Association of HIV Education with HIV Testing and Sexual Risk Behaviors Among US Youth, 2009–2017: Disparities Between Sexual Minority and Sexual Majority Youth

Abstract

HIV remains a serious concern among youth, particularly among sexual minority youth (SMY). Risk behaviors including low rates of HIV testing and inconsistent condom use as well as use of substances before sex contribute to these disparities. Therefore, HIV education in schools may be a valuable tool for reducing HIV-related risk behaviors. Using a large, pooled sample of youth (N=169468) from the 2009 -2017 Youth Risk Behavior Survey (YRBS), we conducted the first population-level assessment of associations between HIV education and risk behavior prevalence among high school aged youth by sexual behavior (i.e., sex of sexual partner[s]) in the US. Results demonstrated that racial/ethnic minority youth and SMY were less likely to have received HIV education than White or heterosexual peers. HIV education was associated with less substance use at last sex. Among males, HIV education was associated with increased condom use and HIV testing, emphasizing its promise as a potential intervention for risk behavior reduction. Results are discussed in light of current literature with future recommendations.

Associations between State‐Level High School HIV Education Policies and Adolescent HIV Risk Behaviors

“…Also consistent with our hypothesis, we found that compared to policies requiring an inclusive approach to sexual orientation content, students from states that had no policies or that required a discriminatory approach to sexual orientation were more likely to demonstrate at least 1 HIV risk behavior—specifically condomless last sex. Moreover, our findings of significantly higher odds of all HIV risk behaviors among students who identified as bisexual are especially important considering the limited available evidence focusing on youth who self‐identify as bisexual; recent evidence has demonstrated results consistent with our findings with youth who have sex with both males and females having higher odds of both substance use before last sex and condomless last sex 7 . These findings highlight the need to focus on addressing the disproportionate HIV incidence and prevalence among sexual minority youth (SMY) 2,16 .…”

“…It is known that SMY, particularly young men who have sex with men, have significantly higher rates of HIV risk behaviors and HIV incidence 2,16 . However, previous studies have also shown that SMY are less likely to report receiving school‐based HIV education, indicating a missed opportunity for HIV education to meet the specific needs of SMY 6,7,11 . To that end, our findings support the benefits that can result from having HIV education with inclusive sexual orientation content and that reaches and resonates with SMY.…”

“…There was considerable variation in the HIV education content regarding condom education, abstinence and other safe sex options, and the tone of sexual orientation content. Previous studies have found that HIV and condom education either reduce or have neutral relationships with sexual risk 5‐7,11‐15 . Similarly, we found that students in states mandating HIV and condom education were neither more nor less likely to report engaging in any of the studied HIV risk behaviors.…”

“…The benefits of school‐based HIV education include reduction of a range of sexual risk behaviors among adolescents: delaying age at first sexual intercourse, 5 reducing number of sexual partners, 5,6 decreasing drinking or drug use before sexual intercourse, 5,7 and increasing condom use 5‐7 . However, these benefits can be attenuated depending on the HIV education curriculum content and delivery; for example, abstinence‐only education has been associated with greater incident HIV among adolescents 8…”

Editors’ notes

“…Considering how a program, project, intervention, or event will impact LGBTQ+ persons is vital in many contexts. For example, in educational settings, the experiences we consider in our teaching (McCann & Brown, 2018) and the ways in which we ensure that content is meaningful for all groups (Phillips et al., 2020) have serious implications for LGBTQ+ people. You may also find LGBTQ+ Evaluation necessary in the context of a novel viral pandemic, where whether or not we have inclusive data determines our ability to respond effectively to the needs of marginalized communities (Cahill, Grasso, Keuroghlian, Sciortino, & Mayer, 2020; Phillips II et al., 2020).…”