HIV, other STDs and unintended pregnancy for use in alternative schools serving youth ages 14 to 18.

National Dropout Prevention Center/Networkopens in new window
The mission of the National Dropout Prevention Center/Network is to increase graduation rates through research and evidence-based solutions.

1. CDC. Diagnoses of HIV infection and AIDS among adolescents and young adults in the United States and 5 U.S. dependent areas, 2006–2009. HIV Surveillance Supplemental Report 2012;17(No. 2). Available at https://www.cdc.gov/hiv/pdf/statistics_2009_HIV_Surveillance_Report_vol_17_no2.pdfopens in new window
2. Blake SM, Ledsky R, Lehman MA, Goodenow C, Sawyer R, Hack T. Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: the benefits of gay-sensitive HIV instruction in schools. American Journal of Public Health 2001;91(6):940–946.
3. Garofalo R, Deleon J, Osmer E, Doll M, Harper W. Overlooked, misunderstood and at-risk: exploring the lives and HIV risk of ethnic minority male-to-female transgender youth. Journal of Adolescent Health 2006;38:230–236.
4. CDC. Sexual identify, sex of sexual contacts, and health-risk behaviors among students in grades 9-12 ― youth risk behavior surveillance, selected sites, United States, 2001–2009. MMWR Early Release 2011;60[June 6]:1–133.
5. Kosciw JG, Greytak EA, Diaz EM, Bartiewicz MJ. The 2009 National School Climate Survey: The Experiences of Lesbian, Gay, Bisexual and Transgender Youth in Our Nation’s Schools. New York: Gay, Lesbian and Straight Education Network (GLSEN); 2010.
6. Naranbhai V, Abdool Karim Q, Meyer-Weitz A. Interventions to modify sexual risk behaviors for preventing HIV in homeless youth. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No: CD007501. DOI: 10.1002/14651858.CD007501.pub2. Available at https://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007501.pub2/pdf/standardopens in new window
7. Gangamma R, Slesnick N, Toviessi P, Serovich J. Comparison of HIV risks among gay, lesbian, bisexual and heterosexual homeless youth. Journal of Youth and Adolescence 2008;37(4):456–464.
8. Solorio MR, Rosenthal D, Milburn NG, Weiss RE, Batterham PJ, Gandara M, et al. Predictors of sexual risk behaviors among newly homeless youth: a longitudinal study. Journal of Adolescent Health 2008;42(4):401–409.
9. Beech BM, Myers L, Beech B, Kernick NS. Human Immunodeficiency Syndrome and Hepatitis B and C Infections Among Homeless Adolescents. Seminar in Pediatric Infectious Diseases 2003; 14(1): 12-19.
10. Markham C, Tortolero S, Escobar-Chaves S, Parcel, G, Harrist R, Addy R. Family connectedness and sexual risk-taking among urban youth attending alternative high schools. Perspectives on Sexual and Reproductive Health 2003;35(4):174–179.
11. Coyle KK, Kirby DB, Robin LE, Banspach SW, Baumler EE, Glassman Jr. All4You! A randomized trial of an HIV, other STDs, and pregnancy prevention intervention for alternative school students. AIDS Education and Prevention 2006;18(3):187–203.
12. Tortolero S, Markham C, Addy R, Baumler E, Escobar-Chaves S, Basen-Engquist K, et al. Safer choices 2: rationale, design issues, and base-line results in evaluating school-based health promotion for alternative school students. Contemporary Clinical Trials 2008;29(1):70–82.