Community affiliation, participation, gay identification and unprotected anal sex among young substance-using MSM in four u.s. cities

Introduction. HIV infection disproportionately affects men under the age of 30 years in the United States who have sex with men (MSM). Although a few studies have examined gay-related variables and their association with sexual risk behavior, there is a paucity of this type of research with young MSM. Methods. We examined the risk behaviors of a convenience sample of young (18-29 years) substance-using MSM (n=409). Data were collected from 2004–2008 on sociodemographics, most recent sexual risk behavior with a non-primary partner in the previous 3 months, and gay-related variables (i.e., gay [vs. bisexual], importance of gay identification to self, gay community affiliation, participation in MSM community events, and self-homophobia) using ACASI. Multivariate regression analyses were used to examine variables related to engaging in unprotected insertive anal (UIA) and unprotected receptive anal (URA) sex stratified by HIV status. Results. Nearly 36% reported URA and 30% UIA. For young HIV-negative MSM, gay self-identification was a significant predictor of engaging in URA (Odds Ratio [OR] = 3.5, 95% Confidence Interval [CI] = 1.2-10.8). Among HIV-positive young MSM, importance of gay identification was associated with engaging in UIA (OR=0.34; CI=0.13-0.89), and gay community affiliation was associated with UIA [OR=1.8; CI=1.1–3.0]. Conclusions. Associations with gay self-identification, its importance to young MSM self-concept, and community affiliation influences are inconsistent when examining serostatus and sexual risk in this population. Additional research is needed to explore the complexity of gay-related factors to better inform the development of interventions to decrease sexual risk of younger MSM.