Sexual Risk Behaviors in Adolescent Sexual Minority Males: A Systematic Review and Meta-Analysis

Abstract

Although adolescent sexual minority males (ASMM) are at increased risk for human immunodeficiency virus (HIV) in the United States (US), studies that estimate sexual risk behaviors that contribute to HIV risk in ASMM are limited. We completed a systematic review and meta-analysis to compile available data and estimate the prevalence of risk behaviors in this population. We searched four databases for key terms related to ASMM, defined as males aged 14 through 19 who identified as gay or bisexual, reported sex with a male in their lifetime, and/or were considered sexual minority by the study. Articles eligible for inclusion were in English, from US studies, and reported quantitative data on sexual risk behaviors among ASMM. We extracted data from eligible articles and meta-analyzed outcomes reported in three or more articles using random effects. Of 3864 articles identified, 21 were eligible for data extraction. We meta-analyzed nine outcomes. Sixty-two percent of adolescent males self-identifying as gay or bisexual ever had sex with a male, and 67% of participants from ASMM studies recently had sex. Among ASMM who had sex in the last 6 months or were described as sexually active, 44% had condomless anal intercourse in the past 6 months, 50% did not use a condom at last sex, and 32% used alcohol or drugs at their last sexual experience. Available data indicate that sexual risk behaviors are prevalent among ASMM. We need more data to obtain estimates with better precision and generalizability. Understanding HIV risk in ASMM will assist in intervention development and evaluation, and inform behavioral mathematical models.

Keywords: Adolescence; HIV risk; MSM (men who have sex with men); Sexual risk behaviors; United States.

Fig. 1

PRISMA flow diagram for systematic review of sexual risk behaviors in adolescent sexual minority males. ^aTotals do not add up to total articles excluded, since reviewers could select more than one exclusion reason

Fig. 2

Outcomes identified from articles reporting sexual risk behaviors among adolescent sexual minority males. ^aBarney (2003), ^bSaewyc, Bearinger, Heinz, Blum, and Resnick (1998), ^cMustanski, Birkett et al. (2014), ^dRotheram-Borus, Reid et al. (1995) and Rotheram-Borus, Rosario et al. 1995), ^eThoma and Huebner (2014), ^fKann et al. (2016), ^gPathela and Schillinger (2010), ^hSifakis et al. (2007), ⁱHalkitis et al. (2013), ^jWaldo et al. (2000), ^kEverett et al. (2014), ^lGoodenow et al. (2002), ^mArrington-Sanders, Dao et al. (2015), ⁿArrington-Sanders, Oidtman et al. (2015) and Halkitis et al. (2011)