Understanding and Reducing HIV Risk Behavior and Substance Use Among Self-identified Bisexual Adolescent Men

Young gay, bisexual, and other men who have sex with men (MSM) are disproportionately
affected by HIV. Despite this burden, most HIV prevention interventions target adult MSM
(most of whom identify as gay) and heterosexual youth, creating an urgent need for
interventions for gay and bisexual adolescents. Further, self-identified bisexual men,
especially adolescents, have been neglected in research. This is a critical problem because:
(1) there are as many, if not more, bisexual adolescent men than gay adolescent men; (2)
bisexual adolescent men engage in several HIV risk behaviors more than their gay peers; (3)
bisexual adolescent men are at increased risk for substance use-a robust risk factor for HIV;
and (4) bisexual men face unique HIV prevention issues. Given that bisexual men are rarely
included in research and most existing research on them focuses on "behaviorally bisexual"
adult men, little is known about factors that drive engagement in risk behavior among
self-identified bisexual adolescent men. Attending to bisexual identity is critical to
reducing HIV and substance use, because bisexuality is highly stigmatized and stigma-related
stressors (e.g., concerns about disclosing one's bisexual identity) impact sexual behavior,
substance use, and healthcare utilization. Interventions are also more effective when
tailored to populations, underscoring the need for an intervention for self-identified
bisexual adolescent men. The goals of this study are to: (1) examine factors that drive
engagement in HIV risk behavior and substance use among self-identified bisexual adolescent
men; and (2) develop and pilot test a tailored HIV and substance use prevention intervention
for this population. In Phase 1, interviews will be conducted with 60 diverse self-identified
bisexual adolescent men ages 14-17 focused on sexual identity, sexual decision-making,
substance use motivations, and intervention preferences/barriers. In Phase 2, a tailored
intervention will be developed using findings from Phase 1. In Phase 3, feasibility,
acceptability, and preliminary efficacy will be tested in a pilot randomized trial (N = 60)
with a waitlist control and one-month follow-up. In sum, self-identified bisexual adolescent
men are at increased risk for HIV and substance use, but little is known about factors that
drive their engagement in risk behavior. By focusing on self-identified bisexual adolescent
men-an underrepresented, health disparity population-this study can identify prevention
targets and reduce disparities in HIV and substance use.

Inclusion Criteria:

- Age 14-17

- Identifies as male

- Identifies as bisexual or another non-monosexual identity (e.g., pansexual)

- Reports any sexual experience in the past year (oral/vaginal/anal)

- Reports 1+ episode of binge drinking or any drug use in the past year

- HIV-negative (self-report)

- Fluent in English

- Lives in Chicago

Exclusion Criteria:

- Does not meet inclusion criteria