“get them while they’re young!”

1. Newly-Diagnosed YMSM’s Perspective on HIV Prevention: D. Dennis Flores, III Emory Healthcare Barbara Blake and Richard Sowell Kennesaw State University “get them while they’re young!”

2. Objectives • At the end of this section, the audience will be able to: • Describe factors that influence the sexual behaviors of young men who have sex with men (YMSM) • ▪ Discuss factors that makes HIV prevention a persistent challenge for YMSM • ▪ Suggest recommendations to prevent new HIV infections among YMSM

3. The purpose of this study was to • Identify reasons why YMSM continue to be disproportionately infected with HIV despite available prevention information. • Solicit insight from newly-diagnosed YMSM about how to re-structure prevention programs for their non-infected peers. Purpose

4. Individual interviews • Recruited from agencies providing services to YMSM • Informed consent and incentive • Audio recorded • Recordings transcribed verbatim and validated • Data analyzed using content analysis Methodology

5. Sample – 10 participants • Age – Range 18 – 24, Mean – 21 years • Race/ethnicity • 9 – African American • 1 – Latino • Education • 5 – high school graduates • 1 – college degree • 4 – other • HIV Diagnosis • Range – 2 to 11 months prior to interview • Mean - Six months at time of interview FInDings

6. Personal risk Education Technology Role modeling Themes

7. Majority viewed themselves as either unlikely or very unlikely to contract HIV in their lifetimes Half of our participants reported experiencing coercion and sexual abuse at the time of sexual initiation Personal risk

8. Personal Risk “I had to be around 13…He worked at my school, he was around 30, a janitor. He was always nice to me for no reason. I mean, I kind of guessed it after a while. He would talk to me. One day I just left school with him. The most we ever did was oral, we didn’t do anything else. But after that, like, he tried talking to me more about leaving school. I really didn’t like him after that.” -Nathaniel, 18

9. Knowledgeable about HIV transmission • Discounted • Irrelevant • Sex education in school • Excludes gay sex Education

10. Internet • Main source of information for questioning youth • View sexually graphic content • De facto manual for learning dynamics of gay sex Technology

11. Technology “…[internet] taught me how to grasp it, I would say, how to grasp homosexual sex. As far as tops and bottoms and stuff like that. It kinda, you know, gave me an idea of, like, the type of things that I liked to do when being sexual.” “…[internet] sure has taught me a lot of tricks, things that I never thought were humanly possible. It gave me a reference, I guess it was kind of revolutionary for me ‘cause I’d never seen two men, like, actually get enjoyment out of it. So it was like getting exposed to that was, like, wow, you know…different.” - Anthony, 19 -Adrian, 24

12. Nine participants reported not having identifiably-gay role models growing up • Lack of social cues • Lack of mentors Role modeling

13. Role modeling “I was 17…we walked to his place. One thing I can remember is telling him, ‘Don’t nut in me.’... We didn’t have a condom and I was scared about that. I was like, alright, we can do this, but just don’t nut in me…we did it and I was like, did you? He was like, ‘nah’ and it turned out he did….the second time was the same day…I told him again, ‘don’t nut in me’ and it turns out he did it again and I was really pissed by that time and left…The next day came and I was selling newspapers and I got really sick…for a whole week I was doing nothing in bed…I was just just so sick…and my grandmother took care of me.” - Alec, 18

14. High incidence of sexual abuse handicaps YMSM from forming healthy sexual identities Unlimited access to graphic materials online normalizes high risk behavior Non-inclusive sex education causes resistance to generic messages on safe sex practices Current HIV prevention strategies target YMSM too late conclusions

15. So, what do newly-diagnosed YMSM recommend to keep their peers from getting infected? • Targeted and inclusive sex education at an early age (elementary or middle school) • Increase parental education related to sexual coercion and encourage supportive parent-child relationships • Peer or gay mentored interventions • Sophisticated prevention strategies that incorporate technology in developing positive approaches to sexuality Implications for real life

16. references • Elia, John P. and Eliason, Mickey. 2010. Journal of LGBT youth.: Discourses of Exclusion: Sexuality Education's • Silencing of Sexual Others. • Gavin, L., MacKay, A., Brown, K., Harrier, S., Ventura, S., Kann, L., Rangel, M., Berman, S., Dittus, P., Liddon, N., • Markowitz, L., Sternberg, M., Weinstock, H., David-Ferdon, C.,2009. Ryan, G. Sexual and reproductive health • of persons aged 10-24 years – United States, 2002-2007. Morbidity & Mortality Weekly Report; July 2009, • Vol. 58 Surveillance Summaries 6. • Goodenow, Carol; Netherland, Julie; Szalacha, Laura. 2002. AIDS-Related Risk Among Adolescent Males Who • Have Sex With Males, Females, or Both: Evidence from a Statewide Survey. American Journal of Public • Health | -02 | 92:2 |203(8) • Lescano, Celia M.Brown, Larry K., Puster, Kristie L., Miller, Paul M. 2004. Sexual Abuse and Adolescent • HIV Risk: A Group Intervention Framework. Journal of HIV/AIDS Prevention in Children & Youth;, Vol. 6 • Issue 1, p43-57, 15p • Mutchler, Matt. 2000. Young Gay Men's Stories in the States: Scripts, Sex, and Safety in the Time of AIDS. • Sexualities; Feb2000, Vol. 3 Issue 1, p31 • UNAIDS (2008). 2008 Report on the global AIDS epidemic. http://www.unaids.org/en/KnowledgeCentre/ • HIVData/GlobalReport/2008/2008_Global_report.asp.

17. acknowledgments ▪ Wellstar School of Nursing, Health and Human Services at Kennesaw State University ▪ Atlanta Clinical and Translational Science Institute, at Emory University Hospital ▪ Metro Atlanta Chapter, Association of Nurses in AIDS Care ▪ Emory President’s Commission on Sexuality, Gender Diversity and Queer Equality ▪ AID Atlanta’s Joye Bradley Clinic and Evolution Project ▪ AID Gwinnett

18. Questions? Comments? Violent Reactions? Contact Info: D.Dennis Flores,III BSN ACRN dfloresrn@gmail.com