|
Daily HIV/AIDS Report
Public Health &
Education | Bisexually Active Adolescent Boys More Likely to
Engage in Risky Behaviors
[Feb 8, 2002]
Young
men who have had sexual contact with both male and female partners are more
likely to engage in risky sexual behaviors than boys who are uniquely
homosexually or heterosexually active, according to a study published in the
February issue of the American Journal of Public Health, Reuters
Health reports (Reuters Health, 2/1). Nearly 50% of the
estimated 112,000 to 250,000 HIV-positive U.S. adolescents are young men who
have sex with men, but some research has suggested that men who have sex
with both men and women may have different "behavioral risk
profiles" than men who only have sex with other men. Because the
behaviors "that may lead to HIV infection are usually initiated in
adolescence," a study of younger participants could be useful in
examining sexuality and risk taking among youths, the authors state. Dr.
Carol Goodenow of the Massachusetts Department of Education and colleagues
surveyed 3,267 "sexually experienced males" ranging from younger
than 12 years old to older than 18 years from Massachusetts public schools.
Participants were asked to identify themselves as either
"heterosexual," "gay," "bisexual" or "not
sure/none of the above," and they were also placed into one of three
categories based on reported sexual contact: those who only had contact with
partners of the opposite sex (heterosexually active), those who only had
contact with partners of the same sex (homosexually active) and those who
reported contact with partners of both sexes (bisexually active). The
respondents answered questions regarding their history of sexual
intercourse, intravenous drug use, condom use, alcohol and drug use and
whether they had received AIDS education or condom instruction in school.
Results
The "most important" study finding was that young men who were
only homosexually active had behavioral risk levels "no higher than
those of youths with only female partners," but that bisexually active
participants had "an extremely high-risk profile." Compared to
homosexually active participants, bisexually active men were more likely to
have four HIV risk factors: a history of unprotected sex, multiple partners,
injection drug use and an STD. The study results showed "a consistent
pattern of higher levels of AIDS risk behavior among bisexually active
youths than among young males with partners of only one sex," the
researchers write. "Whatever the causes, 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 researchers conclude.
Sexual Identity
There are several reasons for the increased risk behaviors among bisexually
active males, including questions surrounding sexual identity, the
researchers state. They suggest that such boys may feel "isolation,
loneliness and distress" as a result of their sexual feelings, which
may lead them to "ac[t] out" through risky behaviors. The
researchers also suggest that the "psychological turbulence and
distress aroused by believing one has a heavily stigmatized identity leads
to high-risk behavior in the form of attempts to disidentify oneself through
... excessive and often high-risk sexual contact with opposite-sex
partners." However, targeting bisexual adolescents is difficult because
there is a "discordance between sexual behavior and self-defined sexual
identity." Nearly 50% of homosexually active participants identified
themselves as heterosexual, and bisexually active respondents "varied
widely in regard to self-definition." The study states, "The
critical implication of the identity-behavior discordance ... is that few
young men who have sex with men are likely to be reached by prevention
messages based on self-labeled identity." However, the authors state
that the different patterns of behavior between homosexually active and
bisexually active young men illustrate the "urgent need for prevention
programs addressing these youths' specific concerns" and it is
important to find ways to reach adolescents who engage in homosexual
behavior but do not "label themselves as gay, bisexual or
homosexual."
AIDS Education
Strategies
AIDS education in school was associated with lower rates of several HIV risk
factors, including multiple sex partners, unprotected sex and intravenous
drug use. In addition, instruction on condom usage in school was associated
with a decline in unprotected sex. But the study found a
"discrepancy" between the AIDS education received by
heterosexually active respondents and bisexually and homosexually active
participants. One "significant" factor in the lack of AIDS
instruction among bisexually active and homosexually active participants was
the fact that both groups were more likely to have skipped school at least
once in the past month due to feeling unsafe. Bisexually and homosexually
active men had lower reported AIDS education even after controlling for
school attendance, however, and study researchers theorized that this could
be due to the failure of school HIV/AIDS classes to "address the
concerns and questions of many young men who have sex with men." The
authors cite "promising" recent research that found that
"mainstream" school instruction that includes
"gay-appropriate curricula and materials may reduce sexual risk
taking" among gay, lesbian and bisexual adolescents. The researchers
suggest that schools adopt "strong, culturally competent AIDS
prevention education relevant to adolescent males with male sexual
partners," although they acknowledge that such programs may be
difficult to develop in public schools. They also note that AIDS education
in public schools will not reach adolescents in alternative school settings
or those who are no longer enrolled in school. The authors conclude,
"Both school and community prevention programs have the potential for
lowering risk behavior. It is critical that such programs be strengthened
and that their messages be clearly relevant to the needs and choices faced
by all sexually active youths" (Goodenow et al., American Journal
of Public Health, February 2002).
|