If we are going to prevent HIV transmission in young men who have sex with men (MSM), we must find strategies to reach them when they are in their early teens. So say researchers who presented a study Monday, July 19, at the XVIII International AIDS Conference in Vienna.

HIV infection among young MSM is often a conundrum. Studies show that they understand what sexual acts place them at highest risk for HIV infection, but many engage in unprotected anal intercourse with other men of unknown HIV status. What is paradoxical and frustrating is that when prevention researchers ask the young men why they engaged in high-risk behaviors, they typically respond that they didn’t think that what they were doing would lead to becoming infected.

To better understand the context behind this kind of reasoning, D. Dennis Flores III, from Emory Healthcare in Atlanta and his colleagues conducted interviews with 10 young MSM from that city who had recently been diagnosed with HIV. Nine of the men were African American, and one was Latino. Their ages ranged from 18 to 24. The interviews with the young men covered four topic areas: risk behavior, HIV education, the Internet and healthy role models.

As has been found in previous studies, the majority of the young men had viewed themselves as either unlikely or very unlikely to contract HIV in their lifetimes, and half reported experiencing coercion and sexual abuse at the time of sexual initiation.

One 18-year-old participant, Nathaniel, described his own sexual initiation: “I had to be around 13… He worked at my school, he was around 30, a janitor. He was always nice to me for no reason. I mean, I kind of guessed it after a while. He would talk to me. One day I just left school with him. The most we ever did was oral; we didn’t do anything else. But after that, like, he tried talking to me more about leaving school. I really didn’t like him after that.”

Flores and his colleagues found that while all the young men had undergone sex education while in middle school or high school, none reported that these classes included information about gay sex. Moreover, only one of the young men reported having any gay role models while growing up. This meant that relevant sex education occurred on the Internet, which from a sexual risk perspective, can be quite perilous. When these young men went online, most of them saw graphic high-risk sexual encounters, and this behavior quickly became what they perceived as normal and desirable.

“[The Internet] sure has taught me a lot of tricks,” explained 24-year-old Adrien. “Things that I never thought were humanly possible. It gave me a reference. I guess it was kind of revolutionary for me ’cause I’d never seen two men, like, actually get enjoyment out of it. So it was like getting exposed to that was, like, wow, you know…different.”

One of the most important findings, said Flores, was that by the time the young men encountered prevention messages and programs targeted to young gay men, higher-risk sexual activity had already become the norm. For some, they contracted HIV before having ever encountered targeted prevention information.

Flores concluded his presentation by stressing that targeted education, focused on young MSM, should be occurring as early as elementary or middle school and that parents should be taught to be supportive and to teach their sons how to avoid sexual coercion. Moreover, Flores’s team recommends engaging young MSM who are out about their sexual orientation to serve as peer educators and role models for other young men. Lastly, Flores stressed the critical need to use new technologies online to reach young MSM with prevention methods before it is too late.