Young Gay Men at Risk

Young gay men in the United States currently become infected with HIV at a rate of 4 percent a year. At that rate, half of all gay men who are now 18 years old will be HIV positive by the time they are 30.

Although the last decade has seen HIV infection rates decline among gay men overall, high rates of infection persist among young gay men. In San Francisco, where a decade ago the gay community succeeded in reducing infection rates, a recent study of gay men aged 18 to 29 found that 18 percent were HIV positive. Another study sampled young gay men aged 17 to 22 from public venues-such as bars, street corners, dance clubs, and parks-and found an overall HIV infection rate of 9 percent, with 21 percent of young African American men infected. In New York City, a study of gay men aged 18 to 24 also found 9 percent to be infected.

Are HIV prevention messages reaching young gay men? According to Steven Romero, special projects director for MPower, a peer-led HIV prevention program in Albuquerque, young gay men are receiving the prevention message, but whether they are acting upon that message is another question.

"The 18- to 20-year-olds especially have a very black and white view of HIV," says Romero. "They tell us when they come through the door, 'Oh no, I would never have sex without a condom.' Whether they actually have the self-esteem and power to say no, that I'm not so sure about."

Oscar Lopez, a coordinator of youth services for the COLOURS Organization, a service organization for men and women of color, believes not all young people are getting the safer sex message. Despite a continuing increase in the rate of HIV infection among gay men of color, says Lopez, there continues to be a lack of programs targeted to this group.

"When our kids go out on the street, they don't get correct facts about condoms or safer sex," says Lopez. "The mainstream HIV education field needs to understand that interventions used for the white community cannot be used for our communities' needs. We deal with our sexuality in many different ways. Services need to be made available in a culturally and linguistically sensitive manner."

Trust, Intimacy, and Friendship
A number of studies have revealed that young gay men in the United States are engaging in activities that place them at risk for HIV infection-including unprotected sexual intercourse and drug and alcohol abuse-at alarming rates. Interpersonal issues, such as the desire for companionship and wanting to fit in, can induce young gay men to take sexual risks.

"The reasons young gay men engage in high-risk behaviors are similar to the reasons lots of gay men or, for that matter, most straight people, engage in high-risk behaviors," says Robert Perez, media manager for the STOP AIDS Project in San Francisco. "It's about trust and intimacy."

"Having sex with another man is one of the only ways many young men have to make a connection to being gay and the gay community," says Robert Hays, a researcher at the Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, and director of the MPowerment Program, an HIV prevention program for young gay men. "Sex has more than just physical meaning. It's a way to make friends, increase self-esteem, find companionship."

Other factors also may contribute to risky behavior. Many in the gay community believe the media hype around treatment advances and the decline in AIDS deaths have led to the misperception that young men do not need to worry about AIDS.

"There are so many other issues that young gay guys are dealing with besides HIV-coming out, dealing with their sexuality, gaining family acceptance," says MPower's Romero. "A lot of guys are all too willing to put HIV out of their heads. The media hype gives them one more reason not to think about HIV, to tell themselves, 'It's treatable, I won't get sick, I won't die.'"

The Role of Schools
The sense of alienation that can often lead to risk-taking behavior is exacerbated by the rampant homophobia often found in schools. "Gay kids are not safe in the schools," says Lopez about the young men in the COLOURS support group in Philadelphia. "They are being harassed physically, verbally, and emotionally by students, teachers, administrators, and security guards. And the schools are doing nothing to protect them. Almost half of our kids drop out of school because of harassment."

"It's a concern," says Perez. "The new generation of young gay men is coming out at younger and younger ages. Even in San Francisco there are not the resources available to adequately address the needs of young gay men coming out in schools."

To compound the problem, in recent years schools have been slowly relinquishing responsibility for providing sex education. Thirteen states do not require schools to provide education on sexuality, sexually transmitted diseases, or HIV. Several of those states are in the South, where high rates of new HIV infections in youth are occurring. In addition, eight states require or recommend teaching that homosexuality is not an acceptable lifestyle. The impact of these teachings on young gay men varies by school and region.

Men of Color at Risk
At particular risk are gay teenagers living in inner-city neighborhoods. For young African American and Latino populations, rates of infection have actually increased. "Gay youth of color have many issues to deal with; it's not only sexuality," says Lopez. "We have to deal with many things most white kids don't have to deal with, like racism, poverty, and violence. If you walk down the street in our neighborhoods you might get shot, you see drug deals happening. A lot of our kids have to work to help pay the rent because their parents are too drunk or involved in drugs."

Many young men of color suffer from the lack of a strong support system behind them. "Gay kids see all their support systems-their families, the school system, the church-turning their backs on them," says Lopez. "So they turn to the street or to the clubs, where they may meet adults who take advantage of them in many ways. And one of those ways is sexually."

Risky Social Venues
The social structure of gay culture is another factor supporting high-risk behavior. In many cities, gay bars and public sex areas are the only gathering sites for gay men. Even in San Francisco, where there are more social options available to gay men, the context in which gay men can be together is often one that does not promote safer sex.

"When I go to a bar, I'm amazed at the ability of young gay people to have a phenomenal time," says Romero. "Conversely, I think, my God, what are we doing to ourselves? I'm watching us practice unsafe and unhealthy behaviors, like drinking, drug abuse, sex abuse. I think how sad it is that this is the only place where we can be together."

Taking Action
With infections high among young gay men and many older gay men returning to unsafe sex, gay community leaders know they must step up efforts if they are to avoid the tragic, unnecessary loss of another generation of gay men to AIDS. In response, programs have sprung up that create alternative social venues for young gay men. The MPowerment Program, which is now in three states, sponsors monthly parties and weekly social events, such as volleyball games, movie nights, and barbecues. All activities are alcohol-free.

"A lot of guys are starved for anything," says Hays. "They may not even like volleyball, but they join because it's there."

Q Action in San Francisco sponsors cafe chats-topical meetings in coffee houses that offer social interaction with other young gay men. Topics focus on issues of interest, such as relationships, dating across racial and ethnic lines, and body image. HIV prevention is part of the mix.

The COLOURS Organization in Philadelphia offers a supportive environment for young gay men of color with weekly support groups, peer educator training, and individual case management. It also trys to foster gay-friendly drug and alcohol services.

"A lot of gay youth of color have learned that the best thing to do is keep quiet about their sexual orientation when seeking services," says Lopez, citing instances in which young men perceived to be gay have encountered discrimination when seeking help. "We try to help them find a friendly, non-hostile treatment facility that they feel comfortable going back to."

In the past several years, gay men of all ages have begun to gather for cross-generational dialogue. The exchanges help young gay men learn from the experiences of older gay men and provide them with a support network. Last year, the STOP AIDS Project held a public meeting that drew gay men ranging in age from their twenties to their seventies. "It was a great discussion, and we asked some hot, controversial questions," says Perez.

"Sometimes there's a negative response from older men," says Perez, about programs for young gay men. "A lot of men think it's ageist, separating the young and the old. We're definitely breaking down the barriers, but there's still a lot of work that needs to be done."

The attitude of young men toward older men has changed as they realized they need older men, says Romero. "Young guys lack the social networks, the monetary security, and the keys that open doors to access and influence. For our needs to be met, we need the support of our elders.

"We have a wonderful program here, but now we're going out to try to attract money to keep the program going, and we're in trouble," Romero adds. "We don't have the expertise or the knowledge to get funding without the support of our community elders."

The gay community, say its leaders, must come together just as it did early in the epidemic to develop prevention efforts that will succeed in lowering the HIV infection rate among young gay men. "There are still a lot of agencies that set up a table in a gay bar with AIDS posters and condoms and wonder why young guys don't come up to talk to them," says Hays. "But at least most people now recognize that young gay men are an important group to target for prevention. And there are more innovative programs emerging.

"With young gay men, you have to think about marketing-prevention issues in and of themselves are not compelling," Hays adds. "Don't assume HIV is appealing. Programs that address personal relationships, self-esteem, companionship, and dealing with homophobia in the context of safer sex and drug use are going to be much more effective."

- Pamela DeCarlo is communications specialist at the Center for AIDS Prevention Studies, University of California, San Francisco.