Understanding and reducing HIV risk behavior and substance use among self-identified bisexual adolescent men - Project Summary:
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. This
award will provide the applicant with career development training in adolescent health, qualitative methods, and
intervention development at Northwestern University’s Institute for Sexual and Gender Minority Health and
Wellbeing–a well-resourced, rich intellectual environment for training scholars in sexual and gender minority
health research. The training and research activities will facilitate the applicant’s transition to an independent
investigator with a program of research focused on understanding and eliminating HIV and substance use
disparities affecting bisexual men. 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.
