Birth Cohort Variations Across Functional Knowledge of HIV Prevention Strategies, Perceived Risk, and HIV-Associated Behaviors Among Gay, Bisexual, and Other Men Who Have Sex With Men in the United States

Abstract

Gay, bisexual, and other men who have sex with men (GBMSM) in the United States remain heavily impacted by HIV. The purpose of this study was to describe intergenerational differences in functional knowledge of HIV prevention strategies, perceived risk, recent condomless anal sex (CAS), and HIV testing behavior. Eight hundred sexually active GBMSM were recruited via Facebook from August to September 2015, and administered a Web-based survey which included 12 multiple-choice questions to elicit data regarding functional knowledge of different HIV prevention approaches (e.g., condom use, pre-exposure prophylaxis post-exposure prophylaxis, treatment as prevention, circumcision). Cumulative logit and multivariable logistic models were formulated to examine birth cohort variations across four analytic outcomes. Younger generations were significantly more knowledgeable, as were GBMSM with higher education. Non-Hispanic non-White GBMSM and those reporting a bisexual/other sexual orientation had lower functional knowledge. Younger generations were equally concerned about contracting HIV as their older counterparts. Perceived risk was significantly higher among non-Hispanic non-White and Hispanic GBMSM, but lower among those with higher education and those in a relationship. Finally, birth cohort variations with respect to engaging in CAS with ≥2 men in the past 3 months and testing for HIV in the past year were not markedly pronounced. Younger GBMSM might be more knowledgeable about HIV prevention strategies compared to their predecessors, but are equally concerned about contracting HIV. Researchers and practitioners should consider intergenerational and other demographic differences while designing multifaceted HIV prevention programs for GBMSM.

HIV/AIDS knowledge among MSM in Brazil: a challenge for public policies

“…The association between having suffered discrimination due to sexual orientation and the highest level of HIV/AIDS knowledge suggests that recognizing one´s discrimination is indicative of a broader recognition of their sexual orientation and rights. In this sense, the literature highlights the association between self-reported sexual identity as gay/homosexual and better knowledge, a result also found in this study 21,25,26,36 .…”

“…The association of age with a better level of knowledge is controversial in the literature. In some studies, younger populations have higher knowledge 24,36 , whereas in others age did not show any differences or there were lower levels of knowledge at the extremes of the sample 25,37 .…”

“…It is also noteworthy the association between high level of knowledge, being white, and having private health insurance -important proxy variables that indicate belonging to higher social strata. On the other hand, several studies also indicate that nonwhite MSM have less knowledge when compared to white people 25,36 . The association of age with a better level of knowledge is controversial in the literature.…”

“…This study indicates the need for prevention policies focused on MSM and with more effective communication strategies. Although information is necessary, knowledge must be provided by developing motivation and ability towards a safer behavior 36 . These results should be interpreted with caution.…”

How heterogeneous are MSM from Brazilian cities? An analysis of sexual behavior and perceived risk and a description of trends in awareness and willingness to use PrEP.

“…One explanation of this finding might be that younger individuals may be more fearless of HIV and/or optimistic of HIV treatment and prevention strategies (44)(45)(46). In a web-based survey conducted among MSM from the US, younger MSM had higher knowledge of HIV prevention compared to the older, but no differences regarding HIV perceived risk (47). However, in Brazil, sexual education at schools or within the families are still a taboo and may impact knowledge of HIV transmission risk and prevention strategies (33).…”