Where Are the Young Men in HIV Prevention Efforts?

Comments on HIV Prevention Programs and Research From Young Men Who Sex With Men in Los Angeles County

Ian W. Holloway; Julie A. Cederbaum; Antonette Ajayi; Steven Shoptaw


J Prim Prev. 2012;33(5):271-278. 

In This Article

Abstract and Introduction


Despite increasing rates of HIV infection among young men who have sex with men (YMSM), only a minority participate in formal HIV prevention efforts. Semi-structured mixed-methods interviews were conducted with a diverse sample of YMSM (N = 100, M age = 25.0 years) in Los Angeles, California, to identify facilitators and barriers to participation in HIV prevention programs. Summative content analyses were used to evaluate transcribed field notes from these interviews. Results showed that 28.0 % of all participants had previously attended an HIV prevention program, and that 21.3 % of those who were also asked if they had ever participated in any research pertaining to HIV prevention had done so. A significantly higher percentage of those who had participated in HIV prevention programs had been tested for HIV in the past 6 months compared to those who had not (p <.05). The most frequently mentioned barriers to participation in such a program were being too busy to attend (12.0 %), not perceiving themselves to be at risk for HIV infection (14.0 %), and believing that they already knew everything they needed to know about HIV transmission (23.0 %). YMSM suggested that future interventions should use technology (e.g., the Internet, mobile devices), engage their social networks, and highlight HIV prevention as a means for community connection. Collectively, these results provide some explanations for why YMSM account for a minority of HIV prevention program participants and offer possible directions for future HIV prevention efforts that target YMSM.


Despite continued efforts to develop and implement behavioral HIV prevention programs, incidence rates for HIV among men who have sex with men (MSM) continue to rise (Centers for Disease Control and Prevention [CDC], 2009; HIV Epidemiology Program, Los Angeles County Department of Public Health, 2010; Hall et al., 2008; Jaffe, Valdiserri, & De Cock, 2007). This is especially true for young MSM (YMSM), who may be less informed than their older counterparts about HIV (CDC, 2010). Moreover, some research suggests that YMSM do not currently access HIV prevention programs and services as much as older MSM. For example, surveillance data show that among YMSM, those who self-identify as African American, those who are less affluent, and those who are older are over-represented in HIV prevention programs (Iguchi et al., 2009; Koblin et al., 2003; Orellana, Picciano, Roffman, & Swanson, 2006). According to survey data collected in Los Angeles County, although 60 % of HIV/AIDS cases among MSM are in those aged 20–39 years (Bingham, 2009), the average age of those who participate in HIV prevention programs is between 40 and 49 years (Bingham, 2009; Shoptaw et al., 2009). Another study conducted in the Pacific Northwest demonstrated that MSM aged 20–24 years were over three times more likely not to enroll in an HIV prevention program than those aged 40 and over (Orellana et al., 2006).

Limited research has investigated why YMSM are less likely than their older counterparts to participate in HIV prevention programs. Some researchers have suggested that YMSM may feel less vulnerable to HIV, weakening their commitment to changing HIV risk behavior (Rutledge, Roffman, Picciano, Kalichman, & Berghuis, 2002). Others have suggested that YMSM who reached sexual maturity in the age of highly active antiretroviral therapies may be complacent about sexual risk behavior because HIV can now be managed as many other chronic diseases (Valdiserri, 2004). These epidemiological and clinical observations shaped the objective of this study: To collect contemporary impressions about HIV prevention approaches and understand facilitators and barriers to participation in HIV prevention programs in a diverse sample of YMSM.