Context Studies conducted in the late 1980s on human immunodeficiency virus
(HIV) infection among older men who have sex with men (MSM) suggested the
epidemic had peaked; however, more recent studies in younger MSM have suggested
continued high HIV incidence.
Objective To investigate the current state of the HIV epidemic among adolescent
and young adult MSM in the United States by assessing the prevalence of HIV
infection and associated risks in this population in metropolitan areas.
Design The Young Men's Survey, a cross-sectional, multisite, venue-based survey
conducted from 1994 through 1998.
Setting One hundred ninety-four public venues frequented by young MSM in Baltimore,
Md; Dallas, Tex; Los Angeles, Calif; Miami, Fla; New York, NY; the San Francisco
(Calif) Bay Area; and Seattle, Wash.
Subjects A total of 3492 15- to 22-year-old MSM who consented to an interview
and HIV testing.
Main Outcome Measures Prevalence of HIV infection and associated characteristics and risk
Results Prevalence of HIV infection was high (overall, 7.2%; range for the 7
areas, 2.2%-12.1%) and increased with age, from 0% among 15-year-olds to 9.7%
among 22-year-olds. Multivariate-adjusted HIV infection prevalence was higher
among blacks (odds ratio [OR], 6.3; 95% confidence interval [CI], 4.1-9.8),
young men of mixed or other race (OR, 4.8; 95% CI, 3.0-7.6), and Hispanics
(OR, 2.3; 95% CI, 1.5-3.4), compared with whites (referent) and Asian Americans
and Pacific Islanders (OR, 1.1; 95% CI, 0.5-2.8). Factors most strongly associated
with HIV infection were being black, mixed, or other race; having ever had
anal sex with a man (OR, 5.0; 95% CI, 1.8-13.8); or having had sex with 20
or more men (OR, 3.0; 95% CI, 2.0-4.7). Only 46 (18%) of the 249 HIV-positive
men knew they were infected before this testing; 37 (15%) were receiving medical
care for HIV, and 19 (8%) were receiving medical drug therapy for HIV. Prevalence
of unprotected anal sex during the past 6 months was high (overall, 41%; range,
Conclusions Among these young MSM, HIV prevalence was high, underscoring the need
to evaluate and intensify prevention efforts for young MSM, particularly blacks,
men of mixed race or ethnicity, Hispanics, and adolescents.