Professional Documents
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HIV/AIDS has increased most among YMSM, especially young men of color.
• From 2001 through 2006, male-to-male sex was the largest HIV transmission category in the United States* and the only
one associated with an increasing number of HIV/AIDS diagnoses.3
• Of all age groups of MSM, HIV/AIDS cases increased most among YMSM aged 13–24 (Figure 1).
• Among YMSM aged 13–24, young black MSM had the most dramatic increase in diagnoses—from 938 cases in 2001
to 1,811 cases in 2006, an increase of 93% (Figure 2).
Figure 1. Estimated Number of HIV/AIDS Cases Figure 2. Estimated Number of HIV/AIDS Cases
Among Adolescent and Adult MSM, Among YMSM Aged 13–24 Years,
by Age Group, 2001–2006—33 States* by Race/Ethnicity, 2001–2006—33 States*
7,000
4,000
1,200
Black
3,000 45–54 yrs
800
2,000 13–24 yrs
White Hispanic
≥55 yrs 400
1,000 American Indian/
Asian/Pacific Islander Alaska Native
0 0
2001 2002 2003 2004 2005 2006 2001 2002 2003 2004 2005 2006
Year of diagnosis Year of diagnosis
The reasons for these disparities are varied and not well understood.
The reasons for continued high HIV/AIDS rates among YMSM are multiple and complex. Possible factors include the following:
• The alarming percentage of young HIV-infected MSM who do not know they are infected. In one recent study,
77% of young, urban MSM aged 15–29 who tested HIV-positive as part of the study mistakenly believed they were not
infected. The percentage was even higher for young black HIV-infected MSM, 90% of whom did not know their infection
status.4 People who don’t know they are infected might be less likely to take measures to keep from spreading the virus
to others.
1
• Failure to reach MSM with effective HIV interventions or prevention education. A CDC study of MSM 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 exclude information about sexual orientation or ignore issues in the lives
of sexual minority youth might not be effective in preventing HIV transmission among those students.
• Unintended consequences of successful treatment. 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 infection
as less dangerous and more treatable, leading them to become complacent about risks.6
• Use of alcohol and illegal drugs. Alcohol, methamphetamine, and other “party drug” use is prevalent among
some YMSM and can lead to risky sexual behavior.6
• Elevated rates of sexually transmitted diseases (STDs) among MSM. Having an STD can raise the risk of
HIV infection by two- to fivefold. STDs also appear to increase the risk of transmitting HIV to sex partners.6
• Mental health consequences of stigma and discrimination. Bullying, harassment, family disapproval,
social isolation, and sexual violence—which are experienced frequently by sexual minority youth—can lead to
feelings of shame and poor self-concept. This can lead to higher rates of emotional distress, suicide attempts,
substance use, and risky sexual behavior.7–9
The racial/ethnic disparities in HIV/AIDS among young MSM are also not well understood. The disparities do not
appear to reflect individual racial/ethnic differences in risk behavior. An analysis of 53 studies found no significant
differences between black and white MSM in levels of unprotected anal intercourse, commercial sex work, sex
with a known HIV-positive partner, or HIV testing history.10 Other 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 antiretroviral treatment, which can reduce the amount of HIV in the blood and potentially
decrease transmission.10
2
The benefits of adding a question about the gender of adolescents’ sex partners to the YRBS are many. Collecting
such data enables states and cities to analyze same- or both-sex sexual activity in relation to unprotected sex,
substance use, suicidal behavior, and other health risk behaviors and then adjust intervention priorities accordingly.
Furthermore, by documenting that many youth do engage in same-sex sexual activity and sexual risk behaviors,
these data can help establish the imperative for meeting the health needs of sexual minority youth in schools.
The following question is on the list of optional YRBS questions:
During your life, with whom have you had sexual contact?
□ I have never had sexual contact □ Females
□ Males □ Females and males
3
• The HIV/AIDS Prevention Unit of the Los Angeles Unified School District (LAUSD) developed a chapter about
sexual orientation for inclusion in the Sexuality and Society textbook (Holt, Rhinehart, and Winston, 2005) that is
used in required health education courses in LAUSD high schools. The district employs two full-time staff members
to address issues pertaining to sexual minority youth, and approximately 35,000 LAUSD employees and students—
including all teachers hired since 2003—have received the district’s anti-bias training. In addition, the district has 50
active GSAs, cosponsors an annual Model of Pride conference, and accommodates safe zones for students who
have concerns around perceived sexual orientation and mistreatment by peers.
• In response to requests from school districts throughout Michigan for guidance on creating safe school environments
for sexual minority students, the Michigan Department of Education (MDE) collaborated with the Calhoun
(Michigan) Intermediate School District (CISD) to update CISD’s guide and training program on the topic and
to offer trainings statewide. Now in its 4th edition, nearly 2,000 copies of A Silent Crisis: Creating Safe Schools
for Sexual Minority Youth have been distributed throughout Michigan and 20 other states. MDE has conducted
workshops using the guide for nearly 900 educators in 180 Michigan school districts. The guide is available at
www.emc.cmich.edu/products/misc/SilentCrisis.htm.
• The School District of Philadelphia offers teachers and staff in all K–12 schools a training entitled “Fostering
Knowledge About and Respect for LGBT Youth.” The training helps teachers and school staff members understand
terminology and issues regarding sexual orientation, reinforces district policy prohibiting harassment, and involves
teachers in role plays where they learn how to respond to harassing language.
CDC’s Division of HIV/AIDS Prevention also funds health departments and community organizations to promote the use
of evidence-based HIV interventions, many of which are geared toward YMSM and young people of color. Information
about these interventions is available at www.cdc.gov/hiv/topics/research/prs/evidence-based-interventions.htm.
References
1. Hall HI, Ruiguang S, Rhodes P, et al. Estimation of HIV incidence in the United States.
JAMA 2008;300:520–529.
2. CDC. HIV/AIDS surveillance in adolescents and young adults (through 2006).
Atlanta: US Department of Health and Human Services; 2008. Available at
www.cdc.gov/hiv/topics/surveillance/resources/slides/adolescents/index.htm.
3. CDC. Trends in HIV/AIDS diagnoses among men who have sex with men—33 states, 2001–2006.
MMWR 2008;57:681–6.
4. MacKellar DA, Valleroy L, Secura G, et al. Unrecognized HIV infection, risk behaviors, and perceptions
of risk among young men who have sex with men: opportunities for advancing HIV prevention in the third
decade of HIV/AIDS. J AIDS 2005; 38:603–614.
5. CDC. MMWR analysis provides new details on HIV incidence in U.S. populations.
Atlanta: US Department of Health and Human Services; 2008. Available at
www.cdc.gov/hiv/topics/surveillance/resources/factsheets/MMWR-incidence.htm.
6. CDC. HIV/AIDS among men who have sex with men. Atlanta: US Department of Health and Human
Services; 2007. Available at www.cdc.gov/hiv/topics/msm/resources/factsheets/msm.htm.
7. Resnick MD, Bearman PS, Blum RW, et al. Protecting adolescents from harm: findings from the
National Longitudinal Study on Adolescent Health. JAMA 1997;278:823–32.
8. Garafolo R, Wolf RC, Kessel S, Palfrey J, DuRant RH. The association between health risk behaviors
and sexual orientation among a school-based sample of adolescents. Pediatrics 1998;101:895–902.
9. Just the Facts Coalition. Just the Facts about Sexual Orientation and Youth: A Primer for Principals,
Educators, and School Personnel. Washington, DC: American Psychological Association; 2008.
Available at http://www.apa.org/pi/lgbc/publications/justthefacts.pdf.
10. Millett G, Flores F, Peterson JL, Bakeman R. Explaining disparities in HIV infection among black and white
men who have sex with men: a meta-analysis of HIV risk behaviors. AIDS 2007;21:2083–91.
11. Goodenow C, Netherland J, Szalacha L. AIDS-related risk among adolescent males who have sex with
males, females, or both: evidence from a statewide survey. American Journal of Public Health 2002;92:203–10.
12. Robin L, Brener ND, Donahue SF, Hack T, Hale K, Goodenow C. Associations between health risk behaviors and opposite-, same-, and both-
sex sexual partners in representative samples of Vermont and Massachusetts high school students. Archives of Pediatric and Adolescent
Medicine 2002;156:349–55.
13. GLSEN. The 2007 National School Climate Survey. New York: Gay, Lesbian, and Straight Education Network; 2008.
14. Goodenow C, Szalacha L, Westheimer K. School support groups, other school factors, and the safety of sexual minority adolescents.
Psychology in the Schools 2006;43:573–89.