Disparities in STI Risk Behaviors by Sexual Orientation Identity and Same-Sex Behavior

Background: We examined sexual health risk behaviors by both sexual orientation identity and same-sex behavior on STI risk among sexual minority adolescent males and whether disparities vary by race/ethnicity. Method: We pooled YRBS data from 14 locations and 2 years (weighted N>34,000) to examine age at first sex, number of sexual partners, condom use at last sex, and drug or alcohol use during sex among sexual minority males. We performed these analyses for the total population as well as by major race/ethnic groups (non-Hispanic white, non-Hispanic black, Hispanic).

Results: The results showed that a bisexual identity and same-sex contact were consistently associated with all sexual risk behaviors, and that a gay identity was associated with a lower likelihood of reporting condom use at last sex and a greater likelihood of reporting drug and alcohol use during intercourse compared to heterosexual identified respondents. Drug and alcohol use during sex varied by race/ethnic group: when the analysis was restricted to whites, results showed that same-sex behavior was associated with elevated risk of reporting drug or alcohol use during sex but there were no differences by sexual orientation identity. When the sample was restricted to black respondents, however, risk of drug or alcohol use during sex was associated with a sexual minority identity, not behavior.

Conclusion: The results suggest that even when same-sex sexual behavior is accounted for a sexual minority identity is associated with elevated odds of engagement in STI risk behaviors and that these risks differs by whether respondents identify as bisexual or gay. Important differences emerge by race/ethnicity for drug and alcohol use during sex. STI prevention strategies, therefore, may benefit from more tailored programs for different sexual orientation identities and race/ethnic groups.