Also available in Spanish [HTML]

Young men who have sex with men (YMSM) are at high risk for HIV and other sexually transmitted diseases (STD). Many Americans are reluctant to discuss sexuality and sexual health openly. Homophobia and fear of encouraging sexual activity among young people make many adults even more reluctant to address sexual health in regard to YMSM. Because of the social stigma attached to a gay or bisexual identity and the threat of violence, many young men conceal their same-sex sexual behavior. Therefore, effective HIV prevention with youth must address same-sex sexual behavior.

Sexual Attraction, Sexual Behavior, and Sexual Identity May Not Coincide.

• Homosexuality refers to persistent emotional and physical attraction towards people of the same gender; bisexuality, towards people of both genders.¹ Same-sex sexual behavior may not reflect either a homosexual or a bisexual identity.²
• Of male adolescents who reported same-sex intercourse, one study found that 54 percent identified themselves as gay, 23 percent as bisexual, and 23 percent as heterosexual.¹
• Because of a high degree of homophobia among teens, because young people experiment, and because many youth have not yet considered the question of sexual orientation, researchers and service providers agree that it is necessary when discussing risks for HIV or STD infection with young people to discuss same-sex sexual behavior rather than sexual orientation.³

HIV/AIDS and STD Rates Are High Among YMSM.

• Among males ages 13 to 19, 41 percent of AIDS cases and 52 percent of HIV cases reported to the Centers for Disease Control and Prevention (CDC) in 1997 were among YMSM and YMSM injecting drug users.⁴
• During 1994 to 1996, samples of YMSM in six urban U.S. counties indicated that five to nine percent of YMSM were infected with HIV.⁵
• One study of gay and bisexual men ages 17 to 22 revealed that 70 percent of HIV-infected men did not know that they were HIV-positive, and only 22.5 percent were receiving medical care for HIV infection.⁶
• Individuals infected with an STD are at least two to five times more likely than uninfected individuals to acquire HIV if exposed to the virus through sexual contact.⁷
• One study found that among gay male clinic patients screened for STDs, those 15- to 20- years-old had the highest age-specific rates of rectal chlamydia and gonorrhea.⁸
• In a 1997 study, the number of men who have sex with men (MSM) diagnosed with gonorrhea increased 124 percent at a Portland, Oregon, STD clinic and 125 percent at one in Seattle, Washington.⁹

YMSM of Color Face Higher Rates of HIV and Exhibit Greater Risk Behavior.

• Research indicates that African American and Latino YMSM have disproportionately high rates of HIV infection. In one study, four percent of white YMSM were HIV-infected, compared to 11 percent of African Americans and seven percent of Latinos.⁵
• Between 1984 and 1994, the percentage of YMSM with AIDS who were white dropped from 59 to 37 percent, while the percentage of African Americans rose from 27 to 40 percent and the percentage of Latinos rose from 12 percent to 22 percent.¹⁰

High Risk Sexual Behaviors Put YMSM at Risk.

• In a 1994 study among San Francisco's YMSM, 28 percent of those 17- to 19-years-old and 34 percent of those 20- to 22-years-old reported engaging in unprotected anal intercourse during the previous six months.¹¹ A similar study in Los Angeles later found 55 percent of YMSM reporting unprotected anal intercourse in the previous six months.¹²
• In a 1996 study, 38 percent of YMSM reported having unprotected anal sex, and 27 percent reported having unprotected receptive anal sex. ⁵
• Many YMSM perceive AIDS to be a disease of older gay men, often lack peer or other social support to encourage safer sex behavior, often do not consider their peers to be at high risk, and believe they can determine the HIV status of others by their appearance. ¹⁰
• Some YMSM lack adequate communication and assertiveness skills to negotiate safer sex. Some feel unable to refuse unwanted sex or feel compelled to exchange sex for money, food, or shelter.¹⁰
• A 1998 nationwide study of 15- to 22-year-old YMSM indicates that predictors of unprotected anal intercourse include finding safer sex difficult to practice, having suffered forced sexual contact, being high on amphetamines or alcohol during sex, and having little social support. Other predictors are having a steady sex partner in the past six months and having only male sex partners in the past six months. A final predictor of unprotected anal intercourse among YMSM is feeling that there is little or no chance of avoiding HIV infection.¹³

Younger MSMs Differ from Older MSMs.

• HIV seroprevalence—the number of people infected within a given group—is greater in older MSM, but HIV incidence—the number of new infections within a group—is greater in younger MSM.¹⁰
• Older MSM were targeted from the early 1980's with materials and programs designed to address their particular risk behaviors. Young gay and bisexual males today have not experienced an amount of personal loss of friends and lovers that would compel them to modify their risk behaviors and—at a time when HIV prevention messages primarily target heterosexual individuals—maintain the belief that they are not susceptible.¹⁴

Prevention Programs Can Be Effective among YMSM.

• Peer-based interventions have been effective with YMSM in reducing unprotected anal intercourse and improving consistent use of condoms with new partners. One program showed 60 percent fewer YMSM reporting unprotected anal intercourse after sustained sexuality-related peer education.¹⁵
• One intervention with gay men significantly reduced sexual risk-taking behavior among the peer leaders. Peer leaders reduced their own unprotected anal intercourse by 15 percent.¹⁶
• One program found that YMSM were most likely to be reached effectively through outreach activities, such as dances, movie nights, picnics, gay rap groups, and volleyball.¹⁷
• Since multiple factors contribute to HIV risk behavior among YMSM, prevention programs must address both individual and societal issues. To meet individual needs, programs must address self-esteem, coming out, substance use, health attitudes, and interpersonal and social competencies.^18,19
• To address societal issues, interventions should mobilize and empower the community of YMSM. Empowerment interventions should enhance the capacity of communities to change social, cultural, and other barriers to health.¹⁹

References

1. Ryan C, Futterman D. Lesbian & Gay Youth: Care & Counseling. New York: Columbia University Press, 1998.
2. Reynolds S, et al. Surviving AIDS: Simple Answers to Complex Questions About AIDS and Adolescent Homosexuality. St. Paul, MN: University of Minnesota Youth and AIDS Project, 1993.
3. National Community AIDS Partnership. A Generation at Risk: A Background Report on HIV Prevention and Youth. Washington, DC: The Partnership, 1993.
4. Centers for Disease Control & Prevention. U.S. HIV and AIDS cases reported through June 1997. HIV AIDS Surveillance Report 1997; 9(1):1-39.
5. Valleroy L, et al. HIV and Risk Behavior Prevalence among Young Men Who Have Sex with Men Sampled in Six Urban Counties in the USA. Presented to the 11th International Conference on AIDS. Atlanta, GA: CDC, 1996.
6. Lemp GF, et al. Seroprevalence of HIV and risk behaviors among young homosexual and bisexual men: the San Francisco/Berkeley young men's survey. JAMA 1994; 272:449-454.
7. Centers for Disease Control & Prevention. The role of STD detection and treatment in HIV prevention. CDC Update 1998; (July):2 p.
8. Remafedi G. Predictors of unprotected intercourse among gay and bisexual youth: knowledge, beliefs, and behavior. Pediatrics 1994; 94:163-168.
9. _____ Gonorrhea among men who have sex with men: selected sexually transmitted disease clinics, 1993-1996. MMWR 1997; 46:889-892.
10. Centers for Disease Control & Prevention. HIV/AIDS among young gay and bisexual men. Information for HIV prevention community planning groups, no. 2. CDC HIV/AIDS Prevention 1995; (September):4 p.
11. US Conference of Mayors. Safer sex relapse: a contemporary challenge. AIDS Information Exch 1994; 11(4):1-8.
12. Men's Survey - Los Angeles: August 1994 - January 1996. Paper presented to Los Angeles County Adolescent HIV Consortium, Los Angeles, CA, 16 February 1996.
13. Valleroy L. HIV Prevalence and Predictors of Unprotected Receptive Anal Intercourse for 15- to 22-Year-Old Men Who Have Sex with Men in Seven Urban Areas, U.S.A. Presented to the 12th World AIDS Conference, Geneva, June 28 - July 3, 1998. Atlanta, GA: CDC, 1998.
14. Cranston K. HIV education for gay, lesbian, and bisexual youth: personal risk, personal power, and the community of conscience. In: Coming Out of the Classroom Closet. Binghamton, NY: Haworth Press, 1992.
15. Remafedi G. Cognitive and behavioral adaptations to HIV/AIDS among gay and bisexual adolescents. J Adolesc Health 1994; 15:142-148.
16. Kelley JA, et al. HIV risk behavior reduction following intervention with key opinion leaders of a population: an experimental analysis. Am J Public Health 1991; 81:168-171.
17. Kegeles SM, Hays RB, Coates TJ. The Mpowerment Project: a community-level HIV prevention intervention for young gay and bisexual men. Am J Public Health 1996; 86:1129-1136.
18. Hays RB. What Are Young Gay Men's HIV Prevention Needs? San Francisco: University of California, 1995.
19. Beeker C, et al. Influences on sexual risk behavior in young African American men who have sex with men. J Gay Lesbian Medical Assoc 1998; 2(2):59-67.

Compiled by Andy Garcia of the National Youth Advocacy Coalition
October 1998 © Advocates for Youth