HIV Syndemic Factor Associations Among Adolescent Gay and Bisexual Men in the Youth Risk Behavior Survey 2015-2019: A Secondary Data Analysis.
David R Garcia, Jason Fletcher, Lloyd Goldsamt and 3 others
PMID 37603450WHAT IT FOUND
Adolescent gay and bisexual men with more substance use and intimate partner violence were significantly more likely to report sexual debut before age 13, multiple partners, and sex under the influence.
HIV testing remained low, especially among Black/African American youth.
Key findings
01A syndemic of substance use and intimate partner violence was associated with increased odds of sexual intercourse before age 13, having four or more lifetime partners, and using drugs or alcohol before last intercourse.
02Only 21% of the analytic sample had ever tested for HIV, and Black/African American participants were significantly less likely to have tested compared to White participants.
03Exposure to two or more types of intimate partner violence was associated with substantially higher odds of sexual intercourse before age 13 and having four or more lifetime sexual partners.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used cross-sectional data, so it cannot prove that substance use or violence caused the HIV risk behaviors; it only shows they occur together. The sample was limited to students present in high school, which may underrepresent youth who have dropped out, are truant, or are not in school. Data were self-reported, which can be affected by memory errors or a desire to answer in a socially acceptable way. The survey did not collect data on gender identity, only sex assigned at birth, which may conflate experiences of transgender youth with those of gay and bisexual men. The small sample size for some subgroups may have led to unstable estimates, particularly for the very large odds ratios seen in additive risk models.
Declared interests
The authors declared no conflicts of interest. The study was supported by the National Institute of Nursing Research of the National Institutes of Health.
The easy way to misread this
Do not assume that mental health issues like depression are the primary drivers of HIV risk in this population once substance use and violence are accounted for. The adjusted models showed that substance use and intimate partner violence remained significant risk factors, while mental health associations lost significance.