New CDC data presented today at the International AIDS Conference in Durban, South Africa, suggest there are no significant differences in several HIV-related risk behaviors among U.S. male students in ninth through 12th grades who identify as heterosexual, gay, or bisexual. Still, young gay and bisexual males are at much higher risk for HIV because their sex partners are more likely to be infected with HIV.
The analysis is the first nationally representative look at HIV-related risk behaviors among heterosexual, gay, and bisexual male high school students. Roughly the same proportion of gay and bisexual male students and heterosexual male students reported that they:
- Had ever had sexual intercourse (51 percent of gay/bisexual and 41 percent of heterosexual).
- Were currently sexually active (35 percent of gay/bisexual and 30 percent of heterosexual).
- Had had sexual intercourse with four or more partners (15 percent of gay/bisexual and 11 percent of heterosexual).
- Had used a condom the last time they had sex (48 percent of sexually active gay/bisexual and 58 percent of sexually active heterosexual).
Despite similar levels of these behaviors, young gay and bisexual males remain at substantially higher risk for HIV infection than heterosexual males, largely because of substantially higher HIV prevalence among their male sexual partners. HIV diagnosis rates are 57 times higher among men who have sex with men (MSM) than among heterosexual men. The higher level of HIV in a sexual network dramatically increases the risk of HIV exposure with every sexual encounter.
"Although most HIV infections occur after high school, it is critical to help teens establish behaviors today that will protect their health now and in the future," said Jonathan Mermin, M.D., director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "Ensuring access to HIV prevention interventions and information is critical to avoiding HIV infections during the teen years -- and could have lasting impact over the course of a lifetime."
Gay and Bisexual Teens at Higher Risk of Injection Drug Use
While other data indicate that most HIV infections among MSM are sexually acquired, this analysis also found disproportionately high levels of injection drug use, as well as high rates of other types of drug use, among gay and bisexual male students. This compounds their risk for HIV infection.
About 10 percent of gay and bisexual male students reported having ever injected drugs, compared with less than 2 percent of heterosexual male students. In addition to injection drug use, which can directly transmit HIV, CDC also found gay and bisexual male students are significantly more likely than heterosexual male students to have ever used a number of drugs that may contribute to increased sexual risk behavior, even if not injected, including:
- Heroin: eight times more likely (14 percent of gay/bisexual and 2 percent of heterosexual).
- Methamphetamines: six times more likely (15 percent of gay/bisexual and 2 percent of heterosexual).
- Cocaine: three times more likely (18 percent of gay/bisexual and 5 percent of heterosexual).
- And prescription drugs without a doctor's prescription: two times more likely (30 percent of gay/bisexual and 17 percent of heterosexual).
"Sexual risk behaviors and substance use among gay and bisexual youth may be influenced by a number of complex and interrelated factors -- not only education and peer norms, but also social factors like stigma, discrimination, and lack of family or social support," says Laura Kann, Ph.D., chief of the School-Based Surveillance Branch within CDC's Division of Adolescent and School Health. "Although these new national data do not address why these behaviors occur, they are an important first step toward better understanding the level of risks that exist among these young males and developing solutions to address them in homes, schools, and communities."
Analysis Underscores the Need for Multiple Prevention Strategies
Overall, MSM -- including those who inject drugs -- account for 60 percent of the 1.2 million people living with HIV in the United States. In 2014, 13- to 24-year-olds accounted for more than one in five (22 percent) HIV diagnoses. Among the 13- to 24-year-olds diagnosed with HIV in 2014, 80 percent were gay and bisexual males.
CDC's new data point to the need for additional research and multiple strategies to address both sexual and drug-related risks for HIV infection among adolescent and young adult gay and bisexual males. These include:
- Continued access to HIV testing to reduce the number of undiagnosed infections.
- Education about and access to the full range of effective HIV risk reduction and prevention strategies.
- Increased linkages to and retention in HIV treatment for MSM living with HIV to reduce their viral load and risk of transmission to sexual and injection drug partners.
- School-centered HIV prevention.
- Family and community support.
- Additional research to better understand and address factors contributing to injection drug use and other substance abuse among gay and bisexual males.
To prevent HIV transmission through injecting drug use, CDC has long recommended that people who inject drugs have access to integrated prevention services from a reliable source, including sterile injection equipment, substance use treatment, and testing for HIV and hepatitis.
In December, Congress allowed states and local communities, under limited circumstances, to use federal funds to support certain components of syringe services programs. CDC is working with partner agencies to implement this new provision, which could help further expand access to prevention tools and services.
CDC is also engaged in a number of strategies to reduce prescription drug abuse. CDC's new opioid prescribing guideline released in March 2016 aims to improve opioid prescribing practices and to reduce the number of people who suffer from opioid use disorder or overdose from these drugs.
The new data presented at the International AIDS Conference will be published later this year as part of a broader report on a wide range of health risk behaviors among gay, lesbian, and bisexual students. In 2015, a question to ascertain sexual identity and a question to ascertain sex of sexual contacts was added to the National Youth Risk Behavior Survey (YRBS)(http://www.cdc.gov/healthyyouth/data/yrbs/index.htm) questionnaire, allowing for the first time an examination of the prevalence of risk behaviors among gay, lesbian, and bisexual students nationwide. The analysis presented at the International AIDS Conference is based on a subset of data that examine HIV-related risk behaviors among gay and bisexual male students.