Where Are the Young Men In HIV Prevention Research? Young Men Who Have Sex with Men In Los Angeles County Comment On HIV Prevention Programs and Research

Background and Purpose: Despite the expense and effort in developing and implementing 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, 2009; HIV Epidemiology Program, Los Angeles County Department of Public Health, 2010; Jaffe, Valdiserri, & De Cock, 2007). This is especially true for young MSM (YMSM), who may be less aware of the significance of being HIV-infected than their older counterparts (Centers for Disease Control and Prevention, 2010). Some evidence points to a disconnect between current HIV prevention approaches and interest in those approaches among YMSM (Orellana, Picciano, Roffman, Swanson, & Kalichman, 2006). The present study sought to collect contemporary impressions about current HIV prevention approaches and understand facilitators and barriers to participation in HIV prevention in a diverse sample of affluent YMSM.

Methods: Qualitative interviews were conducted with a convenience sample of racial and ethnically diverse YMSM (n=100, mean age 25) in Los Angeles, California. Data were transcribed and analyzed by independent coders using content analysis (Krippendorff, 2004), began by reducing (selecting, simplifying, and transforming) data (Miles & Huberman, 1999). A priori descriptive domains were developed based on the research questions. This summative content analysis (Hsieh & Shannon, 2005) used to explore the usage and meaning of statements was based on concepts related to the research questions, not specific words. Inter-coder agreement was 95%; disagreements in coding were reviewed, resolved, and recoded.

Results: Thirty-one percent of participants attended an HIV-prevention program previously and 21% participated in HIV-related research projects. Twelve percent indicated they were too busy to participate in such a program; 23% stated they knew everything they needed to know about HIV transmission; and 14% said they were not affected by HIV. These men noted that HIV prevention materials often contain “stale” information and wanted to be given the latest information and skills about HIV prevention through an intervention effort that was minimally invasive (5% said “quick” and 14% said the intervention would need to have new information they did not perceive they knew). Several participants spoke about a desire to help the larger gay community prevent HIV and that a program that explicitly emphasized the altruistic nature of participating in HIV prevention activities would encourage them to attend a program (14%). YMSM suggested future interventions should use technology (e.g., mobile devices), engage their social networks, and be implemented in venues that would interest them.

Conclusions and Implications: These findings provide some explanations for why YMSM account for a minority in HIV prevention and offer some direction for future HIV prevention efforts that target YMSM. The agency-based, day-, week-, or month-long prevention programs of the past have little attractiveness for today's YMSM. Findings suggest that successful HIV prevention programs in the future will engage YMSM and their friends through their social networks; involve these men by appealing to their intellect and by including new and relevant information, which also capitalizes on their continued desire to care for their community.