JMIR Publications

ABSTRACT

Background:

Nearly one-third of HIV new infections occurred among youths in 2019 worldwide. Previous studies suggested that student-youths living with HIV (SYLWH) and non-student-youths living with HIV (NSYLWH) might differ in some risk factors, transmission routes, HIV care, and disease outcomes.

Objective:

This study aimed to compare the HIV epidemic, disease outcomes, and access to care among SYLWH and NSYLWH aged 16 to 25 years in Guangxi, China.

Methods:

We performed a historical cohort study by extracting data on all HIV/AIDS cases aged 16 to 25 years in Guangxi, China, during 1996-2019 from the Chinese Comprehensive Response Information Management System of HIV/AIDS (CRIMS). We conducted analyses to assess possible differences in demographic and behavioral characteristics, HIV care, and disease outcomes between SYLWH and NSYLWH. Multivariate COX regression and logistic regression were used to assess differences in mortality and virologic failure between SYLWH and NSYLWH.

Results:

A total of 13,839 youths aged 16 to 25 years were infected with HIV during 1996-2019. Among them, 10,202 cases were infected through sexual contact, most of whom were men (54%), 8.5% were students, and 91.5% were not students. The number of SYLWH was lower before 2006 but gradually increased from 2007 to 2019. In contrast, the NSYLWH cases increased rapidly in 2005, then gradually declined after 2012. SYLWH were mainly infected through homosexual contact (70.7% vs. 15.5%, P<.001), while NSYLWH were more likely to be infected through heterosexual contact (84.5% vs. 29.3%; P<.001). Moreover, NSYLWH had a significantly lower CD4 count than SYLWH at the time of HIV diagnosis (332 vs. 362 cells/μL, P<.001). Also, NSYLWH also had a delayed antiretroviral therapy (ART) initiation with 93 days compared to SYLWH (22 days; P<.001). Furthermore, the mortality rate of 0.4 and 1.0 deaths per 100 person-years was recorded for SYLWH and NSYLWH, respectively. Overall, the mortality risk in NSYLWH was 2.3 times that of SYLWH (adjusted hazard ratio [AHR], 2.3; 95% confidence interval [CI], 1.2–4.2 P=.008).

Conclusions:

NSYLWH might face a low CD4 count at the time of HIV diagnosis, delayed ART initiation, and increased risk of death. Thus, HIV prevention and interventions should target youths who dropped out of school early to encourage safe sex and HIV screening, remove barriers to HIV care, and promote early ART initiation to curb the HIV epidemic among youths.