Where Do Young Adult Men Get Information About HIV Prevention?
Back in the early 1990s, nearly all U.S. high schools offered AIDS education, so most young people presumably had easy access to HIV prevention information. But what happened after high school, when they typically were not regularly involved with institutions that facilitated education and prevention efforts? In particular, by what means did young men, who had high rates of HIV infection, obtain information on how best to minimize their risk? A 2000 article in Perspectives addressed that question, using data from the National Survey of Adolescent Males. In the survey’s 1995 round, when participants were 22–26 years old, 95% said that they had gotten information about AIDS in the last year. Various media—TV, magazines or radio—were the main sources of information and, for some men, the only ones. Lectures, brochures and discussions about AIDS within men’s social circles were fairly important, but conversations with doctors or nurses played bit parts. And of course this was all before the Internet was at our fingertips.
Roughly two dozen years since those data were collected, and close to four decades since HIV was recognized, are young adult men still in need of special attention in this regard? Laura Lindberg, one of the authors of the 2000 article, is a principal research scientist at the Guttmacher Institute and an expert on the sexual and reproductive health needs and behaviors of young men. We asked her to share some thoughts.
PSRH: Your study posed a novel question. Did you and your coauthors have any expectations as to what you’d find? And the flip side of that question: Were there any big surprises?
LL: We expected to find big gaps in access to HIV and STI information among young men, because we knew that they had relatively weak ties to the health care system. But it was surprising to find that even when young men had a regular health care provider, they were not more likely to get this information. It was also surprising how many young men—nearly half—said they got STI/HIV information from a lecture or brochure. We didn’t think that so many young men would have accessed this kind of instruction, because they either weren’t in the right settings or didn’t perceive the information as particularly relevant to themselves.
PSRH: In this article and some of your subsequent work, you called for reaching young adult men “where they are” to meet their sexual and reproductive health information needs. How do the Internet and social media, which give young people a more private way to explore sensitive issues, fit in?
LL: Digital media is a powerful tool for reaching young men “where they are,” but we can’t expect young people to Google their way to good health. Although lots of information is available at their fingertips, it’s limited by what they know to search for. And the Internet is filled with lots of misinformation. The development of sexual health apps, including those that don’t just provide information, but focus on changing behavior, offer new opportunities. But I worry that if we rely too heavily on the Internet for sexual health education, we send young people a message that sexual health is unimportant or should be hidden. The continuing value of face-to-face interactions—with health care providers, partners, friends and others—shouldn’t be minimized.
PSRH: Young adult men have persistently had among the highest rates of HIV infection in the U.S. Yet, a 2017 national survey of young adults (men and women) found that substantial proportions held misperceptions about risk; many were unaware of the effectiveness of condom use in preventing infection, which seems like HIV Prevention 101. Is there something about prevention messages that’s not getting across? Or something about the way they’re delivered—for instance, a retreat from the urgency that we saw in the early years of the epidemic—that’s not working?
LL: In recent years we have seen a retreat from formal sex education, especially around contraception. Abstinence-only instruction often spreads incorrect or misleading information, and overemphasizes condom failure. So even when young people say they learned about condoms and contraception, often all they’ve been told is that condoms fail and can’t be relied on. Abstinence programs also have a Chicken Little approach—the sky is always falling if sex is involved—which I think doesn’t help young people recognize and prioritize real levels of risk. But it does also seem like we’ve backed off from the urgency and focus on HIV prevention. We are far from the days when the surgeon general was promoting a national conversation.
PSRH: So, from where you sit, what’s the top-priority next step in ensuring that young adults have all of the information they need to avoid HIV infection?
LL: I’m all about sex education, in many forms. We need policies that ensure that young people get medically accurate comprehensive sex education in schools. We need to put more emphasis on no longer having “missed opportunities” in which young men have a medical exam, but their sexual and reproductive health isn’t addressed. And we need to promote our most up-to-date prevention tools—PrEP and the HPV vaccination—to young men, and assure that they’re covered by insurance.
PSRH: Thanks so much for talking with us.