Key Issues

While gay men continue to represent the greatest number of people who are HIV-positive or living with AIDS, the proportion who are between the ages of 15 to 29 is growing at an alarming rate. Prevention education and support programs designed specifically for gay youth are a priority.

.

In the late 1990s in Canada, we are witnessing significant changes in who is seroconverting*, and when. The median age of infection has fallen just over five years, from 29.6 for 1975-1984, to 24.5 years for 1985-1990.

Statistics for young gay men are difficult to define due to variable methods of reporting HIV infections and the resulting reliance on AIDS statistics. Because young people with HIV progress to AIDS much more slowly than older persons, AIDS statistics are bound to disproportionately under-represent youth.2 Finally, gay youth are more prone to substance use, dropping out of school, prostitution, sexually transmitted diseases, homelessness and suicide.

Particular to young men as they identify as gay, are the powerful influences of homophobia, social isolation, and struggles with notions that gay equals AIDS, loneliness, and the loss of family and friends. Historically, gay youth have not been actively involved in the development and implementation of prevention programs directed at them, although this is changing with more community consultation, focus groups and projects like the Canadian AIDS Society's "Make Noise Project: Empowering Youth to Confront HIV/AIDS.", Phase I and Phase II.

Given the current situation, several questions must be answered: In a population of gay men that has grown up and become sexually active in the context of the AIDS epidemic, why are so many of them seroconverting? Are prevention programs/campaigns adapted to this population? Are young gay men involved in prgraoms to insure they respond to their needs? Where can a young gay man go to get the answers he needs? Is peer counselling an option? How do issues facing young gay men differ in urban versus rural settings?

*Seroconversion occurs when someone is exposed to HIV. Their body tries to eliminate the virus by making antibodies. After someone seroconverts, his/her blood test for the HIV antibody will come back positive. This stage usually happens one to three months after infection.

Who are they?

Young gay men are:

• somewhere in the range of 14-29 years, depending on who you consult
• in school
• drop-outs
• living at home
• living on their own
• street-involved
• in care
• secure and happy in their sexual identity
• extremely conflicted about their sexual identity
• connected to the gay community
• isolated physically, emotionally and psychologically from other lesbian, bisexual and gay (lesbigay) individuals and communities
• ambivalent about their sexuality and their health
• of every race, class, ethnicity, ability and cultural background
• everywhere

Why are they seroconverting?

• Young gay men face all of the difficult issues facing all youth, straight or gay, in our society. They are individuals striving to understand who they are and to have others respect their identities.
• Just like older people/everyone, young people often feel invincible to some degree, and can’t or won’t see long-term consequences of present behaviours.
• People who seroconvert at a young age in relatively good health will live healthy lives for up to 10 years. When treated for opportunistic infections and introduced to current drug therapies, they may have up to 20 years of relatively healthy living. For someone young, this may seem like forever.
• Many young gay men see HIV/AIDS as an old gay men's disease and believe that by only having sex with men their own age, they won't be exposed to HIV.
• School-based AIDS education rarely if ever includes supportive or affirming education about homosexuality. Anti-homophobia and anti-heterosexist education is rare across Canada.
• For many street-involved youth, concerns about HIV become secondary to securing shelter, food and money. For some, this means depending on prostitution, or survival sex.
• Young gay men are everywhere while services, resources and support directed at their needs are not.
• In many cities, the gay community is centered around the bars, and if you are too young, there is little chance of connecting with other gay youth.
• The lack of support and self-esteem for many young gay men can make it difficult to insist on safer sexual practices, or even to talk openly with their sexual partners.
• Many young gay man are more concerned with the issues surrounding their sexuality than they ar with issues of HIV prevention.
• A lack of connection between young gay men and the adult gay community can further lead to a sense of isolation with important impacts on self-esteem and the ability to make healthy choices.

Where can young gay men go for information?

• For rural and isolated young gay men, getting information on safer sex is often their most pressing issue. Services are often severely lacking or non-existent in their communities. Where they exist, youth serving agencies, local lesbigay organizations and local AIDS Service Organizations (ASOs) can be good resources for this group. These services are often more effective when partnerships are developed in order to best assess and address the needs of lesbigay youth in their region. It is important for these agencies/organizations to reach out specifically to young gay men.
• Phone support lines can serve as extremely important links for physically isolated youth. The anonymity of the phone combined with the resources, support and affirmation available can provide valuable supports to otherwise completely isolated individuals who are struggling to deal with their sexuality and their ability to protect themselves from HIV and other STDs. Again, it is important that these resources are widely advertised.
• For rural youth and youth in smaller communities it is important to recognize the fear of disclosure of one's sexuality. This information can make life in smaller communities difficult or impossible for some young gay men. Access to testing, counselling and AIDS education may involve such obstacles as (potentially costly) travel and unexplained absences from home.

Strategies for reaching young gay men

• For youth serving agencies, it is important never to assume heterosexuality, and to encourage the development of safe spaces for youth to discuss their sexuality. Youth-serving organizations can advertise their services widely and emphasize a gay positive approach.
• Many youth-serving agencies have developed trusting relationships with youth. ASOs and prevention initiatives can take advantage of these relationships and work together with agencies to deliver prevention information.
• Encourage and insist that young gay men participate in the development, design and delivery of prevention education for this group. They are the experts on what it's like to be young, gay and male in the late 1990s. This includes focus testing and evaluation of materials and programs by youth prior to implementation and distribution.
• Services and resources and information around sexuality, as well as HIV and AIDS should be advertised as widely as possible in as many of the spaces youth hang out as possible.
• ASOs can review programming targeted to men who have sex with men and ask themselves if young men under the age of 19 years are being reached by their programming.
• A harm reduction approach to prevention education for this group is more likely to realistically reflect the types of decisions young people make and the ways in which they make them. Harm reduction approaches can go some way towards promoting a respect for those prevention educators are trying to reach by believing in the young man's ability to make the best decisions for himself given all the available information.

Is peer counselling an option?

• Peer counselling can be an excellent means of reaching young gay men. For many of the reasons listed above, this group might not want to deal with adults, or has trouble relating to them. Peers are often more trusted and are already de facto providers of information.
• The challenge for ASOs and HIV prevention strategies is to ensure that these peers have as much accurate information as possible. While peers can be an effective means of education, they can also be influential sources of misinformation.
• It is also important to remember that some youth would prefer to speak with someone they see as an 'expert' - often this can be someone older. Out gay, lesbian and bisexual adults can be important as positive role models and providers of HIV prevention information.

1. Health Canada. Recent Trends: Canadian HIV Epidemics. Ottawa: Division of HIV/AIDS Epidemiology, Laboratory Centre for Disease Control, Health Canada, 1995.
2. Health Canada. The experiences of Young Gay Men in the Age of HIV: A Review of the Literature. Ottawa: Canada, 1996.

(Other source: Make Noise! : empowering youth to confront HIV/AIDS, Canadian AIDS Society, 1996.)