Most Gay, Bisexual Male Adolescents Don't Get Tested for HIV

By Anne Harding

February 13, 2020

NEW YORK (Reuters Health) - Fewer than one in four adolescent men who have sex with men (AMSM) have had an HIV test, new U.S. research shows.

"Among HIV-positive teens only about half know their status, whereas among adults it is over 85%," said Dr. Brian Mustanski, who directs the Northwestern Institute for Sexual and Gender Minority Health and Wellbeing and is a professor at Northwestern University Feinberg School of Medicine in Chicago.

"HIV testing is the only way for them to know their status and get access to treatments that are not only lifesaving, but also can prevent transmission to others," he told Reuters Health in an email. "We will not end the HIV epidemic in the U.S. if we don't scale up testing with this group."

Dr. Mustanski and his colleagues looked at 699 young men aged 13 to 18 participating in SMART, an ongoing trial of online HIV prevention interventions for AMSM. Overall, 162 (23.2%) reported ever having had an HIV test, and 81 had more than one (11.6%).

A history of vaginal or anal sex was reported by 64.2%, and 45.5% reported having condom-less anal sex (CAS). Sexually experienced participants were more than six times as likely to have had an HIV test.

While 67.5% of study participants said they had a regular doctor, just 21.3% had discussed having sex with males with their physician, 19.2% had talked about HIV testing and 29.2% said they were asked about their sexual orientation.

"Doctors - pediatricians in particular - need to be having frank and open conversations with their male teenage patients, including a detailed sexual history and a discussion about sexual orientation - ideally a private conversation without parents present," Dr. Mustanski said. "If their patient is sexually active with other males, an HIV test is strongly recommended given their high epidemiological risk."

Clinicians who don't want to discuss sexual orientation with patients can default to HIV testing with informed "opt-out," he added. "These conversations can also be facilitated by providers outwardly displaying their acceptance of the LGBTQ community through intake forms, asking questions that don't imply a partner's gender, and through visual cues like posters," he said.

Dr. Mustanski noted that the American Academy of Pediatrics recommends discussing sexual-health-related topics such as HIV, same-sex behavior and sexual orientation with patients, "and research shows most teens want their doctors to ask them these questions."

He added: "We need to pay particular attention to the needs of adolescents as we seek to implement programs that can help end the HIV epidemic. I would like to see us push towards all sexually active gay and bisexual boys receiving an HIV test and 90% of those who are positive knowing their status."

In a commentary accompanying the study, Dr. Errol L. Fields of John Hopkins School of Medicine in Baltimore and Dr. Travis A. Gayles of Montgomery County Department of Health and Human Services in Rockville, Maryland, write: "Pediatricians, and physicians in general, are often undertrained in the care of sexual and gender minority youth; therefore, more upstream, educational interventions may be necessary to support effective implementation of the authors' recommended changes."

SOURCE: and Pediatrics, online February 11, 2020.