Objectives: To compare HIV seroprevalence and sexual risk behavior among very young gay and bisexual men (aged 15-17 years) and their older counterparts (aged 18-22 years). To examine drug-use patterns and correlates of sexual risk behavior in both of these age groups.
Design and Methods: An interviewer-administered cross-sectional survey of 719 gay and bisexual males between 15 and 22 years old was conducted through a venue-based sampling design. Blood specimens were collected and tested for HIV antibodies, hepatitis B, and syphilis. Interviews assessed sexual and drug-use behavior as well as psychosocial variables believed to be related to sexual risk-taking, including self-acceptance of gay or bisexual identity, perceptions of peer norms concerning safer sex, and perceptions of the ability to practice safer sex (safer sex self-efficacy).
Results: Of the 719 participants, 100 (16.2%) were aged between 15 and 17 years. HIV seroprevalence was somewhat lower among those aged 15 to 17 years (2.0%) compared with those aged 18 to 22 years (6.8%). Overall, the prevalence of hepatitis-B core antibody was significantly lower in the younger age group (5.0%) than in the older group (14.1%). The men aged 15 to 17 years used alcohol, ecstasy, and heroin less frequently than those aged 18 to 22 years. The age groups did not differ in the proportion of men who reported any unprotected anal intercourse in the previous 6 months (31.2%). In both age groups, use of amphetamines, ecstasy, and amyl nitrate was associated with unprotected anal intercourse. Self-acceptance of gay or bisexual identity was related to less sexual risk for those aged 15 to 17 years. In both age groups, greater safer sex self-efficacy was linked to less HIV sexual risk-taking. In the younger group, perceptions of peer norms that support safer sex were related to less risk behavior.
Conclusions: Very young gay and bisexual men engage in unprotected anal sex at rates comparable with those for their somewhat older counterparts, raising serious concern over their risk of acquiring HIV infection. To prevent seroconversions, interventions must target those <18 years of age, and prevention programs should address the use of certain drugs in relation to sex and sexual risk-taking. To be most effective, programs should develop innovative communication strategies to take into account lack of self-acceptance of gay or bisexual identity and low self-efficacy for practicing safer sex.
The HIV/AIDS epidemic continues among young gay and bisexual men in the United States. The first San Francisco/Berkeley Young Men's Survey conducted during 1992 to 1993 found an HIV seroprevalence rate of 9.4% in its sample of 425 gay and bisexual men aged 17 to 22 years (1), and current data indicate that the level of HIV seroprevalence continues to be high (2). Other data from San Francisco documented a 17.9% seroprevalence rate of HIV for 380 gay and bisexual men in a multistage household probability sample of men aged 18 to 29 years (3). The same study also found that 63% of these men had engaged in unprotected anal intercourse in the 12 months before the survey. In other community-based samples, Kegeles et al. (4) found that 41% of gay and bisexual men aged between 18 and 27 years reported unprotected anal intercourse in the 2 months before the survey. Similar rates have been found in other studies (1,5-8).
Gay and bisexual youth <18 years of age have been studied infrequently (9). Institutional review boards generally require that youths under 18 receive parental consent before participating in studies and often are reluctant to approve studies that include assessments of the sexual behavior of adolescents. Gay and bisexual youths, however, may not be out (that is, known to self-identify as homosexual or bisexual) to their parents, thus making parental consent to participate in a study of gay and bisexual youths nearly impossible. An important transition occurs in the lives of many young gay and bisexual men at age 18 years-legally they become adults and often leave home for places where they can more freely explore their sexuality. Thus, gay and bisexual youths <18 years of age are an important group for study because their experiences may be quite different from those of their older counterparts. Most studies on those under 18 (10) have sampled predominantly street youths or those seeking services at agencies for runaway, homeless, or troubled youths, partly because of the waiver of parental consent among emancipated minors. Thus, research on young gay and bisexual men has typically excluded those <18 years of age or has studied young men under 18 who may not be representative of this population.
Researchers studying HIV in young gay and bisexual men often do not address associations between mental health or psychosocial issues and sexual risk behavior. One study suggested that the most sexually risky young gay and bisexual men are those who are less accepting of their homosexuality and who use drugs more often (8). Perceptions of peer norms regarding safer sex and safer sex self-efficacy have also been associated with HIV sexual risk behavior in samples of gay and bisexual men of differing ages. (7,11-14). Perceptions of peer norms have been successfully manipulated for the purpose of HIV prevention among older gay men; at follow-up, members of communities randomly selected for the promotion of safer sex peer norms were less likely to engage in unprotected anal intercourse than those in comparison communities (15). These findings, however, were often not specifically documented for younger men, although there is reason to believe that the influence of peers may be especially profound for youths, particularly adolescents (16,17).
The causal directions of the associations between acceptance of gay or bisexual identity, drug use, peer norms regarding safer sex, safer sex self-efficacy, and HIV sexual risk behavior are not well-documented, and these associations have not been explored extensively in samples of young men. These variables are important because understanding their relation to sexual risk behavior may assist interventionists in preventing HIV transmission among young gay and bisexual men.
We compared HIV seroprevalence and sexual risk behavior among very young gay and bisexual men (aged 15-17 years) and their older counterparts (aged 18-22 years). In addition, we examined the relations between sexual risk-taking and drug use, self-acceptance of gay or bisexual identity, perceptions of peer norms concerning safer sex, and perceived safer sex self-efficacy in both age groups.