Role of Multiple Identities in Engagement in Care among Gay/Bisexual Male Adolescents Living with HIV

Gay and bisexual male adolescents are disproportionately impacted by HIV/AIDS in the U.S. In order to provide these youth with the critical medical and psychosocial services they need to remain healthy and to limit the further spread of HIV, they must be engaged with their care providers. The current study sought to explore developmental determinants of adherence to medical appointments as one aspect of engagement in care among gay/bisexual male adolescents living with HIV/AIDS.

Quantitative survey data were collected using an audio computer assisted self interview format from 200 gay/bisexual male adolescents (16-24 years) living with HIV/AIDS who were receiving care at 14 clinical care sites across the U.S. The primary developmental factors explored were ethnic identity, sexual identity, and identity as a young man living with HIV.

Logistic regression analyses explored associations between multiple identities and adherence to medical appointments, as one aspect of engagement in care. The model significantly predicted missed appointments (X²= 14.5, df = 3, p <.002). Ethnic identity affirmation (OR = 0.6; 95% CI: 0.3, 0.9), morality of homosexuality (OR = 1.7; 95% CI: 1.2, 2.5), and HIV-positive identity salience (OR = 1.5; 95% CI: 0.9, 2.4) were associated with significantly higher risk for missed appointments in the past 3 months.

These findings highlight the importance of attending to developmental factors, such as the development of multiple identities, when attempting to increase engagement in care for gay/bisexual male adolescents living with HIV/AIDS. Given the salience of ethnic and gay/bisexual sexual orientation identity for youth, care providers should attend to the role that these developmental factors may play in adherence to medical appointments.