Advancing Sexual and Reproductive Health and Rights
 
In Brief: Fact Sheet

Facts on Young Men’s Sexual and Reproductive Health

SEXUAL ACTIVITY

Young men (15–19-year-olds) are waiting longer than in previous years to have sex.* The average age at first sex increased to 17.5 in 2002, from 16.9 in 1995. In 2002, 15% of never-married young men had had sex before age 15, compared with 21% in 1995. [1,2]

The proportion of young men who have ever had sexual intercourse has declined, from 60% in 1988 to 55% in 1995 to 46% in 2002. [2]

The share of young men that are sexually experienced declined significantly among young black men, from 80% in 1995 to 63% in 2002, compared with a decline from 50% to 41% among young white men in the same period. Rates for Hispanics did not change significantly (61% to 55%). [2]

Since 2001, the downward trend in sexual experience has stalled. Although the rate of sexual experience for high school males declined from 1991–2001 (57% to 49%), the rate of sexual experience for high school males between 2001 and 2007 did not change significantly (49% versus 50%). [3,4]

More than three-quarters of young men will become sexually active by age 20. Almost all (96%) will have sex prior to marriage. [5]

Young men are slightly more likely to engage in oral than vaginal sex with their female partners. Just over half (55%) have had oral sex, about half (49%) have had vaginal sex and 11% have had anal sex with a female partner. [6]

Five percent of males aged 15-19 report ever having had oral or anal sex with a male sexual partner. Some of these young men may have also had female partners. [6]

From 1991 to 2007, the proportion of high school males with four or more female partners declined from 23% to 18%. [4]

In 2002 about one quarter of young men (27%) described their last sexual relationship as “just met” or “going out once in a while,” compared with nearly one-third (36%) in 1995. The proportion who were “going steady,” engaged or married increased from 64% to 73%. [7,8]

CONDOM USE

Among 15–19-year-olds, condom use at first sex increased slightly from 69% to 71% between 1995 and 2002. This change represents a decline among young white men (from 76% to 68%) counterbalanced by substantial increases among young black and Hispanic men (61% to 85% and 55% to 67%, respectively). [2,9] Fewer than half of sexually active young men aged 15–19 reported using condoms 100% of the time during the previous year (48% in 2002). [2]

Condom use declines with age. In 2007, 76% of sexually active ninth grade males used condoms at last sexual intercourse, compared with 60% of 12th graders. At the same time, older male students were more likely to report that their partner used the pill at last sex (8% of ninth graders vs. 21% of 12th graders). [4]

FATHERHOOD

The rate of teen fatherhood declined 21% between 1990 and 2001, from 24 to 19 per 1,000 males aged 15–19. [10]

Teen fatherhood rates vary considerably by race. In 2001, the rate among young black men (37 per 1,000 males aged 15–19) was more than twice that among similar whites [10]

The decline in the teen fatherhood rate between 1990 and 2001 was far more substantial among blacks than among whites (34% vs. 14%). [10]

SEXUALLY TRANSMITTED INFECTIONS

Recent estimates suggest that while men and women aged 15–24 make up 25% of the sexually experienced population, they account for nearly half of all new STIs. [11]

Between 2001 and 2006, rates of chlamydia and syphilis increased among males aged 15–19. Rates of gonorrhea declined between 2002 and 2005 among this age-group, but increased between 2005 and 2006 from 256 to 279 per 100,000 young men. [12]

More than half of sexually active men in the United States will become infected with the human papillomavirus (HPV) at some point in their lives. An estimated 2.3 million males aged 15–24 contracted new HPV infections in 2000, and 4.6 million were infected and thus capable of spreading the virus. [11, 13]

STIs continue to disproportionately affect racial and ethnic minorities. Some of these disparities can be attributed to reporting bias. However, other factors include poor access to quality health care, poverty and the high prevalence of disease in minority populations. [12]

HIV/AIDS

HIV/AIDS prevalence among young adults aged 19–24 is relatively low—1.06 per 1,000—but it is estimated that 15–30% of all infections are acquired before age 25. [14]

In both 1995 and 2002, about one-quarter of sexually experienced 15–19-year-old males reported ever having had an HIV test. [15]

Sex with other men is the primary mode of HIV transmission among adolescent and young adult men. Many adolescents and young adults who have sex with men are unaware they are infected with HIV, reducing motivation to alter risky behaviors and increasing risk of transmission. [16, 17]

SEX EDUCATION

Ninety percent of young men aged 15–19 had ever received formal education about birth control or abstinence in 2002. Although young men were less likely than young women to receive formal sex education in 1995, by 2002 there were no significant gender differences. [18]

Although the proportion of young men who had ever received formal instruction in “how to say no to sex” increased between 1995 and 2002 (from 74% to 83%), there were sharp declines in the proportion receiving any formal instruction about birth control methods (81% to 66%). [18]

Only one-third of sexually active young black men and 45% of young Hispanic men received instruction about birth control methods prior to first sex, compared with about 66% of their white peers. [18]

Fifty-two percent of 15–19-year-old males report that they have talked with a parent about STIs; only 33% have talked about methods of birth control. In 2002, 27% of males in this age-group had never received information about birth control from either school or parents. [19, 20]

The proportion of male high school students who were taught about AIDS or HIV infection in school increased from 83% to 92% between 1991 and 1997, but declined to 89% in 2007. [21, 4]

The proportion of high schools in which teachers taught students how to correctly use a condom declined from 50% in 2000 to 39% in 2006. [22]

SERVICES

Although men served by the Title X national family planning program represent a small proportion of all clients, a growing number of men are utilizing services. The number of male clients of all ages has increased moderately over the past decade, from 94,000 in 1995 (2% of all users) to 244,000 in 2004 (5% of users). [23]

Among publicly funded family planning clinics surveyed in 2003, 36% offered nonreproductive health services for men and 35% had recruitment efforts targeting the partners of their female clients. [24]

Relatively few clinics offer programs focused on males, and only 4% of clinics offer special hours for male clients. [24]

Young adult men are particularly likely to be uninsured. Adult males aged 19–29 were the fastest growing age-group among the uninsured between 2000 and 2004; 31% were uninsured in 2004, compared with 12% aged 18 and younger. [25]

Young men who have sex with men face continued challenges in obtaining appropriate and sensitive health services. In addition to higher rates of HIV and other STIs, these young men experience higher rates of victimization, depression, suicide and other health problems than their peers. [26-29]

There are substantial missed opportunities to educate and counsel adolescent men in health settings. Although two out of three males aged 15–19 had a physical exam in the past year, fewer than 20% received counseling or advice from a health care provider about birth control or STIs, including HIV. [7]

1. Lindberg LD, Sonfield A and Gemmill A, Reassessing adolescent male sexual and reproductive health in the United States: research and recommendations, American Journal of Men's Health, 2008, 2(1):40–56.

2. Abma JC et al., Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2002, Vital and Health Statistics, 2004, Series 23, No. 24.

3. Centers for Disease Control and Prevention (CDC), Trends in HIV-related risk behaviors among high school students—United States, 1991–2005, Morbidity and Mortality Weekly Report, 2006, 55(31):851–854.

4. CDC, Youth risk behavior surveillance—United States, 2007, Morbidity and Mortality Weekly Report, 2008, Vol. 57, No. SS-4.

5. Finer LB, Trends in premarital sex in the United States, 1954–2003, Public Health Reports, 2007, 122(1):73–78.

6. Mosher WD, Chandra A and Jones J, Sexual behavior and selected health measures: men and women 15–44 years of age, United States, 2002, Advance Data from Vital and Health Statistics, 2002, No. 362.

7. Martinez GM et al., Fertility, contraception, and fatherhood: date on men and women from cycle 6 (2002) of the 2002 National Survey of Family Growth, Vital and Health Statistics, Series 23, No. 26.

8. Guttmacher Institute, Special tabulations of data from the 1995 National Survey of Adolescent Males.

9. Abma JC and Sonenstein FL, Sexual activity and contraceptive practices among teenagers in the United States, 1988 and 1995, Vital and Health Statistics, 2001, Series 23, No. 21.

10. Ventura SJ, Hamilton BE and Sutton PD, Revised birth and fertility rates for the United States, 2000 and 2001, National Vital Statistics Reports, 51(12):1–18.

11. Weinstock H, Berman S and Cates W, Jr., Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000, Perspectives on Sexual and Reproductive Health, 36(1):6–10.

12. CDC, Sexually Transmitted Disease Surveillance Report, 2006, Atlanta: CDC, 2007.

13. CDC, Genital HPV infection, CDC Fact Sheet, Atlanta: CDC, 2007.

14. Morris M et al., Prevalence of HIV infection among young adults in the United States: results from the Add Health Study, American Journal of Public Health, 2006, 96(6):1091–1097.

15. National Campaign to Prevent Teen Pregnancy, HIV testing among sexually experienced teens, Science Says, 2005, No. 18.

16. CDC, Cases of HIV infection and AIDS in the United States, 2004, HIV/AIDS Surveillance Report, Vol. 16.

17. MacKellar DA et al., Unrecognized HIV infection, risk behaviors, and perceptions of risk among young men who have sex with men: opportunities for advancing HIV prevention in the third decade of HIV/AIDS, Journal of Acquired Immune Deficiency Syndromes, 2005, 38(5):603–614.

18. Lindberg LD, Santelli JS and Singh S, Changes in formal sex education: 1995–2002, Perspectives on Sexual and Reproductive Health, 2006, 38(4):182–189.

19. National Campaign to Prevent Teen Pregnancy, Parent-child communication about sex and related topics, Science Says, 2006, No. 25.

20. Lindberg LD, Singh S and Finer LB, Changes in sex education in the U.S., 1995–2000, paper presented at the annual meeting of the American Public Health Association, Philadelphia, Dec. 10–14, 2005.

21. CDC, Percentage of students who had ever been taught about AIDS or HIV infection in school, Youth Online, Comprehensive Results, 2007, <http://apps.nccd.cdc.gov/yrbss/selectlocyear.asp?cat=4&quest=Q85>, accessed May 30, 2008.

22. Division of Adolescent and School Health, CDC, HIV Prevention Fact Sheet, School Health Policies and Programs Study, 2006, Atlanta: CDC, 2007.

23. Frost JJ and Frohwirth L, Family Planning Annual Report: 2004 Summary, Part 1, New York: The Alan Guttmacher Institute, 2005.

24. Lindberg LD et al., Provision of contraceptive and related services by publicly funded family planning clinics, 2003, Perspectives on Sexual and Reproductive Health, 38(3):182–189.

25. Kaiser Family Foundation, Health Insurance Coverage in America: 2004 Data Update Report, Menlo Park, CA: Henry J. Kaiser Family Foundation, 2005.

26. Saewyc EM et al., Hazards of stigma: the sexual and physical abuse of gay, lesbian, and bisexual adolescents in the United States and Canada, Child Welfare, 2006, 85(2):195–213.

27. Massachusetts Department of Public Health, Massachusetts high school students and sexual orientation: results 2005 Youth Risk Behavior Survey, 2006, , accessed May 29, 2008.

28. Garofalo R and Katz E, Health care issues of gay and lesbian youth, Current Opinions in Pediatrics, 2001, 13(4):298–302.

29. Stall R et al., Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men, American Journal of Public Health, 2003, 93(6):939–942.

*Unless otherwise noted, throughout this Brief “sex” refers to vaginal intercourse.