Bisexually Active Adolescent Boys More Likely to Engage in Risky Behaviors
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.
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.
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).