Return To Sexual Abstinence Among Young Men Who Have Sex With Men

Sharon Marie Hudson, Health Research Association
Social and Behavioral

Over a third of all AIDS cases in California have been reported in Los Angeles County, and young men who have sex with men (YMSM) represent a sizeable portion of those affected. YMSM are an important target for HIV prevention campaigns because they report engaging in high levels of sexual risk behaviors; they are more likely to engage in sexual risk than older MSM are. In this context, the as-yet-unpublished findings of our previously funded UARP grant are particularly striking: in a sample of 170 18- to 24-year-old MSM recruited outside gay- oriented clubs and bars, virtually all were sexually experienced, yet fully 25% reported they had not had sex within the past 6 months. Our data further indicate that the abstainers may be likely to engage in less sexual risk even when they do have sex. Their risk for HIV and other sexually transmitted infections is therefore very low. These findings suggest an important possibility for prevention interventions that is virtually unheard of in the published literature on YMSM: promoting a return to sexual abstinence. Understanding more about YMSM who are no longer sexually active will help us develop interventions to promote a return to abstinence and thereby achieve a great public health impact.

The data from our preliminary study were not designed to explore issues related to sexual abstinence; nevertheless, they do provide some insights into how abstainers may differ from YMSM who are sexually active. The abstainers tended to be men of color, and appear to have what can be described as a stronger sense of self, relating to the importance of race, community and religion in their lives. Based on these preliminary findings, and guided by theories on self- categorization and adaptive identity, we propose carrying out a qualitative study to further explore these issues and others that may be important in return to sexual abstinence. We will conduct 50 in-depth interviews with YMSM who report that they are sexually experienced but have not had sex in the previous 6 months. The specific aims of the project are to answer the following questions:

  1. How do these YMSM perceive their own sexuality and sexual behavior? What norms do they hold regarding sexual behavior?
  2. For those YMSM who have actively chosen to remain sexually abstinent, what factors did they weigh in making this choice?
  3. What groups--sexual, racial ethnic, religious, etc.--do these YMSM identify with, and what characteristics associated with these groups support a return to abstinence?
  4. Who are their friends, and to what groups do they belong? What are their friends' norms about sexual behavior?
  5. What is the pattern of drug and alcohol use among these YMSM, and how is substance use related to their sexual behavior?
  6. What is the club experience like for these YMSM? Why do they go to venues such as clubs, and how or why do they refrain from meeting sexual partners there?

The participants in this study will be 18 to 24 years old, and will be ethnically diverse. The data collected will be transcribed and coded, and then analyzed to identify patterns. Findings will be applied to the development of future research: quantitative studies on larger and more representative samples of YMSM, and intervention studies aimed at promoting a return to abstinence and thus a dramatic reduction in HIV risk.