In the JournalsPerspective

Less than a quarter of adolescent MSM have ever been tested for HIV

Less than a quarter of adolescent men who have sex with men, or AMSM, have ever been tested for HIV despite being at higher risk for infection, study findings suggested.

According to Brian Mustanski, PhD, director of the Institute for Sexual and Gender Minority Health and Wellbeing at Northwestern University, and colleagues, an estimated 51.4% of adolescents aged 13 to 24 years with HIV are undiagnosed, compared with 14.5% of total HIV infections in the United States.

In their study, Mustanski and colleagues found that few AMSM are having conversations with their pediatricians about same-sex relationships.

“Doctors — pediatricians in particular — need to be having frank and open conversations with their male teenage patients, including a detailed sexual history and a discussion about sexual orientation, ideally a private conversation without parents present,” Mustanski told Healio. “If their patient is sexually active with other males, an HIV test is strongly recommended, given their high epidemiological risk. For providers who do not want to engage in conversations about sexual orientation, defaulting to HIV testing with informed ‘opt-out’ can be effective, too.”

Males aged 13 - 24 who reported having an HIV test 
Males aged 13 - 24 years who reported having an HIV test

Mustanski and colleagues included 699 participants aged 13 to 18 years, largely recruiting them via social media. The mean age of participants was 16.6 years. About a quarter (n = 162; 23.2%) reported ever having an HIV test, and half that many (n = 81; 11.6%) reported having more than one. Most participants who had been tested (n = 121; 74.7%) said their parents were not present for the tests.

“This study found that when parents talked with their children about expectations for healthy sexual behavior that their sons were more likely to have received an HIV test,” he said. “We encourage parents to learn how to have these discussions with their children and then initiate them early — well before their child may initiate sexual behavior.”

Mustanski said that if parents ask their child’s provider to talk about sexual health and testing with them, it may be enough to start a dialogue in the exam room, which could lead to an HIV test.

Among all participants, 64.2% reporting having vaginal or anal sex before the study, including 45.5% who said they had condomless anal sex. The researchers found that 66.4% of participants learned about HIV in school, but only 32.5% spoke with their parents about the topic. Likewise, 67.5% had a regular pediatrician, but only 21.3% had conversations with them regarding sexual behavior with males.

“We need to pay particular attention to the needs of adolescents as we seek to implement programs that can help end the HIV epidemic,” Mustanski said. “I would like to see us push toward all sexually active gay and bisexual boys receiving an HIV test and 90% of those who are positive knowing their status.”

In a smaller study conducted in 2014, the rates were only slightly lower, suggesting little to no headway in increasing HIV testing rates, Mustanski said.

Mustanski and his colleagues are testing an online program called SMART, which is designed to help educate young gay, bisexual and queer males regarding HIV prevention. He said the program is being conducted in English and Spanish throughout the country. For more information on the project, you can visit the website. – by Ken Downey Jr.

Disclosures: The authors report no relevant financial disclosures.

Less than a quarter of adolescent men who have sex with men, or AMSM, have ever been tested for HIV despite being at higher risk for infection, study findings suggested.

According to Brian Mustanski, PhD, director of the Institute for Sexual and Gender Minority Health and Wellbeing at Northwestern University, and colleagues, an estimated 51.4% of adolescents aged 13 to 24 years with HIV are undiagnosed, compared with 14.5% of total HIV infections in the United States.

In their study, Mustanski and colleagues found that few AMSM are having conversations with their pediatricians about same-sex relationships.

“Doctors — pediatricians in particular — need to be having frank and open conversations with their male teenage patients, including a detailed sexual history and a discussion about sexual orientation, ideally a private conversation without parents present,” Mustanski told Healio. “If their patient is sexually active with other males, an HIV test is strongly recommended, given their high epidemiological risk. For providers who do not want to engage in conversations about sexual orientation, defaulting to HIV testing with informed ‘opt-out’ can be effective, too.”

Males aged 13 - 24 who reported having an HIV test 
Males aged 13 - 24 years who reported having an HIV test

Mustanski and colleagues included 699 participants aged 13 to 18 years, largely recruiting them via social media. The mean age of participants was 16.6 years. About a quarter (n = 162; 23.2%) reported ever having an HIV test, and half that many (n = 81; 11.6%) reported having more than one. Most participants who had been tested (n = 121; 74.7%) said their parents were not present for the tests.

“This study found that when parents talked with their children about expectations for healthy sexual behavior that their sons were more likely to have received an HIV test,” he said. “We encourage parents to learn how to have these discussions with their children and then initiate them early — well before their child may initiate sexual behavior.”

Mustanski said that if parents ask their child’s provider to talk about sexual health and testing with them, it may be enough to start a dialogue in the exam room, which could lead to an HIV test.

Among all participants, 64.2% reporting having vaginal or anal sex before the study, including 45.5% who said they had condomless anal sex. The researchers found that 66.4% of participants learned about HIV in school, but only 32.5% spoke with their parents about the topic. Likewise, 67.5% had a regular pediatrician, but only 21.3% had conversations with them regarding sexual behavior with males.

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“We need to pay particular attention to the needs of adolescents as we seek to implement programs that can help end the HIV epidemic,” Mustanski said. “I would like to see us push toward all sexually active gay and bisexual boys receiving an HIV test and 90% of those who are positive knowing their status.”

In a smaller study conducted in 2014, the rates were only slightly lower, suggesting little to no headway in increasing HIV testing rates, Mustanski said.

Mustanski and his colleagues are testing an online program called SMART, which is designed to help educate young gay, bisexual and queer males regarding HIV prevention. He said the program is being conducted in English and Spanish throughout the country. For more information on the project, you can visit the website. – by Ken Downey Jr.

Disclosures: The authors report no relevant financial disclosures.

    Perspective

    As a medical-pediatric HIV physician, I have been searching for answers to why pediatricians and youth providers do not test for HIV, especially in the era of pre-exposure prophylaxis (PrEP). I co-run a free PrEP clinic for people without insurance, and it is surprising the number of patients who have never had an HIV test nor ever had a real conversation about sex with a medical provider.

    • Susana W. Keeshin, MD
    • Assistant professor
      University of Utah

    Disclosures: Keeshin reports no relevant financial disclosures.