Black male teens cautious but HIV rates high among same-sex encounters

By Ruojing Liu

A report from the Centers for Disease Control and Prevention on HIV-related risk behavior among male high school students who had sexual contact with other males reveals that black males are more cautious in their sexual behavior, despite a higher black male HIV infection rate than white males.

The findings are based recent Youth Risk Behavior Surveillance System reports conducted by the CDC. Data were combined from 32 such surveys taken within 17 large urban school districts, including New York City, Chicago and Houston among others, during 2009 to 2013 on public school students in grades 9 through 12.

The newly released report isolated 17 questions on risk behavior from those surveyed that are related directly or indirectly to HIV transmission, and only from male students who have indicated that they had sexual contact with other males.

As young people constitute a large proportion of new HIV diagnoses, and as some sexual behavior is formed at a young age, monitoring adolescent behavior could be helpful in controlling and explaining HIV, said Laura Kann, chief of the surveillance and evaluation research branch in the CDC’s Division of Adolescent and School Health.

The CDC’s most recent annual HIV Surveillance Report on diagnoses of HIV infections in the United States in 2014 shows that black men who engage in sex with other men are disproportionally affected by HIV infection.

Among all 39,877 new HIV diagnoses throughout the country in 2014, blacks constitute about 44 percent, with a rate of infection of about 49 per 100,000. The proportion of blacks in the United States, according to the U.S. Census Bureau, is only about 13 percent. In comparison, white people, about 77 percent of the nation’s entire population, comprise less than 28 percent of new HIV diagnoses.

Additionally, when new diagnoses are broken down to categories of ages, at the age range of 15 to 19, which fits the target of the survey, 1,045 cases were found among black adolescents, while only 203 cases were found among whites. For young people age 13 to 29 all together, 8,239 cases were blacks and 3,246 cases were whites.

Most new HIV diagnoses occur among men who have sex with men, with male-to-male sexual contact alone forming about 54 percent among all transmission categories, according to the Surveillance Report. In that category, blacks constitute about 36 percent and whites 31 percent.

However, among all 1,681 records in the combined data set collected from high school male students who had sexual contact with males, blacks, who make up 40 percent of the pool, had a significantly lower prevalence than white students of engaging in HIV-related risk behavior.

The incidences among black students compared with white students of consuming five or more consecutive alcoholic drinks, or of using such drugs as heroin and ecstasy, which are all considered HIV-related risk factors, are significantly lower.

At the same time, 47.4 percent of black students who identified themselves as sexually active said that they used a condom during their last sexual encounter, compared to white students at 25.2 percent.

The study, led by Laura Kann, concludes that although HIV-related risk behavior is a major path for HIV transmission, it is not that alone that results in higher numbers of HIV diagnoses among young black males who have sex with other males.

The report suggests that one possible reason for the higher black male infection rate could be because the HIV infection already has a large population base in the black community, and that even a higher percentage of cautious behavior would not result in lower numbers of infections.

Also, because black men who have sex with men are more likely to have sex partners of the same race, they are at greater risk for HIV infection within their sexual network. Additionally, a lower financial status makes many within the black community who are infected with HIV less likely to have adequate health insurance. Not having access to antiretroviral treatment that could suppress HIV infection makes transmission more likely.

The report concludes by calling for more access to effective programs for young black males who have sex with other males in addition to the CDC’s existing funding and technical support. The report also advocates for more efforts by public schools to facilitate access to youth-friendly health care both on campus and through referrals, and to provide supportive environments and healthy relationships among students.

Photo at top: The new poster designed for this year’s National Black HIV/AIDS Awareness Day on February 7 under the theme “I am my Brother/Sister’s Keeper: Fight HIV/AIDS.” (National Black HIV/AIDS Awareness Day Strategic Leadership Council)