HIV and Young Men Who Have Sex With Men

Young people in the United States remain at risk for HIV infection. An estimated 56,300 Americans are infected with HIV each year.¹ Of these, 34% -- or approximately 19,000 -- are adolescents or young adults aged 13-29 years.¹ Young men who have sex with men (YMSM), especially black YMSM, are at highest risk. This fact sheet highlights the ongoing risk for HIV infection among YMSM and underscores the need to reach each new generation with effective HIV prevention messages and services. Schools and education agencies are important partners in this effort.

Overview

HIV infection affects certain groups of young people disproportionately, especially:

Young men who have sex with men:

• Among adolescents aged 13-19 years, nearly two-thirds of all diagnosed HIV infections are from male-to-male sexual contact.²
• From 2005 to 2008, YMSM aged 13-24 years had the greatest percentage increase in diagnosed HIV infections* of all age groups (Figure 1).³

Black adolescents:

• In 2008, 75% of all diagnosed HIV infections in youth aged 13-19 years were among black youth, even though blacks represented only 17% of the population in that age group.²

Black YMSM:

• Nearly two-thirds (63%) of all YMSM aged 13-24 years with HIV infection in 2008* were black YMSM, followed by white YMSM (18%) and Hispanic/Latino YMSM (17%).³
• Black YMSM also experienced the largest increase of all racial/ethnic groups in diagnosed HIV infections -- from 1,841 in 2005 to 3,188 in 2008 (Figure 2).³

Figure 1. HIV Infection Diagnoses Among MSM, by Age Group, 2005-2008 -- 37 States and 5 U.S. Dependent Areas*

* In the 37 states and five U.S. dependent areas with confidential name-based reporting since at least January 2005.

Figure 2. HIV Infection Diagnoses Among YMSM Aged 13-24 Years, by Race/Ethnicity, 2005-2008 -- 37 States and 5 U.S. Dependent Areas

a Hispanics/Latinos can be of any race.

The reasons for these disparities are varied and not well understood, but possible factors include the following:

• Lack of knowledge of infection status. A high percentage of HIV-infected men who have sex with men (MSM) do not know they are infected, especially MSM of color and YMSM.⁴ Those who do not know they are infected might be less likely to take measures to keep from spreading the virus to others.
• Failure to reach MSM with effective interventions or prevention education. A CDC study of gay and bisexual men in 15 cities found that 80% had not been reached in the past year by HIV interventions known to be most effective.⁵ In addition, sex education programs that do not include information about sexual orientation or that ignore issues in the lives of sexual minority youth might not be effective in preventing HIV transmission among those students.
• Use of alcohol and illegal drugs. Alcohol, methamphetamine, and other "party drug" use is common among some YMSM and can lead to risky sexual behavior.⁶
• Complacency about risk. Improved treatment for HIV infection has helped many people with HIV infection live longer and healthier lives. An unintended consequence of this success is that younger MSM, who did not witness the toll of AIDS in the early years of the epidemic, might view HIV as less dangerous and become complacent about risks.⁶
• Mental health consequences of stigma and discrimination. Bullying, harassment, family disapproval, social isolation, and sexual violence -- which are experienced frequently by gay, lesbian, and bisexual youth -- can cause feelings of shame and poor self-esteem. This can lead to higher rates of emotional distress, suicide attempts, substance use, and risky sexual behavior.^7-9

Racial/ethnic disparities in HIV/AIDS among young MSM are also not well understood. The disparities do not appear to reflect individual racial or ethnic differences in risk behaviors such as unprotected anal sex, commercial sex work, sex with a known HIV-positive partner, or HIV testing history.¹⁰ Possible factors include the high prevalence of HIV in black male social networks, elevated rates of STDs among black men, and the reduced likelihood of black men receiving treatment (which can reduce the amount of HIV in the blood and potentially decrease transmission).¹⁰

Strategies for Addressing HIV Among YMSM in Schools

Collect and Analyze Data on Sexual Identity, Sex of Sexual Contacts, and Associated Health Risk Behaviors Among Youth

The Youth Risk Behavior Survey** is being used by some states and large urban school districts to monitor health risk behaviors and selected health outcomes among sexual minority students.^† States and school districts participating in the YRBS can add optional questions to the standard YRBS questionnaire, including:

During your life, with whom have you had sexual contact?

☐ I have never had sexual contact
☐ Males
☐ Females
☐ Females and males

Which of the following best describes you?

☐ Heterosexual (straight)
☐ Gay or lesbian
☐ Bisexual
☐ Not sure

In 2009, a total of 17 states and large urban school districts included one or both of these questions on their YRBS. Among these:

• 9 asked about both the sex of students' sexual contacts and about students' sexual identity.
• 4 asked about the sex of students' sexual contacts only.
• 4 asked about students' sexual identity only.

Analyses of YRBS data have contributed greatly to knowledge about health risks among gay, lesbian, and bisexual youth.^11-13 A CDC analysis of data from 13 YRBS sites found that sexual minority students, especially those who identified as homosexual or bisexual, were disproportionately likely to engage in many health risk behaviors, including sexual risk behaviors (such as having sexual intercourse for the first time at younger ages, having multiple sex partners, and not using condoms); tobacco, alcohol, and other drug use; and behaviors related to attempted suicide.¹³

Adding these YRBS questions enables states and districts to identify risk behaviors among sexual minority students and then adjust intervention priorities accordingly. Furthermore, by documenting that many youth do engage in same-sex sexual activity and various health risk behaviors, these data can help establish the imperative for meeting the health needs of sexual minority youth in schools.