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Study of HIV and STI risk is a “wake-up call” for health providers serving young gay men

, by Emily Land

two_menFor the first time, a study documents the incidence of HIV and sexually transmitted infections (STIs) among very young men who have sex with men—including those under age 18—who were followed over a period of two years. Rates of new HIV and STI cases were as high, or higher, among participants than among rates previously found for older age groups, especially for Black and Hispanic young men.

“These high rates of incident HIV and urogenital STIs among YMSM [young men who have sex with men] in this study should be a wake-up call for health-care providers working with these young men,” said Garofalo and colleagues. “Health-care providers and clinicians working with YMSM need to prioritize health education and discussions of sexual risk and partner selection, including strategies for prevention and offer routine testing at regular intervals, consistent with current CDC guidelines.”

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In the study, a total of 355 HIV-negative young men who have sex with men between 16 and 20 years of age were followed for two years. They completed HIV and STI testing at the beginning of the study and then once a year during the study. Participants also completed questionnaires about risk behavior including substance use and sexual practices.

A total of 26 young men tested positive for HIV during the study, for an overall HIV incidence rate of 4.11 per 100 person years. Cumulative incidence of HIV over the course of the 24-month study period was 7.3%, with significant differences found by race and ethnicity. The 24-month cumulative HIV incidence was:

  • 1.7% among white men (1 infection among 60 men);
  • 5.2% among Hispanic men (6 infections among 116 men); and,
  • 10.8% among Black men (17 infections among 157 men).

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There were 39 gonorrhea and chlamydia urogenital infections detected during the course of the study (rectal testing was not conducted) for an overall incidence rate of 11%, with significant differences between racial and ethnic groups. The 24-month cumulative STI incidence was:

  • 1.7% among white men (1 infection among 60 men);
  • 12.7% among Hispanic men (20 infections among 116 men); and,
  • 12.9% among Black men (15 infections among 157 men).

“The incidence of HIV and STI infections in black YMSM found in this study is particularly and strikingly high but to a large extent consistent with the current and evolving epidemiology of HIV in many urban centers of the United States,” the authors note.

Many study participants reported engaging in risk behaviors. In the six months before the first study visit, 65% reported having two or more male sex partners, 64% reported that they or their partner had concurrent partners, 49% reported unprotected anal intercourse, and 40% reported sex with a male partner of unknown HIV status. 38% reported alcohol use during sex and 25% reported drug use during sex.

“We hope this study will be the first of a growing and evolving body of longitudinal research examining a broad range of potential factors that may contribute to the acquisition of HIV and STIs in YMSM. To date, this population, particularly YMSM under age 18, have been understudied in both existing HIV intervention and epidemiological work. Our findings strongly suggest the need for more data in this area as we aim to reverse the current trend toward rising rates of HIV in YMSM and specifically YMSM of color,” said Garofalo and colleagues.


Garofalo, R. and others. Incidence of HIV infection and sexually transmitted infections and related risk factors among very young men who have sex with men. JAIDS. May 1, 2016.


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