Also available in [PDF] format. Order publication online.

Young men who have sex with men (YMSM) are at high risk for HIV and other sexually transmitted infections (STI). In fact, men who have sex with men (MSM) accounted for more than half of all new infections in the United States from 2005- 2008, with 85 percent of cases among MSM ages 13-24 attributed to male-to-male sexual contact.[1] HIV rates have risen steadily among MSM since the 1990s.[2]

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

• According to CDC estimates in 2010, 4 percent of U.S. males engaged in same-sex behavior in the past 5 years, and 7 percent of U.S. males have ever engaged in same-sex behavior.[3]
• Sexual identity, behavior, and desire are not always synonymous, but often conflated. Sexuality is fluid and most likely influenced by a combination of socio-cultural and biological factors. [4,5] In order to create effective programs, it is important to understand that not all YMSM identify as gay; they may fear the "gay" label, regard their same-sex behavior as temporary, or identify as bisexual.

HIV/AIDS and STI Rates Are High Among YMSM, Yet Many Are Unaware They Are Infected

• In 2008, young MSM (ages 13-29) accounted for over 5,000 of the 22,810 new infections among MSM overall.[1]
• From 2005 and 2008, the number of new HIV diagnoses among MSM 13-24 years old rose dramatically. MSM ages 13-24 experienced the greatest percentage increase in diagnoses of HIV among MSM during that period.[1]
• A study of 21 major cities revealed that among YMSM who tested positive for HIV, 75 percent of young men ages 18-19 and 68 percent of young men ages 20-24 were unaware of their status.[6]
• Individuals infected with an STI are at least two to five times more likely than uninfected individuals to acquire HIV if exposed to the virus through sexual contact.[7] Although most STI statistics do not include questions about sexual behaviors or mode of transmission, available data from the CDC indicates that STI rates among MSM are rising.[8]

YMSM of Color Are Disproportionately Impacted by HIV

• Socioeconomic and cultural disparities, including and unemployment, decreased access to medical care, and greater likelihood of incarceration, contribute to a heightened HIV risk for youth of color as compared to white youth.[9]
• Studies have shown that among men who have sex with men, African American/black men are more at risk for HIV even when they have the same or fewer risk behaviors. An analysis of 53 studies found that black men were not more likely than whites to have unprotected anal sex, engage in commercial sex work, or have sex with a known HIV positive partner; and in fact reported having fewer partners than white men.[10]
• Sixty-three percent of all HIV/AIDS diagnoses among young MSM aged 13–24 in 2008 were among African American/black youth, even though blacks represented only 17 percent of the population in that age group.[1,11]
• African-American/Black and Hispanic MSM have a greater likelihood of becoming infected with HIV at a younger age (13–29 years) than whites.[12]
• Young black MSM (13-24) experienced the highest increase in diagnoses—from 1841 cases in 2005 to 3188 cases in 2008, an increase of 73 percent.[1]

High Risk Sexual Behaviors Put YMSM at Risk.

• According to the National HIV Behavioral Surveillance System, 89 percent of the young MSM reported anal intercourse with a male partner in the past year and 46 percent had unprotected anal intercourse (UAI). Seventeen percent had UAI with more than one male partner.[13]
• Compared to young men who had UAI with only one male partner, those who had UAI with multiple male partners were more likely to have engaged in UAI with a casual male partner* (77 percent versus 16 percent). Thirty-one percent of young men in the study reported drug use during sex.[10]
• One study of found that the odds of HIV infection increased significantly as the age of sexual partners increased – participants with partners 5 or more years older had twice the odds of becoming infected with HIV than study participants as a whole.[14]
• Many young MSM are not aware of their HIV status. In one nationwide study of MSM which included HIV testing, ten percent of young MSM tested positive, with 69 percent of those who tested positive unaware of being infected with HIV.[15]
• Studies have found that because of the existence of medications which can prolong an HIV positive individual's life and prevent the virus from developing into AIDS, some young MSM may be taking more sexual risks, including unprotected sex with untested or known HIV positive individuals.[16]

Prevention Programs Can Be Effective among YMSM

Complex issues are fueling HIV transmission among YMSM—particularly for YMSM of color. In order to address those complexities, interventions must address individual behavior, and the socio-cultural determinants that fuel HIV transmission.[17]

One intervention with gay men significantly reduced sexual risk-taking behavior in four cities by recruiting popular peers and training them to pass on behavior recommendations to friends through conversation. Surveys found that at one-year follow-up, unprotected anal intercourse in the cities decreased between 15-29 percent, condom use increased, and the number of sex partners decreased and unprotected anal intercourse.[18]

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.[19]

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.[20]

Like all young people, young men who have sex with men need culturally-competent, pragmatic, and inclusive prevention messages – as well as programs which address behavioral, cultural, and institutional barriers to sexual health information and services.

Written by Andy Garcia of the National Youth Advocacy Coalition, October 1998

Revised by Durryle Brooks, Program Manager, GLBTQ Initiatives.

Advocates for Youth © October 2010

References

1. Centers for Disease Control and Prevention (CDC). HIV Surveillance in Men who Have Sex with Men. Accessed from http://www.cdc.gov/hiv/topics/surveillance/resources/slides/msm/index.htm on October 26, 2010.

2. Centers for Disease Control and Prevention (CDC). Subpopulation Estimates From the HIV Incidence Surveillance System -- United States, 2006. MMWR. 2008; 57(36):985-989

3. Purcell, DW. 2010 National STD Prevention Conference (NSTDP): Abstract LBc. Presented March 10, 2010.

4. Frankowski, B. Sexual Orientation and Adolescents. Pediatrics 2004;113;1827-1832.

5. Hammack, P. The Life Course Development of Human Sexual Orientation: An Integrative Paradigm. Human Development. University of Chicago, 2005.

6. Taussing et al. Prevalence and Awareness of HIV Infection Among Men Who Have Sex With Men --- 21 Cities, United States, 2008. MMWR, September 24, 2010; 1201-1207.

7. Centers for Disease Control & Prevention. The role of STD detection and treatment in HIV prevention. CDC Update 1998; (July):2 p.

8. Centers for Disease Control and Prevention. 2008 Sexually Transmitted Diseases Surveillance. STDs in Men Who Have Sex with Men (MSM) Accessed from http://www.cdc.gov/std/stats08/msm.htm on October 22, 2010.

9. Steele BC et al. Health Disparities in HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis: Issues, Burdens, and Response, A Retrospective Review, 2000-2004. Atlanta, GA: Department of Health and Human Services, Centers for Disease Control and Prevention, 2007. Accessed fromhttp://www.cdc.gov/nchhstp/healthdisparities/docs/NCHHSTP_Health%20Disparities%20Report_15-G-508.pdf on October 22, 2010.

10. Millett et al. Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors. AIDS 21 (15) 2083-2091.

11. U.S. Census Bureau. 2009 American Community Survey 1-Year Estimates, Detailed Tables. Accessed from factfinder.census.gov on October 26, 2010.

12. MacKellar DA, Valleroy L, Secura G, et al. Unrecognized HIV infection, risk behaviors, and perceptions of risk among young men who have sex with men: opportunities for advancing HIV prevention in the third decade of HIV/AIDS. J AIDS 2005; 38:603–614.

13. Centers for Disease Control and Prevention (CDC_). "National HIV Behavioral Surveillance: HIV Risk and Testing Behaviors Among Young MSM." Accessed from http://www.cdc.gov/hiv/topics/msm/ymsm.htm on 5/6/2010.

14. Hurt CB, Matthews DD, Calabria BM, et al. Sex with older partner is associated with primary HIV infection among men who have sex with men in North Carolina. J Acquir Immune Defic Syndr. 2010;54:185–190.

15. CDC. Prevalence and Awareness of HIV Infection Among Men Who Have Sex With Men --- 21 Cities, United States, 2008. MMWR, September 24, 2010.

16. MacKellar DA et al. A Plausible Causal Model of HAART-Efficacy Beliefs, HIV/AIDS Complacency, and HIV-Acquisition Risk Behavior Among Young Men Who Have Sex with Men. AIDS Behav, Published Online September 23, 2010.

17. Center for Disease Control and Prevention (CDC). Best Evidence. Interventions. Accessed from http://www.cdc.gov/hiv/topics/research/prs/best-evidence-intervention.htm on October 22, 2010.

18. Kelly, J. A., Murphy, D. A., Sikkema, K. J., McAuliffe, R. L., Roffman, R. A., Solomon, L. J., Winett, R. A., Kalichman, S. C. (1997). Randomised, controlled, community-level HIV-prevention intervention for sexual-risk behaviour among homosexual men in US cities. Community HIV Prevention Research Collaborative. Lancet, 350(9090), 1500-1505.

19. 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.

20. Remafedi G. Cognitive and behavioral adaptations to HIV/AIDS among gay and bisexual adolescents. J Adolesc Health 1994; 15:142-148.