Young men who have sex with men have highest HIV infection risk — Just 1 in 5 is tested

Young men who have sex with men (MSM) have the highest risk for HIV infection, but only one in five has ever been tested for HIV, according to new research.¹

Low levels of testing are a concern in this age group, because young gay and bisexual men ages 13-24 accounted for 72% of new HIV infections among all persons in that age group in 2010, and they represented 30% of new infections among all gay and bisexual men, according to statistics from the Centers for Disease Control and Prevention (CDC).² Black/African American or Hispanic/Latino gay and bisexual young men are especially affected, CDC data reflect.³

Looking at 2007-2010 statistics, the CDC reports 89% of HIV/AIDS cases among young men ages 13-24 were attributed to male-to-male sexual contact; 58% of HIV/AIDS infections were in African Americans/blacks, 20% in Latinos/Hispanics, and 19% in whites. During this same time period, cases of HIV/AIDS among young African American/black MSM ages 13-24 increased by 48%. While diagnoses of HIV also increased among white and Hispanic men who have sex with men, rates rose less sharply, CDC data indicate.⁴

Little is known about testing rates among men ages 18 and younger or about the barriers that they face when contemplating an HIV test, say researchers at the Chicago-based Northwestern University Feinberg School of Medicine and the Center for Innovative Public Health Research (IMPACT Program), based in the School’s Department of Medical Social Sciences. The IMPACT Program is focused on conducting translational research that improves the health of the lesbian, gay, bisexual, and transgender (LGBT) community and increases understanding of the development of sexual orientation and gender identity.

Supported by a grant from the National Institutes of Health’s National Institute of Mental Health, the researchers examined testing behaviors and barriers among a diverse national sample of adolescent gay and bisexual men. They reported results in the current study.¹

Between June and November 2014, scientists enrolled a national sample of 302 males ages 14-18 who identified themselves as gay, bisexual, or queer into a text messaging-based HIV prevention program. Questions about their HIV-testing behaviors were included in the study. Researchers report only 20% of the teen boys had ever been tested for HIV, a rate that is much lower than what other studies have found with adult gay and bisexual men. Nearly half (42.9%) of sexually active participants did not know where they could go to get tested for HIV.¹

Researchers asked nine questions to assess potential barriers to HIV testing; these factored into three subscales: external factors, fear, and feelings of invincibility. Among sexually active participants, those who had never been tested for HIV had significantly greater scores on the external factors (odds ratio, 1.63; 95% confidence interval, 1.01-2.66) and fear (odds ratio, 1.88; 95% confidence interval, 1.11-3.19) subscale. Older youth ages 16-18 were especially likely to be affected by external factor barriers, and fear was associated with never testing among gay-identified individuals.¹

Break down the barriers

The Chicago-based researchers found that the greatest barriers to teen males getting tested are not knowing where to obtain an HIV test, worries about being recognized at a testing site, and to a lesser degree, thinking they are invincible and won’t get infected.

“Understanding the barriers to testing provides critical information for intervening, so we can help young men get tested,” said Gregory Phillips II, PhD, a research assistant professor of medical social sciences at Northwestern University Feinberg School of Medicine and an investigator for the IMPACT LGBT Health and Development Program at Feinberg. Phillips served as the study’s first author.

Rates of new HIV infections are increasing among young gay and bisexual men, noted Brian Mustanski, PhD, an associate professor of medical social sciences at Feinberg and director of IMPACT, in a press statement accompanying the publication.

“Testing is critical because it can help those who are positive receive lifesaving medical care,” noted Mustanski, who served as the principal investigator of the project. “Effective treatment can also help prevent them from transmitting the virus to others.”

Findings from the study indicate that testing might be increased by providing young men with an easy way to find nearby testing sites via text messaging or online programs, as well as opening testing sites in high schools. Providing in-school testing would normalize the process, Phillips states. With the constant presence of on-site testing at schools, testing would seem less stigmatized, increase knowledge about the testing process, and make it less scary, he observes.

Increase testing access

Because young people spend a significant part of their day in school, education agencies and schools can play key roles in supporting HIV testing, states the CDC.⁵

School-based referral programs can help connect students to adolescent-friendly community healthcare providers.^6,7 According to the CDC, some schools might be able to offer on-site testing with a school-linked or school-based clinic, or in partnership with mobile testing programs.

Online information explaining the testing procedure also can calm young men’s fears, note the Chicago-based researchers. Adolescents might not know that finger stick or cheek swabs are options for testing. To help young people understand the testing process, the IMPACT Program at Feinberg created a video to show what it’s like to get an HIV test. (See the video at http://bit.ly/1NVXpP1. Click on the link “video that shows young people what it’s like to get an HIV test.”)

High schools can strengthen their HIV prevention curricula by including information on locations and procedures for obtaining free, or low-cost, confidential HIV testing, advises the CDC.

Support grows

Federal support for preventing HIV/AIDS in adolescents is growing.

The Department of Health and Human Services’ Office of Adolescent Health awarded a $350,000 grant in June 2015 to Boston-based JSI Research and Training Institute to support an online National HIV/AIDS Resource Center. The center will promote practical strategies for community-based providers and youth-serving professionals. It will offer information and resources targeted to adolescents who might be at high risk for HIV infection and those living with AIDS. It also will have links to training and technical assistance. The online service also will include interactive media and social media to help improve adolescent health and well-being.

REFERENCES

1. Phillips G 2nd, Ybarra ML, Prescott TL, et al. Low rates of human immunodeficiency virus testing among adolescent gay, bisexual, and queer men. J Adolesc Health 2015; 57(4):407-412.
2. Centers for Disease Control and Prevention. HIV among Gay and Bisexual Men. Accessed at http://1.usa.gov/1GBOga1.
3. Centers for Disease Control and Prevention. HIV among Youth. Accessed at http://1.usa.gov/1jVAHgW.
4. Centers for Disease Control and Prevention. HIV Surveillance — Men Who Have Sex With Men (MSM). Accessed at http://1.usa.gov/1Lcpore.
5. Centers for Disease Control and Prevention. HIV Testing Among Adolescents: What Schools and Education Agencies Can Do. Accessed at http://1.usa.gov/1FabzMG.
6. Dittus P, Loosier P, DeRosa C, et al. The Project Connect health systems intervention: Sexual and reproductive health outcomes for sexually active youth. Presented at the Annual Meeting of the Society for Adolescent Health and Medicine. Seattle; March 2011.
7. Lezin N, Witt S, Taylor J, et al. PATHS: Providing Access to HIV Testing Through Schools: A Resource Guide for Schools. Scotts Valley, CA: ETR Associates; 2010.