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Linda A. Valleroy, PhD; Duncan A. MacKellar, MA, MPH; John M. Karon, PhD; Daniel H. Rosen, PhD; William McFarland, MD, PhD; Douglas A. Shehan, BA; Susan R. Stoyanoff, MPH; Marlene LaLota, MPH; David D. Celentano, ScD; Beryl A. Koblin, PhD; Hanne Thiede, DVM, MPH; Mitchell H. Katz, MD; Lucia V. Torian, PhD; Robert S. Janssen, MD; for the Young Men's Survey Study Group

JAMA. 2000;284:198-204.

Context  Studies conducted in the late 1980s on human immunodeficiency virus (HIV) infection among older men who have sex with men (MSM) suggested the epidemic had peaked; however, more recent studies in younger MSM have suggested continued high HIV incidence.

Objective  To investigate the current state of the HIV epidemic among adolescent and young adult MSM in the United States by assessing the prevalence of HIV infection and associated risks in this population in metropolitan areas.

Design  The Young Men's Survey, a cross-sectional, multisite, venue-based survey conducted from 1994 through 1998.

Setting  One hundred ninety-four public venues frequented by young MSM in Baltimore, Md; Dallas, Tex; Los Angeles, Calif; Miami, Fla; New York, NY; the San Francisco (Calif) Bay Area; and Seattle, Wash.

Subjects  A total of 3492 15- to 22-year-old MSM who consented to an interview and HIV testing.

Main Outcome Measures  Prevalence of HIV infection and associated characteristics and risk behaviors.

Results  Prevalence of HIV infection was high (overall, 7.2%; range for the 7 areas, 2.2%-12.1%) and increased with age, from 0% among 15-year-olds to 9.7% among 22-year-olds. Multivariate-adjusted HIV infection prevalence was higher among blacks (odds ratio [OR], 6.3; 95% confidence interval [CI], 4.1-9.8), young men of mixed or other race (OR, 4.8; 95% CI, 3.0-7.6), and Hispanics (OR, 2.3; 95% CI, 1.5-3.4), compared with whites (referent) and Asian Americans and Pacific Islanders (OR, 1.1; 95% CI, 0.5-2.8). Factors most strongly associated with HIV infection were being black, mixed, or other race; having ever had anal sex with a man (OR, 5.0; 95% CI, 1.8-13.8); or having had sex with 20 or more men (OR, 3.0; 95% CI, 2.0-4.7). Only 46 (18%) of the 249 HIV-positive men knew they were infected before this testing; 37 (15%) were receiving medical care for HIV, and 19 (8%) were receiving medical drug therapy for HIV. Prevalence of unprotected anal sex during the past 6 months was high (overall, 41%; range, 33%-49%).

Conclusions  Among these young MSM, HIV prevalence was high, underscoring the need to evaluate and intensify prevention efforts for young MSM, particularly blacks, men of mixed race or ethnicity, Hispanics, and adolescents.

Author Affiliations: Division of HIV/AIDS Prevention–Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Valleroy, Karon, Rosen, and Janssen, and Mr MacKellar); San Francisco Department of Public Health, San Francisco (Drs McFarland and Katz), and Los Angeles County Department of Health Services, Los Angeles (Ms Stoyanoff), Calif; University of Texas Southwestern Medical Center at Dallas (Mr Shehan); Florida Department of Health, Tallahassee, (Ms LaLota); Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md (Dr Celentano); The New York Blood Center (Dr Koblin), and the New York City Department of Health (Dr Torian), New York, NY; and Public Health—Seattle and King County, Seattle, Wash (Dr Thiede).

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