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Gay / Bisexual Male Youth: 

Multidimensional Problems

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The following citations from the Seal et al. (2000) study highlight some of the many problems experienced by gay and bisexual male youth. Similar studies of GB males adolescents ranging in age from 12 to 17 are awaited.

Seal DW, Kelly JA, Bloom FR, Stevenson LY, Coley BI, Broyles LA (2000). HIV prevention with young men who have sex with men: what young men themselves say is needed. AIDS Care, 12(1), 5-26. Medline Abstract.

The Study: Qualitative: semi-structured interviews, with some open-ended questions. Seventy-two (72) YMSM (Young Men Who have Sex With Men) - ranging in age from 16- to 25-years old (Mean Age = 20.9 years) - from Milwaukee (n = 41) and Detroit (n = 31). Local service providers were used to identify "a number of young men's social network segments. These segments included YMSM who patronize gay bars, YMSM under 21 who frequent coffee shops and cafes, non-gay identified YMSM, drag queens, YMSM college groups, church-affiliated YMSM, young commercial sex trading men, public sex environment participants and other groups. The sample of YMSM recruited for interviews... was selected purposefully to include representation from all these segments and to yield a sample with maximum heterogeneity with respect to age, ethnicity and sexual identity." Sample = 44% white, 32% black/African-American, 10% Latino, 14 others (p. 7). "Data... were collected as part of a Centers for Disease Control and Prevention (CDC) community-level multi-site research project" (p. 23)

Many YMSM perceived that a 'free-love lifestyle' norm permeated the gay community, and felt pressured to adhere to this standard:

Young men think that they have to live up to the peer pressure to say, 'I have done this or that.' They don't want to appear to be a virgin. Ejaculating, fucking, those are the things that signify your masculinity. Thus, men are always challenging around new and exciting ways to have sex. (p. 9)

YMSM's attempt to conform to a free-love lifestyle often conflicted with their need for emotional attachment and support. Many younger men expressed difficulty in finding emotional intimacy within the gay community:

The one thing that everyone wants is love. And in the gay lifestyle, it is very difficult to find someone of the male nature who would be willing to stick with a commitment relationship. So the only way to keep them would be sex. I think we have moved sex into the position of love. To use that [sex] as an alternative to get our emotional needs. Thinking that it is one and the same. (pp. 9-10)

[On "gay couples who could serve as gay role models"].

There is no such thing as a gay role model. I don't know any couple that doesn't have an open relationship, that aren't sluts. So everyone follows the stereotype: 'There is no such thing as a relationship. We can't get married.' (p. 10)

Low self-esteem and self-worth, a lack of self-care and self-love, hopelessness and depression and teen suicide factors were believed to underlie unsafe sexual behavior:

There are time when I wished to God I would have just been dead. I couldn't go through the pain of who I was or the pain of trying to live my life. There was so much hurt. It wouldn't have mattered if I had gotten HIV. To be that would have been the simplest solution. I wouldn't have had to do a thing. I just would have had to lay there. I wouldn't have had to slit my wrists or commit suicide any other way. It's a more painful way, but if you're on a suicide mission it doesn't matter. (p. 10)

Participants further pointed out that may YMSM, and particularly YMSM of Color, lived with a pervasive sense of hopelessness in multiple aspects of their lives. Consideration of adverse long-term consequences of behavior was difficult for men who lived with daily violence, poverty, and despair and who held few expectations about a lengthy life:

When it comes down to it, the guys I talk to just don't care about life. They say life has nothing to offer them. A lot of times their mothers and fathers have disowned them and their family won't deal with them anymore because they are gay. They have no life, no family no future. (p. 10)

YMSM felt that HIV prevention programmes needed to promote self-love and self-care. Providing people with a desire to live was deemed critical for consistent safer-sex behavior:

The lack of older YMSM role models who could promote future hope was also noted:

They [YMSM] figure that they will have as much fun as they can now because they see old guys sitting in Venue X who like 40 and 50 and 60 years old and who haven't done anything with their life. Or, if they have, they're single and sitting in Venue X hitting on the young guys. The [YMSM] figure if they die young they wouldn't have to worry about that. It's the fear of age that many kids don't want to face - that they will get old. They figure that they have do do lots of things before their beauty fades. (pp. 10-11)

Physical arousal was cited as a reason that YMSM practice unsafe sex, an action that could have dire consequences, as illustrated by this story:

This man was beautiful. After the fourth time we had sex in 14 hours, we were laying and he said he had something to tell me. I was just thinking please don't tell me he's going to say that he was HIV or something. And he just kind of turned to me and said I should have told you earlier, but I'm positive. I was like, oh my God, but i didn't freak out because I knew what I had done. I had chosen to let him fuck me without a condom. What was I going to do? Take out a knife and stab him? So I rolled over and went to sleep. The next morning I woke up and saw he had a hard on and made him fuck me again. The sex was just that good. (p. 11)

Some YMSM derived excitement from conscious unsafe sex: 'There's times with anonymous pickups that I won't use a condom. The thrill of not knowing whether he (an anonymous pickup) is gay or straight makes it difficult for me to stay safe.' Several respondents reported that more and more YMSM found sexual excitement in the 'Fuck of Death', that is, conscious unprotected receptive anal sex with a known HIV-positive partner or 'bug giver'. (p. 11)

Although participants felt there was a need to help YMSM to develop ways to enact safe sex when sexually aroused, they stressed that 'just say no' messages were not the answer. Rather respondents felt that programmes needed to move beyond abstinence-only ideology toward the management of sexual arousal and the promotion of responsible and healthy sexual choices that included abstinence or sexual delay as options. Respondents also felt that condom use needed to be eroticized: 'Gay sex is supposed to be erotic, but introducing safe sex makes it less of a fantasy. We need to find ways to make it more enjoyable. More intense.' (p. 11-12)

Many respondents noted that bars, raves and house parties were central to the social fabric of the gay community. For many young men, their emerging identity as a gay man was associated with their ability to enter gay bars. Often, this happened before the men reached a legal drinking age. A variety of strategies were available to under-age YMSM who desired access to gay bars, including the use of fake IDs, the escort of an older man or sexual relations with bar staff. Being invited to a house party, particularly in communities of color, serve a similar function for under-age YMSM or YMSM who were just coming out as gay men. (p. 12)

Although bars, raves and house parties were viewed as a center of gay social life, many respondents noted that drugs and alcohol use accentuated men's likelihood of having casual sex and having unprotected sex: 'You don't care about who you're messing with. Or whether you use a condom.' Participants also noted that drug used increased the likelihood that people would be taken advantage of sexually:

Club scenes and raves can be unsafe because there are a lot of drugs. People snort 'K' which is dangerous. You can go onto a 'K-hole' which is when you enter a void of consciousness for about 30 minutes or an hour. During that time you are taken advantage of, like rape or anything. Sometimes you can't move. If you are out of it and in a 'K-hole', and you are having sex with somebody, it's pretty easy not to know if they are using protection or if you are. There are kids who are contracting AIDS at 14, 13, and 12 because they are doing drugs and not completely aware of what they are doing  and then get taken advantage of or they take advantage of someone else. (p. 12)

Men's discomfort with identifying as gay was seen as a barrier to emotional intimacy: 'Sex is sex, but if you actually kiss or hug or hold one another, you're gay. Thus, people just have sex so they can somehow fool themselves that they're not gay.' (p. 12)

To many programs for gay men put pressure on people to come out... (p. 13)

It's [the gay community] a very pressuring community. A lot of peer pressure when it comes to being gay or straight. For some strange reason bisexuality isn't really considered sexuality. Bisexuals are seen as gay men who are having trouble with their sexuality. Like it is the first stage of coming out. If someone is really bisexual, people will harass them until they say if they are gay or straight. It's more or less, you know you're gay, get over it. (p. 13)

The gay community is also perceived to be dismissive of transgendered people:

Although researchers and providers often cite sex for pay or drugs as a source of HIV risk among YMSM, few participants reported that this behavior was common... However, participants frequently describe relationships between YMSM and older men ('sugar daddies') who financially took care of or otherwise provided for their younger partners:

People don't pay for sex anymore these days. Once in a while you find a kid who is homeless and will do that, but paying for sex is very rare. Like you are going to the bar and the guy is sleeping with you because he's rich and you're being his boyfriend for awhile. That happens a lot. But to find a person on the street corner and say I'll sleep with you for money, that's rare. (p. 13)

Although some YMSM described positive benefits of sugar daddy relationships, many respondents viewed these relationships with suspicion and negativity:

It's difficult for me to believe that there is actually a man over 40 years old or of chicken hawk age who has pure motives when all they want is to take them [YMSM] in so no one can hurt them. I'm sorry but all they want to do is take them home and fuck them... Street kids are really taken advantage of. Somebody will come by and say, 'I'll be your friend. I'll buy you a couple of meals and give you a place to stay', when all they want is to get laid. (p. 13)

Other YMSM related tales of being sexual coerced by older gay men: "When you're young and hot, everyone is sweating you... If you don't give it up, then they [older men] lie about you. Say you have the package {HIV]. Another participant stated, 'Sometimes in the leather group there are initiations. Some have a six-month training program. In some of the initiations the person has sex with all the guys in the group. Sometimes they don't use condoms.' A few participants reported rape experiences:

I was really fucked up and very dizzy to the point where I almost passed out. It was date rape. It was without a condom. I kept telling him to stop it and he didn't. I was so fucked up at the time that everything I was feeling and everything I wanted didn't matter.

Few respondents offered positive solutions to these abuses. Said one participant:

Most older men want fresh meat. They want someone who is new and someone that people haven't dealt with. Younger men want someone to love, to lay in bed with, to introduce them to life, to teach them sexually. Older men have power, security and money. So young men will have unprotected sex with them to get a piece of those things. (p. 14)

YMSM emphasized the importance of creating a fun, comfortable atmosphere, while avoiding lecture-style HIV prevention programmes:

...Don't bring in people to lecture and give people speeches. They [YMSM] hate to sit there and listen to people talk. (p. 15)

...When you are a kid and you realize that you are gay, you are thrown into an adult world because you are gay. There is no world for gay kids. There is only the adult life for gay kids, which doesn't even start until midnight. (p. 16)

YMSM of Color spoke of homophobia from both within and outside of their own communities:

People outside of the community are afraid from going into these communities to provide information to them and make sure they receive it. And the men within these communities themselves are afraid of getting the information for fear of being labeled gay... We need a gay organization that embraces Black gay youth to help them come out. So many organizations address the needs of White youth, but Black youth tend to fall through the cracks. (p. 17)

YMSM held mixed opinions about the amount of support they received from the gay community. For some YMSM, their identification with the gay community was a positive and supportive experience:

'Community means a part of the city, a family. Being around people who are gay feels good because they understand each other more and understand their sexuality.' Not all YMSM felt enthusiastic about the gay community, however: 'They [the gay community] say met, have fun, have sex. But it's all about shit, lies, and disease. They promise to protect us, but then they won't catch us when we fall.' Further, many participants believed that, 'The gay community has never been together. Too many subgroups... It's all about who looks the best, who has the best looking boyfriend.' Stated another: 'There are to many cliques in the gay community. Many groups and programs have hidden agendas. We need to unite and stop downing each other. We can't expect respect from others until we show it to each other.' (p. 18)

Respondents also noted racism within the gay community that mirrored the racism present in the larger society:

There is a lot of racism within the gay community. We don't value our diversity as much as other cities. Gays don't want to get to know other gays. We want acceptance from the heterosexual community but we don't want to get to know each other as people. It's so much stupid shit. (p. 18)

Respondents emphasized the important role of churches could play in HIV prevention, particularly in  communities of Color. However, few gay-accepting churches were identified, Many participants expressed ambivalence toward the church:

Churches offer spiritual fulfillment, but it's nothing but a promise. They offer morals, but they are not. It's very difficult. Almost everyone in the Black community has a sense of God in their lives and growing up in the church. It guides their lives. Invariably, conflict will arise between a person's same-sex attraction, their church, and their family values. You get stuck between a rock and a hard-place with nowhere to turn. I call it the sex-trap. It's a lust thing. You get tired of giving up your desires [for same gender sex] and the guilt and shame that follows. The church teaches you that if you pray and serve God, He will take the gayness away, and you can live a straight life. A lot of gay men have tried to go that route and it just doesn't work for them. (p. 18)

YMSM spoke of the strong cultural taboos and norms that impacted HIV prevention in communities of color. Said one Latino man: 'Latino men believe that they are not at-risk for HIV unless they are penetrated. Therefore, if they are the penetrator, they do not see a need to use condoms.' This difficulty was accented by the strong taboo among many YMSM of Color against admitting that they are gay or had ever been sexually penetrated:

Many men in the Black community still think of aids as a gay disease. If you are just fucking, then you're not gay regardless of whether your partner is a man of a woman. So people don't think about sexuality, but rather just having sex to meet pleasure needs. just fuckin to fuck. Then you're not gay and therefore not at-risk for AIDS. (p. 19)

Respondents also indicated that many men of Color did not consider themselves as gay if they only had receptive oral sex:

Some people think that anal sex is the defining term as to whether you are gay or not as opposed to if you just let someone perform oral sex on you. If you let somebody suck you off you're still not gay. A person who is straight will say, 'Yeh, I let that fag suck me off.' But they won't let anyone know they enjoyed it. Even though the feeling is an orgasm. An orgasm is an orgasm. (p. 19)

A distrust of providers' motives for outreach was also seen as a barrier to HIV prevention. Several YMSM believed that providers used their position to seek sexual relationships, as seen in this response to a question about barriers to participants:

Outreach workers who just want to have sex with you. We need a gay and lesbian youth center where youth can go for discrete services. Someone we can talk to about sex without having to worry about them trying to sleep with you. (p. 19)

Church officials were also portrayed a using their position to seek sex from YMSM:

Then there are a lot of gay ministers and they are all so secretive. You get a lot of pastors in the Black churches fooling around with young men. They drive around in fancy cars  and get young men to perform oral sex on them while telling you that homosexuality is wrong and telling you how ashamed they are that you are doing this [performing oral sex]. They preach anti-homosexuality, but they have been with you the night before. It's a real hurtful thing because you think the person cares, but then they denounce you. And you ain't tell nobody because nobody's going to believe you. No one talks about it. No one understands how disruptive this is to young men. (p. 20)

[On the availability of condoms:] It's weird that people should have to pay for protection. (p. 20)

Discussion:

The development of effective HIV prevention for a population that remains vulnerable to HIV must address risk issues relevant to its members, and intervention activities must be undertaken in ways that are seen a attractive, appropriate and useful by the persons one seeks to reach. (p. 20)

Instead young men voices the opinion that HIV prevention topics should be imbedded in the context of other issues they face such as dating and emotional intimacy and the development of relationships; self-esteem, self-care and self-love; coming out issues; pessimism concerning one's future; safer sex negotiation and communication; alcohol and illicit drug use; and gaining acceptance by one's peers, family members an society as a whole. These findings highlight the importance of approaching HIV prevention from a perspective that recognizes broad contextual issues and needs in the lives of young men rather than approaching prevention from a narrow factual "AIDS education' focus alone. (p. 21)

Not surprisingly, young people in the study felt that peers, same-age buddies and those who could provide peer support should be involved in the development and delivery of HIV prevention interventions. The efficacy of a peer-led programmes targeting young gay men was demonstrated in a community-level HIV prevention study conducted by Kegeles et al. (1996). (p. 21)

YMSM often said they wanted to be able to benefit from the perspectives and experiences of older gay men who have been successful in their lives and relationships. This underscores the lack of intergenerational support available to most YMSM... Older gay mentors could be important influences in these areas. (p. 21)

...interviewees said that unprotected anal intercourse was most likely to occur when a young man had entered an affectionate or regular partner relationship. Particularly needed in HIV prevention programmes for YMSM is attention to issues of sexual safety in dating, affectionate and boyfriend relationships where condom use is presently seen to connote lack of trust or lack of intimacy. (p. 22)

...Rather, the most dominant these among participants was that their status as YMSM serves as a common bond that superseded other differences. 'We need peers and role models of al sexual identities, ages, and ethnicities. We need opportunities to meet others like ourselves, period.' (p. 22)

Implications

Our findings highlight the complexity of developing appropriate HIV prevention programs that will be attractive to YMSM. Our findings underscore gaps in our existing understanding of the context of young men's sexual risk behaviors... HIV prevention programs have historically focused narrowly on safe sex promotion. Such approaches are less likely to prove successful than those which address broader aspects of sexually and emotionally intimate relationships, of which safer sex negotiation and behavior is just one component (Seal, 1999; Seal et al., in press). This broader context should be a starting point for intervention development. (p. 22)

HIV prevention programmes that address the needs of YMSM will also need to reach non-YMSM populations. Prevention efforts must address larger social structures that impede the healthy development of young men's sexual identity and safer sex behavior. Specifically, YMSM HIV prevention efforts must be supplemented by programmes promoting gay awareness and acceptance for parents, school and churches. Programmes are also needed that help bridge generational gaps between YMSM and older members of the gay community. Just as safe spaces are needed for YMSM to gather and socialize, so, too, are safe spaces needed for older persons to provide positive mentorship as role models... we should be cautious to conclude that 'one size fits all' programmes will be adequate for a community of YMSM characterized by multiple population segments that differ in age, ethnicity, sexual self-identity and other dimensions that are likely to influence HIV vulnerability. (p. 23).

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