AIDS-Related Risk Among Adolescent Males Who Have Sex With Males, Females, or Both: Evidence From a Statewide Survey

A study in the February issue of the American Journal of Public Health examines a statewide survey of AIDS-related risk among adolescent males who have sex with males, females, or both.

Study participants were sexually experienced males, from the sample of high school students who completed the 1995, 1997, or 1999 Massachusetts Youth Risk Behavior Survey (MYRBS).

The surveys measure the prevalence of risk behaviors among adolescents in the state. The anonymous study included only male youth who indicated that they had had some sexual contact with another person. The combined data from 1995, 1997, and 1999 resulted in a sample size of 3267 male high school students.

Measures

The majority of the MYRBS questions were developed by the U.S. Centers for Disease Control as part of its Youth Risk Behavior Surveillance System.

The Massachusetts Department of Education added a question asking young people about their sexual contacts. Response options included “I have not had sexual contact with anyone, female(s), male(s), and both female(s) and male(s). Sexual contact was not defined.

Another new question asked youth to describe themselves in terms of sexual orientation. Response options were heterosexual/straight, gay or lesbian, bisexual, and not sure. (In 1995, none of the above was also a response option).

Results

School AIDS Education

Ever received AIDS education in school

• 93% of respondents with partners of opposite sex only reported receiving AIDS education
• 83% of respondents with partners of same sex only reported receiving AIDS education
• 67% of respondents with partners of both sexes reported receiving AIDS education

Sexual Activity

Four or more lifetime sexual intercourse partners*

• 28% of respondents with partners of opposite sex only reported four or more lifetime sexual intercourse partners
• 19% of respondents with partners of same sex only reported four or more lifetime sexual intercourse partners
• 63% of respondents with partners of both sexes reported four or more lifetime sexual intercourse partners

Four or more sexual intercourse partners in the previous three months*

• 7% of respondents with partners of opposite sex only reported four or more sexual intercourse partners in the previous three months
• 6% of respondents with partners of same sex only reported four or more sexual intercourse partners in the previous three months
• 43% of respondents with partners of both sexes reported four or more sexual intercourse partners in the previous three months

(* Sexual intercourse was not defined in the survey.)

Ever had sexual contact against will

• 8% of respondents with partners of opposite sex only reported ever having sexual contact against his will
• 21% of respondents with partners of same sex only reported ever having sexual contact against his will
• 59% of respondents with partners of both sexes reported ever having sexual contact against his will

Condom Use

Condom used at most recent intercourse

• 66% of respondents with partners of opposite sex reported condom use at most recent intercourse
• 61% of respondents with partners of same sex reported condom use at most recent intercourse
• 33% of respondents with partners of both sexes reported condom use at most recent intercourse

Sexually Transmitted Diseases

Ever diagnosed with any sexually transmitted disease

• 3% of respondents with partners of opposite sex reported ever being diagnosed with an STD
• 4% of respondents with partners of same sex reported ever being diagnosed with an STD
• 35% of respondents with partners of both sexes reported ever being diagnosed with an STD

Injection Drug Use

Ever injected illegal drugs

• 4% of respondents with partners of opposite sex reported ever injecting illegal drugs
• 6% of respondents with partners of same sex reported ever injecting illegal drugs
• 39% of respondents with partners of both sexes reported ever injecting illegal drugs

The authors believe the most important findings of this study concern the different risk rates among adolescent males with opposite-sex, same-sex, and both-sex partners.

Young men with only male partners reported behavioral risk levels no higher than those of youths with only female partners. In contrast, young men who had partners of both sexes in this study present an extremely high-risk profile. The authors note it is difficult at this point to determine why this pattern occurs in the findings but that it is important to realize bisexually active males constitute a group at high risk for AIDS and other STDs and their male and female partners are at high risk as well.

The study found a strong association between sexual abuse or coercion and high levels of risk behavior.

The authors note the issue of sexual identity is complicated. In this study, 45 young men reported heterosexual-only activity but indicated that they were gay or bisexual and more than half of the young men with male partners (98/202) self-identified as heterosexual.

The authors conclude that clear differences between young men with only male partners and young men with partners of both sexes indicate the importance of separating these two groups of YMSM in future research, and possibly, in intervention efforts. Also, the differences between sexual behavior and sexual identity highlight the importance of finding ways to reach adolescents who engage in male-male sex but do not label themselves as gay, bisexual, or homosexual.

For more information: Carol Goodenow, Ph.D., et al., AIDS-Related Risk among Adolescent Males who Have Sex with Males, Females, or Both: Evidence from a Statewide Survey, American Journal of Public Health, February 2002, vol. 92, no. 2, pp 203-9.