Men Who Have Sex with Men Receive Less HIV Education

Julia Raifman, ScD, SM, lead author, assistant professor, health law, policy and management, Boston University School of Public Health

Julia Raifman, ScD, SM

According to a recent study led by Boston University School of Public Health (BUSPH), young men who have sex with men (MSM) are less likely to receive school-based HIV education than young men who have sex with women, leading to a higher risk of HIV infection.

Researchers aimed to evaluate HIV education and sexual risk behaviors among young men who have sex with men (YMSM) relative to men having sex with women (MSW) in order to identify the relationships between HIV education and YMSM sexual risk behaviors.

The study, published in LGBT Health, found that 84% of MSM reported learning about HIV in school compared to 90% of MSW.

“It’s striking that the young people who are at most risk of HIV are least likely to report HIV education in school,” Julia Raifman, ScD, SM, lead author, assistant professor, health law, policy and management, Boston University School of Public Health, said in the study.

Researchers used data from the Centers for Disease Control and Prevention (CDC) Youth Risk Behaviors Surveillance System that collected information on sex of sexual contacts and HIV education in 2011 and/or 2013. HIV education, number of sexual partners ever and in the past 3 months, and condom use at last sex were all assessed, controlling for age, race/ethnicity, state and year.

Students who had not had sex, did not report age and/or race in the survey, and who in another survey reported ever having been forced to have sex were eliminated from the study. Of the remaining 16,372 male students, 94.1% reported sex with only women, 2.9% reported sex with only men, while 3% reported sex with men and women.

In 2015, YMSM accounted for 95% of estimated HIV diagnoses among adolescents aged 13—24. Findings reported that YMSM were less likely to receive and report HIV education and more likely to engage in sexual behaviors.

YMSM had lower odds of reporting condom use at last sex, “an alarming finding given the high and increasing rates of HIV transmission among YMSM,” researchers wrote.

Less than half of the YMSM had used a condom the last time they had sex, compared to 72% of young men who have sex with women. Men who had sex with men and women also were found to have a high rate of sexual partners — 3 or more in the last 3 months compared to men who had sex with only men or only women.

Additionally, to finding MSM were less likely to receive HIV education than men who had sex only with women, differences occurred within subgroups of MSM — with 81.1% of young men who had sex with both men and women reporting HIV education compared to 86.8% of young men who only had sex with men.

Across the board, school-based HIV education was associated with lower odds of having 3 or more partners in the last 3 months and higher odds of condom use at last sexual encounter.

The risk behavior differences were more pronounced in MSM than men who only had sex with women, more than doubling the odds of using a condom at last sexual encounter and reducing 5 times the odds of having 3 or more partners in the last 3 months.

HIV education was associated with reduced sexual risks behaviors among all students, with more dramatic reductions among young MSM than their peers.

“I am hopeful that this evidence will prompt more states to make sex education inclusive of gay, lesbian, bisexual and transgender populations,” Raifman added. “Condoms and PrEP are very effective approaches to preventing HIV, but they won’t do any good unless those most at risk know about them.”

The disparity may reflect that sex education is not inclusive of sexual minority students, the study authors said. Findings are consistent with prior research that YMSM don’t feel sex education materials designed for the public are inclusive to their needs.

Only 24% of schools teach or provide supplementary materials about safe sex for sexual minorities, 7 states currently ban positive discussion of same-sex sexual behavior or orientation and 3 states require inclusion of negative information about sexual minorities in sex education.

Currently, 9 states mandate inclusive sex education, “all young people deserve to learn about how to protect their health" while Massachusetts is considering a bill to make sex education inclusive, Raifman noted.

School-based sex education that incorporates relevant information on condom use, PrEP and elevated HIV risk could play an important role in reducing sexual risk behaviors and HIV transmission among YMSM.

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