Predicting HIV Risk among Sexual Minority Youth: The Impact of Sexual Identity Development

Background and Purpose: Sexual minority youth, particularly young men who have sex with men (YMSM), are disproportionately affected by HIV/AIDS. High rates of risky sexual behaviors among these youth are well documented in the literature, yet we know relatively little about how sexual identity development processes and experiences impact their sexual risk. The purpose of this study was to investigate the ways in which sexual identity development may directly and indirectly (via cognitive and behavioral mediators) influence the HIV-related sexual risk behaviors of young sexual minority males. The conceptual framework for this study was the Information-Motivation-Behavioral Skills (IMB) model (Fisher & Fisher, 1992), and to increase cultural relevance of the model for this population, an extended IMB model was developed which included sexual identity development and substance use constructs. It was hypothesized that the extended model tailored for this population would be more predictive of HIV risk than the original IMB model.

Methods: A convenience sample of adolescent males was drawn from youth attending an LBGT community center in a large Midwestern city. A self-administered survey was used to assess cognitive and behavioral HIV risk factors, sexual identity development characteristics, substance use, and sexual risk behaviors. Path analysis was conducted to examine the predictive power of the original IMB model compared to the extended model for primary sexual risk (i.e., behaviors that can directly prevent HIV infection) and secondary sexual risk (i.e., behaviors that exacerbate one's HIV risk but don't directly prevent infection).

Results: Study participants ranged in age from 14-21 years (x¯ =18.64) and were predominantly youth of color. Path analysis results indicated that the extended model predicted substantially more primary and secondary sexual risk (r²=.27 and .38) than the original IMB model (r²=.13 and .08). The extended model fit the data well for both primary (X²=34.63 [30], p=.26; RMSEA=.03; PGFI=.52; TLI=.97) and secondary sexual risk behaviors (X²=45.23 [37], p=.17; RMSEA=.04; PGFI=.53; TLI=.95). Specifically, greater primary sexual risk was predicted by: more negative attitudes toward LBGT people; a sex-centered developmental sequence; more frequent alcohol use; less HIV prevention information; and less HIV prevention motivation. Greater secondary sexual risk was predicted by two additional factors: more frequent marijuana use and non-male exclusive sexual orientation.

Conclusions and Implications: The results of this study suggest that social workers who practice in the area of HIV prevention should consider both sexual identity development and substance use important targets for interventions with sexual minority males, in addition to traditional HIV-related cognitive and behavioral factors. Specifically, interventions to prevent HIV infection among these youth could be strengthened by: reaching youth early (prior to development of a sex-centered developmental sequence), fostering positive attitudes toward LBGT people, and including content on sexual behaviors with both same- & opposite-sex partners (regardless of participants' current orientation or identity label). Study findings also suggest the need for future research with sexual minority youth that: (a) includes additional sexual identity development constructs, and (b) explores the utility of the extended IMB model for specific racial/ethnic subgroups as well as transgender youth.