HIV in Young Men Who Have Sex with Men: A Review of Epidemiology, Risk and Protective Factors, and Interventions

Figures & data

Figure 1 Centers for Disease Control (CDC; 2008) estimated numbers of diagnoses of HIV infection among adolescents and young adults aged 13 to 24 years, by transmission category, in 37 states and five U.S.-dependent areas with confidential name-based reporting. Note. The graph was created using data reported by the CDC (2010b). Data from three youth with “other” cause of infection were removed to increase clarity of graph. MSM = men who have sex with men; IDU = injection drug use; MSM + IDU = individual in both MSM and IDU transmission risk categories.

Figure 2 A visual depiction of Bronfenbrenner's (1979) multi-systemic ecological theory of development, applied to HIV risk and protective factors among YMSM. Note. We used this model to structure our review, placing each risk-related variable into one of the categories and discussing each category successively. MSM = men who have sex with men.

Table 1. Correlates of Sexual Risk among Young Men Who Have Sex with Men

Variable	Correlates of Sexual Risk	Theoretical or Empirical Evidence	Degree of Support
Structural factors	Lack of relevant school-based sexual health education	Santelli et al. (2006)	Policy review and school-based survey
	Lack of evidence-based prevention programs	Johnson et al. (2008); Lyles et al. (2007)	Systematic review and meta-analysis
Societal factors	Institutional discrimination	Hatzenbuehler, McLaughlin, Keyes, & Hasin (2010)	Theoretical
	Minority stress	Meyer (2003)	Theoretical
	Stigma	Hatzenbuehler (2009); Pachankis (2007)	Theoretical
Family factors	Support or rejection	Garofalo, Mustanski, & Donenberg (2008); Mustanski, Garofalo, & Newcomb (in press); Ryan, Huebner, Diaz, & Sanchez (2009)	More research needed
Intimate partner dyads	Primary vs. casual partners	Adam, Sears, & Schellenberg (2000); Crepaz et al. (2000); Davidovich et al. (2001); Dudley, Rostosky, Korfhage, & Zimmerman (2004); Guzman et al. (2005); Hays, Kegeles, & Coates (1997); Kubicek et al. (2008); Stueve, O'Donnell, Duran, San Doval, & Geier (2002)	Strong empirical support
	Partner age	Bingham et al. (2003); Morris, Zavisca, & Dean (1995)	More research needed
	Partner race and ethnicity	Clerkin, Newcomb, & Mustanski (2010)	More research needed
	Internet sex-seeking	Garofalo, Herrrick, Mustanski, & Donenberg (2007); Horvath, Bowen, & Williams (2006); Horvath, Rosser, & Remafedi (2008); Mustanski, Lyons, & Garcia (in press)	Inconsistent empirical support
	Sex work	Allman & Myers (1999); Bacon et al. (2006); Belza & EPI–VIH Study Group (2005); Bimbi (2007); Padilla (2007); Parsons, Koken, & Bimbi (2007); Rietmeijer, Wolitski, Fishbein, Corby, & Cohn (1998); Smith & Grov (2011)	Strong theoretical and empirical support
Peer influences	Peers as agents of behavioral change	Amirkhanian, Kelly, Kabakchieva, McAuliffe, & Vassileva (2003); Hays, Rebchook, & Kegeles (2003); Kegeles, Hays, Pollack, & Coates (1999)	Strong empirical support among emerging adult MSM; more research needed on adolescent MSM
Individual characteristics	Alcohol use	Celentano et al. (2006); Choi et al. (2005); Dufour et al. (2000); Hays, Paul, Ekstrand, et al. (1997); Horvath, Rosser, & Remafedi (2008); McNall & Remafedi (1999); Mustanski (2008); Newcomb, Clerkin, & Mustanski (in press); Stueve et al. (2002); Waldo, McFarland, Katz, MacKellar, & Valleroy (2000)	Inconsistent empirical support
	Drug use	Celentano et al. (2006); Choi et al. (2005); Clatts, Goldsamt, & Yi (2005a, 2005b); Garofalo, Mustanski, McKirnan, Herrick, & Donenberg (2007); Hays, Kegeles, & Coates (1997); McNall & Remafedi (1999); Meyer & Dean (1995); Molitor, Facer, & Ruiz (1999); Newcomb et al. (in press); Remafedi (1994); Rosario, Schrimshaw, & Hunter (2006); Rotheram-Borus, Rosario, Reed, & Koopman (1995); Stueve et al. (2002); Waldo et al. (2000); Weber et al. (2001)	Strong empirical support
	Connectedness to gay community	Daskalakis et al. (2009); Fernandez, Jacobs, Warren, Sanchez, & Bowen (2009); Flores, Mansergh, Marks, Guzman, & Colfax (2009); Grov, Parsons, & Bimbi (2007); Mullens, Staunton, Debattista, Hamernik, & Gill (2009); O'Donnell et al. (2002)	Inconsistent empirical support in adult MSM; more research needed in YMSM
	Sensation-seeking	Dudley et al. (2004); Newcomb et al. (in press)	Strong empirical support in adult MSM; more research needed in YMSM
	Impulsivity and impulsive decision making	Dudley et al. (2004); Hays, Paul, Ekstrand, et al. (1997)	More research needed
	Compulsive sexual behavior	Coleman et al. (2009); Kalichman & Rompa (1995); Miner, Coleman, Center, Ross, & Rosser (2007); Parsons & Bimbi (2007); Reece (2003)	Strong empirical support in adult MSM; more research needed in YMSM
	Self-efficacy	Amirkhanian et al. (2003)	Strong empirical support in adult MSM; more research needed in YMSM
	Depression	Crepaz & Marks (2001); Perdue, Hagan, Thiede, & Valleroy (2003); Rotheram-Borus et al. (1995); Salomon et al. (2009)	Inconsistent empirical support; more research needed in YMSM
	Anxiety	Crepaz & Marks (2001); Rosario et al. (2006)	Inconsistent empirical support; more research needed in YMSM
	Psychological distress	Mustanski, Garofalo, Herrick, and Donenberg (2007)	More research needed
	State affect	Mustanski (2007b)	More research needed
	Sexual abuse	Arreola, Neilands, Pollack, Paul, & Catania (2005, 2008); Catania et al. (2008); Fields, Malebranche, & Feist-Price (2008); Holmes, Foa, & Sammel (2005); Meade, Kershaw, Hansen, & Sikkema (2009); Mimiaga et al. (2009); O'Leary, Purcell, Remien, & Gomez (2003); O'Leary et al. (2005); Parsons, Bimbi, Koken, & Halkitis (2005); Paul, Catania, Pollack, & Stall (2001); Relf (2001); Relf, Huang, Campbell, & Catania (2004); Senn, Carey, & Vanable (2008); Sikkema, Hansen, Meade, Kochman, & Fox (2009); Stall et al. (2003); Welles et al. (2009); Williams et al. (2008)	Strong empirical support in adult MSM; more research needed in YMSM
	Internalized homophobia	Dudley et al. (2004); Hatzenbuehler, Nolen-Hoeksma, & Erickson (2008); Meyer & Dean (1995); Newcomb & Mustanski (in press); Rosario, Hunter, Maguen, Gwadz, & Smith (2001)	Inconsistent empirical support; more research needed in YMSM

Bronfenbrenner , U. ( 1979 ). The ecology of human development: Experiments by nature and design . Cambridge , MA : Harvard University Press .

 Google Scholar

Lyles , C. M. , Kay , L. S. , Crepaz , N. , Herbst , J. H. , Passin , W. F. , et al. . ( 2007 ). Best-evidence interventions: Findings from a systematic review of HIV behavioral interventions for US populations at high risk, 2000–2004 . American Journal of Public Health , 97 , 133 – 143 .

 PubMed Web of Science ®Google Scholar

Pachankis , J. E. ( 2007 ). The psychological implications of concealing a stigma: A cognitive–affective–behavioral model . Psychological Bulletin , 133 , 328 – 345 .

 PubMed Web of Science ®Google Scholar

Ryan , C. , Huebner , D. , Diaz , R. M. , & Sanchez , J. ( 2009 ). Family rejection as a predictor of negative health outcomes in White and Latino lesbian, gay, and bisexual young adults . Pediatrics , 123 , 346 – 352 .

 PubMed Web of Science ®Google Scholar

Crepaz , N. , Marks , G. , Mansergh , G. , Murphy , S. , Miller , L. C. , & Appleby , P. R. ( 2000 ). Age-related risk for HIV infection in men who have sex with men: Examination of behavioral, relationship, and serostatus variables . AIDS Education and Prevention , 12 , 405 – 415 .

 PubMed Web of Science ®Google Scholar

Crepaz , N. , & Marks , G. ( 2001 ). Are negative affective states associated with HIV sexual risk behaviors? A meta-analytic review . Health Psychology , 20 , 291 – 299 .

 PubMed Web of Science ®Google Scholar

Dudley , M. G. , Rostosky , S. S. , Korfhage , B. A. , & Zimmerman , R. S. ( 2004 ). Correlates of high-risk sexual behavior among young men who have sex with men . AIDS Education and Prevention , 16 , 328 – 340 .

 PubMed Web of Science ®Google Scholar

Guzman , R. , Colfax , G. N. , Wheeler , S. , Mansergh , G. , Marks , G. , et al. . ( 2005 ). Negotiated safety relationships and sexual behavior among a diverse sample of HIV-negative men who have sex with men . Journal of Acquired Immune Deficiency Syndromes , 38 , 82 – 86 .

 PubMed Web of Science ®Google Scholar

Hays , R. B. , Kegeles , S. M. , & Coates , T. J. ( 1997 ). Unprotected sex and HIV risk taking among young gay men in boyfriend relationships . AIDS Education and Prevention , 9 , 314 – 329 .

 PubMed Web of Science ®Google Scholar

Kubicek , K. , Carpineto , J. , McDavitt , B. , Weiss , G. , Iverson , E. F. , et al. . ( 2008 ). Integrating professional and folk models of HIV risk: YMSM's perceptions of high-risk sex . AIDS Education and Prevention , 20 , 220 – 238 .

 PubMed Web of Science ®Google Scholar

Morris , M. , Zavisca , J. , & Dean , L. ( 1995 ). Social and sexual networks: Their role in the spread of HIV/AIDS among young gay men . AIDS Education and Prevention , 7 , 24 – 35 .

 PubMed Web of Science ®Google Scholar

Horvath , K. J. , Bowen , A. M. , & Williams , M. L. ( 2006 ). Virtual and physical venues as contexts for HIV risk among rural men who have sex with men . Health Psychology , 25 , 237 – 242 .

 PubMed Web of Science ®Google Scholar

Horvath , K. J. , Rosser , B. R. , & Remafedi , G. ( 2008 ). Sexual risk taking among young Internet-using men who have sex with men . American Journal of Public Health , 98 , 1059 – 1067 .

 PubMed Web of Science ®Google Scholar

Bacon , O. , Lum , P. , Hahn , J. , Evans , J. , Davidson , P. , et al. . ( 2006 ). Commercial sex work and risk of HIV infection among young drug-injecting men who have sex with men in San Francisco . Sexually Transmitted Diseases , 33 , 228 – 234 .

 PubMed Web of Science ®Google Scholar

Belza , M. J. , & the EPI–VIH Study Group s. ( 2005 ). Risk of HIV infection among male sex workers in Spain . Sexually Transmitted Infections , 81 , 85 – 88 .

 PubMed Web of Science ®Google Scholar

Bimbi , D. S. ( 2007 ). Male prostitution: Pathology, paradigms and progress in research . Journal of Homosexuality , 53 ( 1/2 ), 7 – 35 .

 PubMed Web of Science ®Google Scholar

Padilla , M. ( 2007 ). Caribbean pleasure industry: Tourism, sexuality, and AIDS in the Dominican Republic . Chicago , IL : University of Chicago Press .

 Google Scholar

Parsons , J. T. , Koken , J. A. , & Bimbi , D. S. ( 2007 ). Looking beyond HIV: Eliciting individual and community needs of male Internet escorts . Journal of Homosexuality , 53 , 219 – 240 .

 PubMed Web of Science ®Google Scholar

Smith , M. D. , & Grov , C. ( 2011 ). In the company of men: Inside the lives of male prostitutes . Santa Barbara , CA : Praeger .

 Google Scholar

Hays , R. B. , Rebchook , G. M. , & Kegeles , S. M. ( 2003 ). The Mpowerment Project: Community-building with young gay and bisexual men to prevent HIV1 . American Journal of Community Psychology , 31 , 301 – 312 .

 PubMed Web of Science ®Google Scholar

Kegeles , S. M. , Hays , R. B. , Pollack , L. M. , & Coates , T. J. ( 1999 ). Mobilizing young gay and bisexual men for HIV prevention: A two-community study . AIDS , 13 , 1753 – 1762 .

 PubMed Web of Science ®Google Scholar

Choi , K. H. , Operario , D. , Gregorich , S. E. , McFarland , W. , MacKellar , D. , & Valleroy , L. ( 2005 ). Substance use, substance choice, and unprotected anal intercourse among young Asian American and Pacific Islander men who have sex with men . AIDS Education and Prevention , 17 , 418 – 429 .

 PubMed Web of Science ®Google Scholar

Dufour , A. , Alary , M. , Otis , J. , Noel , R. , Remis , R. S. , et al. . ( 2000 ). Correlates of risky behaviors among young and older men having sexual relations with men in Montreal, Quebec, Canada. Omega Study Group . Journal of Acquired Immune Deficiency Syndromes , 23 , 272 – 278 .

 PubMed Web of Science ®Google Scholar

McNall , M. , & Remafedi , G. ( 1999 ). Relationship of amphetamine and other substance use to unprotected intercourse among young men who have sex with men . Archives of Pediatrics and Adolescent Medicine , 153 , 1130 .

 PubMedGoogle Scholar

Mustanski , B. ( 2008 ). Moderating effects of age on the alcohol and sexual risk taking association: An online daily diary study of men who have sex with men . AIDS and Behavior , 12 , 118 – 126 .

 PubMed Web of Science ®Google Scholar

Choi , K. H. , Han , C. S. , Hudes , E. S. , & Kegeles , S. ( 2002 ). Unprotected sex and associated risk factors among young Asian and Pacific Islander men who have sex with men . AIDS Education and Prevention , 14 , 472 – 481 .

 PubMed Web of Science ®Google Scholar

Clatts , M. C. , Goldsamt , L. A. , & Yi , H. ( 2005a ). Club drug use among young men who have sex with men in NYC: A preliminary epidemiological profile . Substance Use & Misuse , 40 , 1317 – 1330 .

 PubMed Web of Science ®Google Scholar

Clatts , M. C. , Goldsamt , L. A. , & Yi , H. ( 2005b ). Drug and sexual risk in four men who have sex with men populations: Evidence for a sustained HIV epidemic in New York City . Journal of Urban Health , 82 , 9 – 17 .

 PubMed Web of Science ®Google Scholar

Meyer , I. H. , & Dean , L. ( 1995 ). Patterns of sexual behavior and risk taking among young New York City gay men . AIDS Education and Prevention , 7 , 13 – 23 .

 PubMed Web of Science ®Google Scholar

Molitor , F. , Facer , M. , & Ruiz , J. D. ( 1999 ). Safer sex communication and unsafe sexual behavior among young men who have sex with men in California . Archives of Sexual Behavior , 28 , 335 – 343 .

 PubMed Web of Science ®Google Scholar

Remafedi , G. ( 1994 ). Cognitive and behavioral adaptations to HIV/AIDS among gay and bisexual adolescents . Journal of Adolescent Health , 15 , 142 – 148 .

 PubMed Web of Science ®Google Scholar

Rosario , M. , Schrimshaw , E. W. , & Hunter , J. ( 2006 ). A model of sexual risk behaviors among young gay and bisexual men: Longitudinal associations of mental health, substance abuse, sexual abuse, and the coming-out process . AIDS Education and Prevention , 18 , 444 – 460 .

 PubMed Web of Science ®Google Scholar

Rotheram-Borus , M. J. , Rosario , M. , Reed , H. , & Koopman , C. ( 1995 ). Predicting patterns of sexual acts among homosexual and bisexual youths . American Journal of Psychiatry , 152 , 588 – 595 .

 PubMed Web of Science ®Google Scholar

Waldo , C. R. , McFarland , W. , Katz , M. H. , MacKellar , D. , & Valleroy , L. A. ( 2000 ). Very young gay and bisexual men are at risk for HIV infection: The San Francisco Bay Area Young Men's Survey II . Journal of Acquired Immune Deficiency Syndromes , 24 , 168 – 174 .

 PubMed Web of Science ®Google Scholar

Weber , A. E. , Chan , K. , George , C. , Hogg , R. S. , Remis , R. S. , et al. . ( 2001 ). Risk factors associated with HIV infection among young gay and bisexual men in canada . Journal of Acquired Immune Deficiency Syndromes , 28 , 81 .

 PubMed Web of Science ®Google Scholar

Grov , C. , Parsons , J. T. , & Bimbi , D. S. ( 2007 ). Sexual risk behavior and venues for meeting sex partners: An intercept survey of gay and bisexual men in LA and NYC . AIDS and Behavior , 11 , 915 – 926 .

 PubMed Web of Science ®Google Scholar

O'Donnell , L. , Agronick , G. , San Doval , A. , Duran , R. , Myint-U , A. , & Stueve , A. ( 2002 ). Ethnic and gay community attachments and sexual risk behaviors among urban Latino young men who have sex with men . AIDS Education and Prevention , 14 , 457 – 471 .

 PubMed Web of Science ®Google Scholar

Coleman , E. , Horvath , K. J. , Miner , M. , Ross , M. W. , Oakes , M. , & Rosser , B. R. S. ( 2009 ). Compulsive sexual behavior and risk for unsafe sex among internet using men who have sex with men . Archives of Sexual Behavior , 39 , 1045 – 1053 .

 PubMed Web of Science ®Google Scholar

Kalichman , S. C. , & Rompa , D. (1995). Sexual sensation seeking and Sexual Compulsivity Scales: Reliability, validity, and predicting HIV risk behavior. Journal of Personality Assessment , 65, 586–601.

 PubMed Web of Science ®Google Scholar

Miner , M. H. , Coleman , E. , Center , B. A. , Ross , M. , & Rosser , B. R. S. ( 2007 ). The compulsive sexual behavior inventory: Psychometric properties . Archives of Sexual Behavior , 36 , 579 – 587 .

 PubMed Web of Science ®Google Scholar

Parsons , J. T. , & Bimbi , D. S. ( 2007 ). Intentional unprotected anal intercourse among sex who have sex with men: Barebacking—From behavior to identity . AIDS and Behavior , 11 , 277 – 287 .

 PubMed Web of Science ®Google Scholar

Reece , M. ( 2003 ). Sexual compulsivity and HIV serostatus disclosure among men who have sex with men . Sexual Addiction & Compulsivity , 10 , 1 – 11 .

 Google Scholar

Perdue , T. , Hagan , H. , Thiede , H. , & Valleroy , L. ( 2003 ). Depression and HIV risk behavior among Seattle-area injection drug users and young men who have sex with men . AIDS Education and Prevention , 15 , 81 – 92 .

 PubMed Web of Science ®Google Scholar

Salomon , E. A. , Mimiaga , M. J. , Husnik , M. J. , Welles , S. L. , Manseau , M. W. , et al. . ( 2009 ). Depressive symptoms, utilization of mental health care, substance use and sexual risk among young men who have sex with men in EXPLORE: Implications for age-specific interventions . AIDS and Behavior , 13 , 1 – 11 .

 Web of Science ®Google Scholar

Catania , J. A. , Paul , J. , Osmond , D. , Folkman , S. , Pollack , L. , et al.. (2008). Mediators of childhood sexual abuse and high-risk sex among men who have sex with men. Child Abuse & Neglect , 32, 925–940.

 PubMed Web of Science ®Google Scholar

Fields , S. D. , Malebranche , D. , & Feist-Price , S. ( 2008 ). Childhood sexual abuse in Black men who have sex with men: Results from three qualitative studies . Cultural Diversity and Ethnic Minority Psychology , 14 , 385 – 390 .

 PubMed Web of Science ®Google Scholar

Holmes , W. C. , Foa , E. B. , & Sammel , M. D. ( 2005 ). Men's pathways to risky sexual behavior: Role of co-occurring childhood sexual abuse, posttraumatic stress disorder, and depression histories . Journal of Urban Health , 82 , 89 – 99 .

 PubMed Web of Science ®Google Scholar

Meade , C. S. , Kershaw , T. S. , Hansen , N. B. , & Sikkema , K. J. (2009). Long-term correlates of childhood abuse among adults with severe mental illness: Adult victimization, substance abuse, and HIV sexual risk behavior. AIDS and Behavior , 13, 207–216.

 PubMed Web of Science ®Google Scholar

Mimiaga , M. J. , Noonan , E. , Donnell , D. , Safren , S. A. , Koenen , K. C. , et al. . ( 2009 ). Childhood sexual abuse is highly associated with HIV risk-taking behavior and infection among MSM in the EXPLORE Study . Journal of Acquired Immune Deficiency Syndromes , 51 , 340 – 348 .

 PubMed Web of Science ®Google Scholar

O'Leary , A. , Purcell , D. , Remien , R. H. , & Gomez , C. ( 2003 ). Childhood sexual abuse and sexual transmission risk behaviour among HIV-positive men who have sex with men . AIDS Care , 15 , 17 – 26 .

 PubMed Web of Science ®Google Scholar

O'Leary , A. , Wolitski , R. J. , Remien , R. H. , Woods , W. J. , Parsons , J. T. , et al.. (2005). Psychosocial correlates of transmission risk behavior among HIV-seropositive gay and bisexual men. AIDS , 19, S67–S75.

 PubMed Web of Science ®Google Scholar

Parsons , J. T. , Bimbi , D. S. , Koken , J. A. , & Halkitis , P. N. ( 2005 ). Factors related to childhood sexual abuse among gay/bisexual male Internet escorts . Journal of Child Sexual Abuse , 14 , 1 – 23 .

 PubMedGoogle Scholar

Paul , J. P. , Catania , J. , Pollack , L. , & Stall , R. ( 2001 ). Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: The Urban Men's Health Study . Child Abuse & Neglect , 25 , 557 – 584 .

 PubMed Web of Science ®Google Scholar

Relf , M. V. ( 2001 ). Childhood sexual abuse in men who have sex with men: The current state of the science . Journal of the Association of Nurses in AIDS Care , 12 , 20 – 29 .

 PubMedGoogle Scholar

Relf , M. V. , Huang , B. , Campbell , J. , & Catania , J. ( 2004 ). Gay identity, interpersonal violence, and HIV risk behaviors: An empirical test of theoretical relationships among a probability-based sample of urban men who have sex with men . Journal of the Association of Nurses in AIDS Care , 15 , 14 – 26 .

 PubMed Web of Science ®Google Scholar

Senn , T. E. , Carey , M. P. , & Vanable , P. A. ( 2008 ). Childhood and adolescent sexual abuse and subsequent sexual risk behavior: Evidence from controlled studies, methodological critique, and suggestions for research . Clinical Psychology Review , 28 , 711 – 735 .

 PubMed Web of Science ®Google Scholar

Welles , S. L. , Baker , A. C. , Miner , M. H. , Brennan , D. J. , Jacoby , S. , & Rosser , B. R. ( 2009 ). History of childhood sexual abuse and unsafe anal intercourse in a 6-city study of HIV-positive men who have sex with men . American Journal of Public Health , 99 , 1079 – 1086 .

 PubMed Web of Science ®Google Scholar

Stall , R. , Friedman , M. , & Catania , J. ( 2008 ). Interacting epidemics and gay men's health: A theory of syndemic production among urban gay men . In R. J. Wolitski , R. Stall , & R. Valdiserri (Eds.), Unequal opportunity: Health disparities affecting gay and bisexual men in the United States (pp. 251 – 275 ). New York , NY : Oxford University Press .

 Google Scholar

Hatzenbuehler , M. L. , Nolen-Hoeksema , S. , & Erickson , S. J. ( 2008 ). Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: Results from a prospective study of bereaved gay men . Health Psychology , 27 , 455 – 462 .

 PubMed Web of Science ®Google Scholar