Methods: AMSM (14–17 years, N = 198) responded to an anonymous online 40-item survey including demographics, disclosure of sexual orientation and behaviors to guardians and primary care physicians (PCP), sexual history, and questions on youth’s motivation to agree or refuse to participate in a surveillance study involving HIV testing.
Results: Across demographic and sexual history, most youth perceived free HIV testing (r = .29, p < .001) and sexual minority sensitive HIV counseling (r = .16, p < .05) as significant motivators for participation. Logistic regressions indicated guardian and PCP awareness of youth’s sexual behavior with male partners significantly affected attitudes toward participation. Most (75%) would not participate if guardian consent was required and odds of refusal were higher for youth whose parents were unaware of their sexual activity (OR 1.74; 95% CI 1.40 – 2.16). Few reported their parents would be happy with study participation (18%) or helpful if tests indicated they were HIV positive (24%). Youth whose PCP was not aware of their sexual activity with male partners (69%) were significantly more positive about confidentiality of HIV testing by researchers compared with PCPs (OR 1.56; 95% CI 1.23 – 1.99), and more likely to obtain HIV testing through research than on their own (OR .73; 95% CI .56 –.95) and to participate (r = .39, p < .001).
Conclusions: Effective prevention strategies for youth at HIV risk requires surveillance data that includes HIV testing. Our data indicate that for AMSM who have avoided HIV testing due to fears of bias and being outed, research provided testing can serve as a gateway to accessing vital sexual health prevention and treatment services. Effective recruitment strategies will need to be sensitive to develop strategies for overcoming AMSM concerns by working with IRBs to waive guardian permission and providing HIV testing counseling and referrals sensitive to their needs.