HIV/STD Risks in Young Men Who Have Sex With Men Who Do Not Disclose Their Sexual OrientationSix U.S. Cities, 1994-2000

TO AVOID SOCIAL ISOLATION, DISCRIMInation, or verbal or physical abuse, many men who have sex with men (MSM), especially young and minority MSM, do not disclose their sexual orientation. Young MSM who do not disclose their sexual orientation (nondisclosers) are thought to be at particularly high risk for human immunodeficiency virus (HIV) infection because of low self-esteem, depression, or lack of peer support and prevention services that are available to MSM who are more open about their sexuality (disclosers). However, the risks for HIV infection and other sexually transmitted diseases (STDs) are unknown for nondisclosers. To better understand the prevention needs of young MSM, CDC analyzed data from the Young Men’s Survey (YMS) to compare HIV/STD risk differences between nondisclosers and disclosers. This report summarizes the results of that analysis, which indicate that 8% of 637 nondisclosers were infected with HIV compared with 11% of 4,952 disclosers. Among blacks, the prevalence of HIV infection was 14% among 199 nondisclosers compared with 24% among 910 disclosers. Compared with disclosers, nondisclosers had similar high risks for other STDs, reported less sexual behavior with men and more sexual behavior with women, reported less use of HIV testing services, and, among those who were HIV infected, were less likely to be aware of their infection. To reduce HIV/STD transmission among young MSM and their female sex partners, comprehensive HIV/STD testing and prevention programs for young nondisclosers, especially for those who are black, should be developed or expanded. YMS was a cross-sectional survey conducted during 1994-2000 of men aged 15-29 years who attended MSMidentified venues in six U.S. metropolitan areas (Baltimore, Maryland; Dallas, Texas; Los Angeles, California; Miami, Florida; New York, New York; and Seattle, Washington). Participants were interviewed with a standard questionnaire, had blood drawn for testing, and were provided HIV/STD prevention counseling and referral for care. Specimens were tested for HIV and hepatitis B virus (HBV) with standard assays. HBV infection was defined as the presence of HBV surface antigen or antibodies to HBV core antigen. Disclosure was assessed with the following measure: “Using this card, choose the number that best describes how out’ you currently are about having sex with men. By out,’ we mean you let others know that you are sexually attracted to men. ” Responses were measured on a 7-point scale (e.g., 1, “Not out to anyone;” 4, “Out to half the people I know;” 7, “Out to everyone”). Participants who answered 1 or 2 were defined as nondisclosers, and participants who answered 3-7 were defined as disclosers. Participants who answered 1 or 2 were grouped together because of similarities in their demographic characteristics, reported risk behaviors, and prevalence of HIV infection. Differences between nondisclosers and disclosers were evaluated by using the CochranMantel-Haenszel chi-square test controlling for city, age group, and race/ ethnicity (if applicable). Analyses were stratified by race/ethnicity for those groups that had 50 nondisclosers. Some analyses were restricted to men aged 15-22 years because YMS was conducted in two different phases, and some questions were not repeated in the second phase, which was conducted among men aged 23-29 years. In the six cities, 5,589 MSM participated in YMS (range by city: 815-1,060). The participation rate among eligible men was 59% (range: 54%-66%). A total of 637 (11%) MSM were defined as nondisclosers (range: 7%-14%); of these, 349 (55%) were aged 15-22 years (median: 22 years; interquartile range: 19-25 years). Black (18%), mixed-race (14%), Hispanic (13%), and Asian/Pacific Islander (10%) MSM were more likely to be nondisclosers than were white MSM (8%) (p 0.05). Among racial/ethnic minorities, age was not associated with nondisclosure. However, among white MSM, the proportion of nondisclosers decreased with age: 12% among those aged 15-19 years, 8% among those aged 20-24 years, and 5% among those aged 25-29 years (p 0.01). Nondisclosers were less likely than disclosers to identify themselves as homosexual and to attend homosexually identified bars and dance clubs (p 0.05), although 64% of nondisclosers attended these venues at least monthly. Among MSM aged 15-22 years, nondisclosers were more likely to report that being homosexual or bisexual or having homosexual or bisexual friends was not important, that they sometimes disliked themselves for being homosexual or bisexual, that they felt isolated from others, and that the majority of persons in their racial/ ethnic group disapproved of homosexuals (p 0.05). The 637 nondisclosing MSM reported a median of five male (interquartile range: 2-13) and three female (interquartile range: 1-12) sex partners during their lifetime. During the preceding 6 months, 212 (33%) reported having unprotected anal interMorbidity and Mortality Weekly Report FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION