High School Students, HIV Testing, and the Moderating Role of Risky Sexual Behaviors and Sexual Minority Status

Background and Purpose: Adverse sexual health outcomes disproportionately impact young people. Adolescents often engage in risky behaviors, including unprotected sexual intercourse, which creates suitability for sexually transmitted infections (STIs), including HIV. In 2020, youth ages 15-24 accounted for 20% of all new HIV infections in the United States. Over half of the roughly 20 million new STIs reported in 2020 were among youth ages 15-24, with sexual minority youth (SMY) disproportionately represented. Considering the risky nature of the adolescent developmental stage, adolescents may engage in sexual activity without adequate preparation, increasing their risk of contracting STIs or HIV. Considering that nearly half of youth aged 13-24 who are living with HIV are unaware, this study examines the interaction effects of risky sexual behaviors (RSB) and SMY status on HIV testing to estimate the degree of impact of identifying as a SMY on HIV testing and variation based on types of RSB.

Methods: We used combined data from the 2015-2019 Youth Risk Behavior Surveillance System (YRBSS). A total of 9,960 youth completed questionnaires on sexual identity, RSB, and HIV testing. Participants' sexual orientation was categorized as heterosexual, gay or lesbian, or bisexual, a primary independent variable in addition to RSB (alcohol and drug use before sex, multiple sex partners, and condom use). The primary dependent variable was HIV testing, defined as ever having tested for HIV. We estimated binary logistic regression models to examine RSB and HIV testing, controlling for gender, race, and age and survey design effects owing to clustering and varying selection probabilities.

Results: Only 6.1% of youth had ever tested for HIV. White youth (aOR=0.59, p< .001) were less likely to be tested for HIV than other racial/ethnic groups. Bisexual youth (aOR=1.32, p< .05), youth with multiple sex partners (aOR=2.07, p< .001) or who used alcohol and drugs before sex (aOR=1.67, p< .05) were all more likely to be tested for HIV. Conversely, males (aOR=0.60, p< .001) and youth who reported condom use (aOR=0.73, p< .001) were less likely to report being tested for HIV. The associations among the assessed RSBs and HIV testing did not vary by sexual minority status as we found no significant moderating effects.

Conclusion: While there were no significant findings regarding the role of SMY status and RSB on HIV testing, our findings suggest differences among HIV testing by race and gender. Racial minority youth groups were more likely to be tested for HIV. Considering pubertal development challenges and the emergence of independence during adolescence, this finding is promising as racial and ethnic minority youth are disproportionately impacted by HIV. Future research is needed to understand ethnic and racial minority youths’ motivation to engage in sexual health care services such as HIV testing. Males were less likely to engage in HIV testing, especially heterosexual males. Social workers serving male youth should emphasize protective sexual health practices, including HIV testing, especially among heterosexual male youth who may underestimate their risk for HIV.