There are no significant differences in overall sexual behavior among male high school students who identify as heterosexual, gay or bisexual. This Centers for Disease Control and Prevention (CDC) finding is from the first national survey of HIV-related risk behaviors among male high school students. Despite not engaging in notably riskier sexual behavior, gay and bisexual male teens have an elevated risk of acquiring HIV because their sex partners are more likely to have HIV, and they are more likely than their peers to inject drugs.
First Estimates of Teen LGB Population
In the 2015 National Youth Risk Behavior Survey, in which more than 15,000 high school students participated, 47% of male gay/bisexual students and 43% of male heterosexual students reported ever having sexual intercourse. A similar proportion of male students -- 32% of male gay/bisexual and 31% of male heterosexuals -- reported being currently sexually active.
This data was first presented at the 2016 International AIDS Conference in Durban, South Africa, and then published online in the Morbidity and Mortality Weekly Report.
The CDC survey has been conducted for more than 25 years, but this is the first time it has included questions on sexual orientation. "Foremost are [questions on] the social issues that result in isolation, marginalization, discrimination," Laura Kann, Ph.D., chief of the School-Based Surveillance Branch within CDC's Division of Adolescent and School Health told TheBody.com. Kann co-wrote the paper and delivered the presentation in Durban. "For the first time in 2015, we added two questions on sexual identity and sexual contact which allowed us to conduct these analyses."
Based on their findings, researchers estimated that approximately 321,000 high school students nationwide are gay or lesbian, 964,000 are bisexual and 541,000 have not defined their sexual identity. According to the CDC, these are the first national estimates of U.S. high school students' sexual orientation.
Gay/Bisexual Teens Least Likely to Be in Care
The CDC found that 12% of gay/bisexual male students and 14% of their heterosexual counterparts have had sexual intercourse with four or more partners. Fifty-three percent -- or slightly more than half -- of the sexually active male gay/bisexual students said they had used a condom the last time they had sexual intercourse. That compares with 62% of male heterosexual students. Despite the similarities, gay and bisexual youth have a substantially increased risk of becoming HIV positive.
"The transmission risk of receptive anal sex is about 17 times higher than vaginal sex," explains Kann. "Data from other surveys tells us that [HIV-positive] diagnoses among men who have sex with men [MSM] are 57 times higher."
Thus MSM teens' sexual partners are much more likely to be living with the virus. They also are more likely not to be aware of their diagnosis and not to be in care, increasing the likelihood that they are infectious.
Youth 13 to 24 years old accounted for more than one in five new HIV diagnoses in 2014. The overwhelming majority -- eight out of ten -- of these new infections was among gay and bisexual males. Of these, younger black and African-American men were the group most affected by HIV.
According to the CDC, youth with HIV are less likely to be linked to care than any other age group. Due to economic and social barriers, health disparities, stigma, homophobia and much more, black MSM with HIV are the least likely of any demographic to be linked to care and virally suppressed -- which would substantially reduce their likelihood of transmission.
The CDC study found disproportionately higher levels of drug use -- including injection drug use -- among gay and bisexual male students: over 10% of MSM versus 1.5% of heterosexuals. This also elevates the risk of infection. Most new infections among MSM are acquired through sexual intercourse; however, MSM who use drugs and lack access to sterile injection equipment are at even higher risk for both HIV and hepatitis C.
These results are consistent with other data showing that gay, lesbian, bisexual and transgender people abuse tobacco, alcohol, drugs and other substances at disproportionately higher rates. Many experts believe that multiple and intersecting stressors -- such as discrimination, racism, stigma, homophobia and poverty -- are the drivers behind unhealthy coping mechanisms.
In a press release on the report, the CDC noted that MSM students were also much more likely to have used a number of drugs that "may contribute to increased sexual risk behavior." The differences are dramatic. Gay/bisexual male students were eight times more likely to have ever used heroin, six times more likely to have ever used methamphetamine, three times more likely to have ever used cocaine and twice as likely to have ever used prescription drugs without a doctor's prescription.
School-Based HIV Education and Prevention
The new data underscore the need for additional research and multiple strategies to address sexual behavior and drug use-related risks for HIV infection among gay and bisexual male high school students. Such strategies include testing, education, linkages to and retention in HIV treatment, as well as school-based HIV prevention.
School-based HIV education and prevention remains a critical challenge. Only 22 states and the District of Columbia require sex education and HIV education, according to the Guttmacher Institute. Only 13 states have mandated that sex and/or HIV education be medically accurate. And educators in four states -- Alabama, South Carolina, Texas and Utah -- cannot show non-heterosexual orientation in a positive manner.
Many states that do not require comprehensive education around sex and HIV are located in the South, the epicenter of the U.S. epidemic. Of the 10 states with the highest rates of new diagnoses, eight are located in the South.
"It is very important that we address sexual and HIV education in a comprehensive nature [that] provides accurate information about sex. In the South, this often becomes subjective from the theology and belief systems across the Bible Belt," Kimberly A. Parker, Ph.D., associate professor of health studies at Texas Woman's University told TheBody.com. Parker has extensively researched HIV prevention strategies targeting African-American communities.
School-based sex and HIV education should include discussions of "sexuality, making informed decisions about reproductive health, engaging in preventive measures, [as well as] laws and stigma around sexuality and gender identity," Parker noted.
She emphasized the importance of making school-based HIV education more comprehensive to reach those gay and bisexual male students at the highest risk of acquiring infection.
"Younger black gay and bisexual men [often] say that school-based HIV education does not encompass them or their identities," Marvell L. Terry II, the Human Rights Campaign's HIV/AIDS project manager told TheBody.com. "If sex education is discussed, it is through the lens of heteronormative relationships."
According to Terry, this means that younger black gay men often learn about having sex with men by watching pornography, in which the use of condoms is not featured. Consequently, "some young gay and bisexual have the perception that they shouldn't or don't have to use condoms," he said.
"We can't ignore the fact that gay and bisexual [youth] are having sex at younger ages and are curious about exploring their growing bodies," said Terry. But, he emphasized, "they are not taught how to protect themselves and how to make the right decisions."
Rod McCullom has written and produced for ABC News and NBC, Scientific American, The Atlantic, The Nation, Ebony, Poz and many others. Rod is a Knight Science Journalism Fellow at the Massachusetts Institute of Technology.