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Reframing the Context of Preventive Health

Care Services and Prevention of HIV and Other
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 FRAMING HEALTH MATTERS

Reframing the Context of Preventive Health Care Services and Prevention

of HIV and Other Sexually Transmitted Infections for Young Men: New
Opportunities to Reduce Racial/Ethnic Sexual Health Disparities
Yzette Lanier, PhD, and Madeline Y. Sutton, MD, MPH

HIV AND OTHER SEXUALLY

Young Black males, aged 13 to 29 years, have the highest annual rates of HIV
infections in the United States. Young Black men who have sex with men (MSM)
TRANSMITTED INFECTIONS AMONG
are the only subgroup with significant increases in HIV incident infections in YOUNG BLACK MEN
recent years. Black men, particularly MSM, are also disproportionately affected
by other sexually transmitted infections (STIs). Therefore, we must strengthen In the United States, an estimated 1.2 million
HIV and STI prevention opportunities during routine, preventive health care men and women are living with HIV infec-
visits and at other, nontraditional venues accessed by young men of color, with tion14; Blacks are disproportionately af-
inclusive, nonjudgmental approaches. The Affordable Care Act and National HIV/ fected.11,13 Although constituting only 13% of
AIDS Strategy present new opportunities to reframe and strengthen sexual the total US population,16 Blacks represent
health promotion and HIV and STI prevention efforts with young men of color. 52% of new diagnoses of HIV infection and
(Am J Public Health. 2013;103:262269. doi:10.2105/AJPH.2012.300921)
the burden of disease rests most heavily on
Black men, particularly MSM.10,11,14 An esti-
mated 1 in 16 Black males will be diagnosed
with HIV infection during his lifetime.17 Black
Periodic, preventive assessments are consid- the burden of HIV and STIs is especially high men also rank rst in number of new HIV
ered prime opportunities to provide screening, compared with that of their White male diagnoses11,14; the primary transmission route
evaluation, and counseling for many health peers.10---14 is sexual transmission with more than 80%
conditions, including HIV and other sexually The absence of consistent, structured, timed, of incident HIV infections attributable to
transmitted infections (STIs).1,2 Evidence is and provider-enforced national guidelines for MSM, especially among men younger than
strong in support of periodic, preventive health preventive reproductive health care visits 40 years.10,11,14 Among male adolescents,
visits for children of both sexes through age for young men aged 13 to 39 years de- aged 15 to 19 years, a group at dispropor-
12 years, girls and women aged 13 years and creases opportunities for screenings, eva- tionate risk for incident HIV infections, 3.6%
older, and men aged 40 years and older, during luations, and counseling in support of HIV to 4.6% report ever having had oral or anal
which time routine screenings and immuni- and STI prevention and improved sexual sexual intercourse, or both, with a male
zations may occur.3---9 For young women, these health. This remains a gap in our public partner.14,18
preventive health visits are culturally accepted health approach to improve sexual health Blacks are also disproportionately affected
and provide important opportunities for and decrease our national burden of HIV by other STIs and account for 71% of all re-
sexual health discussions and screenings, usu- and other STIs, particularly among young ported cases of gonorrhea and nearly half of
ally during annual gynecological visits.1,5,6 Ini- MSM. As adolescence and young adulthood all reported cases of chlamydia and syphilis.12
tial reproductive health visits and discussions can be times of sexual exploration and lack By gender, women have higher reported rates
are formally recommended by the American of disclosure regarding sexual identity and of both chlamydia and gonorrhea,12 but
College of Obstetricians and Gynecologists to sexual behaviors,15 preventive sexual health gender-based routine reproductive examina-
begin with young women aged between 13 discussions and services for young men should tions and screening recommendations have
and 15 years.1,5 be sensitive and inclusive to ensure appro- long been recognized by providers for young,
For young men, however, formal recom- priate prevention coverage. We discuss sexually active women and not men.12,18,19
mendations for routine, preventive sexual the importance of increasing efforts to help When HIV and STI data for young men aged
health visits do not yet exist. Yet, young men in dene an optimal preventive sexual health 13 to 39 years are reviewed by race, wide
this age group, especially young men who have care process for young men, and describe racial/ethnic disparities exist; rates are 9 to 20
sex with men (MSM), are disproportionately strategies to strengthen and improve sexual times higher among Black young men com-
affected by preventable diseases, including health access for young men that are also pared with their White male peers (Table 1).10--13
HIV and other STIs.10---14 For young men of inclusive of and culturally appropriate for Infectious syphilis disparities among men are
color, particularly Black and Hispanic men, young MSM. largely accounted for by disproportionately

262 | Framing Health Matters | Peer Reviewed | Lanier and Sutton American Journal of Public Health | February 2013, Vol 103, No. 2
 FRAMING HEALTH MATTERS
TABLE 1Estimated Numbers of Cases and Rates for HIV and Sexually Transmitted
Infections for Young Men by Race and BlackWhite Rate Ratio Disparities:
United States, 2012
Non-Hispanic Black Young Men Non-Hispanic White Young Men
Variable Cases, No. Ratea Cases, No. Ratea BlackWhite Rate Ratio
b
Diagnoses of HIV infection 13 555 82.9 7132 9.7 8.5
Gonorrheac 73 151 946.0 15 168 46.5 20.3
Chlamydial infectionc 134 202 1706.4 64 323 194.7 8.7
Primary and secondary syphilisc 4172 56.3 2005 6.3 8.9
a conditions. The US Preventive Services Task
Rate per 100 000 population.
b
HIV/AIDS Surveillance Report10; data reported for ages 1339 years.
c
Data reported from the Sexually Transmitted Diseases Surveillance Report,12 for ages 1539 years.
affected Black and Hispanic MSM (compared likely to be uninsured compared with White
with White MSM) and young MSM aged 20 male peers. 34---36 Factors that contribute to
to 29 years.20 mens poor health-seeking behaviors and
Social determinants, which include fewer underutilization of health services include
jobs, increased poverty, disproportionate in- socially constructed notions of masculinity,
carceration, fewer educational opportunities, homophobia, stigma regarding open discus-
stigma, homophobia, and concurrent sexual sions of sexuality and sexual health with
networks in some Black communities, provide health care providers, increasing prefer-
a context for higher community burden of HIV ences for accessing information online, and
and STIs and persistent racial/ethnic dispar- economic factors.37---43 Among those who do
ities; increasing routine HIV and STI screening access services, discussion of reproductive
and treatment efforts with young men, partic- health topics and HIV and STI screening
ularly young MSM, may have a great impact by providers in clinical settings are as low
on these gaps.21,22 Still, barriers remain for as 14% among young men aged 18 years
young men to access preventive health care and older with a doctors visit in the past
services and ensure HIV and STI screenings year. 24,44,45
once accessed.23,24 Other policies contribute to the discrepant
rates of preventive health screenings among
CHALLENGES TO ACCESSING men and women. Young women have long-
HEALTH CARE SERVICES FOR standing recommendations for routine repro-
YOUNG MEN ductive health visits,1,5---7 and these clinical
visits often include preventive services such as
Adolescence and young adulthood are sexual health discussions and HIV and STI
high-risk periods for sexual health challenges, testing. No equivalently enforced reproduc-
such as HIV, STIs, and unintended pregnancy, tive health visit recommendation exists for
as well as for being uninsured and lacking men.33,45 Strategies to shift the sexual health
access to health care compared with older context for men should include at least 2
adults10---15,25---28; this underscores the impor- approaches: (1) adding sexual health preven-
tance of health care access and sexual health tion and screenings to existing recommenda-
care service provision for young people of both tions for routine preventive health visits, and
sexes.27,29 (2) identifying innovative, nontraditional ap-
Lack of health insurance, not having proaches to offer sexual health discussions and
a usual source of medical care, and lacking HIV and STI screening to young men, espe-
a doctor visit in the past year all dispro- cially young Black MSM who are dispropor-
portionately affect young men compared tionately affected by HIV and other STIs and
with young women,29---33 and among men, often difcult to access through traditional
Black and Hispanic young men are more health care systems.38
February 2013, Vol 103, No. 2 | American Journal of Public Health
CURRENT RECOMMENDATIONS FOR
ROUTINE PREVENTIVE HEALTH
SCREENINGS
For young men, expert panels have made
recommendations on the basis of available data
or expert opinion; selected recommendations
for men and nonpregnant women aged 13
to 39 years are summarized in Table 2 and
grouped separately on the basis of recommen-
dations for sexual health and chronic health
Force (USPSTF) provides a highly referenced
and respected set of clinical guidelines for
preventive health services.6 The Centers for
Disease Control and Prevention (CDC), Amer-
ican College of Physicians, and American
College of Obstetricians and Gynecologists
(women only) also offer evidence-based rec-
ommendations for preventive clinical services
for adults and adolescents.1,46---48 The Ameri-
can Academy of Pediatrics Bright Futures
Initiative recommends routine STI screening
for all sexually active adolescents aged 11 to
21 years, although reports of routine STI
screening among young men in this age
group remain low.49 In addition, the Amer-
ican Medical Association provides a set of
recommendations for adolescents, aged 11 to
21 years (Guidelines for Adolescent Preventive
Services), but some of these recommenda-
tions have limited supporting scientic evi-
dence and are not widely implemented by
providers. 50,51
Several differences are noted in the specics
of the HIV and STI recommendations included
in Table 2. Regarding HIV screening, CDC
has the broadest recommendation.46 How-
ever, the USPSTF strongly recommends HIV
screening for adolescents and adults at in-
creased risk for HIV infection, including
MSM and men and women who have un-
protected sexual intercourse with multiple
partners (A recommendation), but evi-
dence for the recommendations for routine,
non---risk-based HIV testing is graded as
a C, which has negative implications for
HIV-screening reimbursement from health
insurance providers.6,52 Routine HIV testing,
with prompt linkage to care and treatment
of those who test positive, remains an effec-
tive yet underutilized tool to prevent the
further spread of HIV.53---55
Lanier and Sutton | Peer Reviewed | Framing Health Matters | 263
 TABLE 2Selected Recommended Preventive Health Screenings for Men and Nonpregnant Women, Aged 1339 Years: United States, 2012
Screening USPSTF6
Reproductive and sexual health
screenings
HIV Strongly recommends
screening all adolescents
and adults at increased
risk for HIV infection.
(July 2005)
264 | Framing Health Matters | Peer Reviewed | Lanier and Sutton
Chlamydia ...
Gonorrhea ...
Syphilis Strongly recommends that
clinicians screen persons
at increased risk for syphilis
infection. (July 2004)
American Journal of Public Health | February 2013, Vol 103, No. 2
Men
CDC46,47
Recommends routine
screening in all health care
settings for all patients aged
1364 y as well as all patients
initiating treatment of TB and
STDs. Annual testing is
recommended for all persons
likely to be at high risk for
HIV.a (Sept. 2006)
Recommends routine (at least
annually) screening for all
sexually active MSM; more
frequent screening (i.e., at
36 mo intervals) is indicated
for MSM who engage in certain
behaviors.b (Dec. 2010)
Recommends routine (at least
annually) screening for all
sexually active MSM; more
frequent screening (i.e., at
36 mo intervals) is indicated
for MSM who engage in certain
behaviors.b (Dec. 2010)
Recommends routine (annual)
screening for all sexually active
MSM; more frequent screening
(i.e., at 36 mo intervals) is
indicated for MSM who engage in
certain behaviors.b (Dec. 2010)
ACP48 USPSTF6
Recommends routine Strongly recommends
screening for all screening all adolescents
individuals and and adults at increased
repeat screening risk for HIV infection.
conducted, on an (July 2005)
individual basis, with
high-risk individuals
being tested more
frequently. (Jan.
2009)
... Recommends screening for
all sexually active
nonpregnant young women
aged 24 y and younger and
for older nonpregnant women
who are at increased risk.
(June 2007)
... Recommends screening all
sexually active women for
gonorrhea infection only if
they are at increased risk for
infection. (May 2005)
... Strongly recommends that
clinicians screen persons at
increased risk for syphilis
infection. (July 2004)
Nonpregnant Women
CDC46,47 ACP48
Recommends routine Recommends routine
screening in all health screening for all
care settings for all individuals and repeat
patients aged 1364 y screening conducted,
as well as all patients on an individual
initiating treatment of basis, with high-risk
TB and STDs. Annual individuals being
testing is recommended tested more frequently.
for all persons likely to be (Jan. 2009)
at high risk for HIV.a
(Sept. 2006)
Recommends annual ...
screening of all sexually
active women aged 25 y
and screening of older
women with risk factors
(e.g., those who have a
new sexual partner or
multiple sexual partners).
(Dec. 2010)
FRAMING HEALTH MATTERS
Recommends screening of
young women (i.e., those
aged < 25 y) at increased
risk for infection. (Dec.
2010)
... ...
Continued
 TABLE 2Continued

STI counseling Recommends high-intensity
behavioral counseling to
prevent STIs for all sexually
active adolescents and for
adults and increased risk
for STIs. (Oct. 2008)
Chronic medical condition
screenings
Blood pressure Recommends screening for
adults aged 18 y and older.
(Dec. 2007)
Lipid disorders Strongly recommends screening
men aged 35 y and
recommends screening men
aged 2035 y if they are at
Encourages health care providers
to routinely obtain sexual histories
from all their patients as well as
offer STD and HIV prevention
counseling. (Dec. 2010)
...
...
Encourages clinicians to Recommends high-intensity
counsel patients to behavioral counseling to
reduce risky behaviors prevent STIs for all sexually
when such counseling active adolescents and for
is feasible. (Jan. 2009) adults at increased risk for
STIs. (Oct. 2008)
... Recommends screening for
adults aged 18 y. (Dec.
2007)
... Recommends screening women
aged 2045 y if they are at
increased risk for coronary
heart disease. (June 2008)
Encourages health care
providers to routinely
obtain sexual histories from
all their patients as well as
offer STD and HIV prevention
counseling. (Dec. 2010)
...
...
Encourages clinicians
to counsel patients to
reduce risky behaviors
when such counseling
is feasible. (Jan. 2009)
...
...

February 2013, Vol 103, No. 2 | American Journal of Public Health

Type 2 diabetes mellitus
increased risk for coronary
heart disease. (June 2008)
Recommends screening in ... ... Recommends screening in ... ...
asymptomatic adults with asymptomatic adults with
sustained blood pressure sustained blood pressure
greater than 135/80 mm greater than 135/80 mm Hg.
Hg. (June 2008) (June 2008)

Note. ACP = American College of Physicians; CDC = Centers for Disease Control and Prevention; MSM = men who have sex with men; STD = sexually transmitted disease; STI = sexually transmitted infection; TB = tuberculosis; USPSTF = United
States Preventive Services Task Force.
a
FRAMING HEALTH MATTERS

Persons likely to be at high risk include injection drug users and their sexual partners, persons who exchange sexual intercourse for money or drugs, sexual partners of HIV-infected persons, and MSM or heterosexual persons who themselves
or whose sexual partners have had > 1 sexual partner since their most recent HIV test.
b
More frequent screening is indicated for MSM who have multiple or anonymous partners, who have sexual intercourse in conjunction with illicit drug use (particularly methamphetamine use), or whose sexual partners participate in these activities.

MEN
among both boys and girls.61
detected only by routine screening.

and chronic medical condition screenings

to open, effective provider---patient sexual

cussions for young men.61,62 A pilot study

pre-established, recommended health care
dations are for young, sexually active men

The recommendations for sexual health

history dialogue that can strengthen STI

quent health care visits by young men and

sexual health disparities for young men, it

cals, which currently lack a sexual health

examinations serve as the only opportunity

gay-identied and non---gay-identied MSM
risk (Table 2).46,57 To combat racial/ethnic

providers.18,29,58 Opportunities also exist to

and that asymptomatic STIs were prevalent

HIV and other STI screenings, during other
For STIs, CDC encourages routine sexual

tunity to offer sexual health evaluations and

nonjudgmental preventive sexual health dis-
to receive a routine medical evaluation.59,60
counseling,47 but lack of cultural and sexual

screening, which leaves a gap in routine STI

component). 59 For approximately 78% of

underutilized opportunities because of infre-
will be important to strengthen broad sexual

including HIV, are asymptomatic and will be

screening for non---gay-identied men having

preparticipation sports physical examinations

screening efforts.56 Current CDC recommen-

health messages for all young men, including

visits (including preparticipation sports physi-

As such, preparticipation sports examinations

among high-school athletes demonstrated the

summarized in Table 2 represent missed and
histories from all patients and STI prevention

who self-identify as MSM to have routine STI

same-sex behaviors who are also at increased

engaging in same-sex behaviors, as most STIs,

may be an optimal time and important oppor-

low delivery rates of preventive screenings by

feasibility of urine-based STI screening during

competency, context, and comfort are barriers

To turn the tide on HIV and STI disparities

NEW OPPORTUNITIES TO INCREASE
PREVENTION EFFORTS WITH YOUNG

among young men, especially men of color and

Lanier and Sutton | Peer Reviewed | Framing Health Matters | 265

high-school young men, preparticipation sports
provide reproductive health services, including

MSM, innovative, effective, nontraditional
strategies must also be considered to increase
opportunities for routine sexual health discus-
sions and HIV and other STI screenings. Re-
cently, there has been growing advocacy to
implement routine, annual sexual health ex-
aminations for young men, and health pro-
motion approaches to improve outcomes have
been suggested.33,63 Similar to the gyneco-
logical examination for women, this annual
examination would assess mens sexual and
reproductive health and provide an opportu-
nity for HIV and STI prevention and screening.
Next steps should include more research to
explore and validate the benets of a periodic
sexual health evaluation for the overall health
of young men and their sexual partners. In
addition, clear, congruent messages from fam-
ily, communities, and providers with young
men to break sexual silences and discuss pre-
ventive sexual health services and a timetable
for the delivery of these services would be
an important component of establishing a new
culture of routine sexual health examinations
and comfortable health dialogue for young
men and their social networks. To support
these efforts toward a normalized sexual health
discussion for young men, federal, local, and
professional organizations have crucial roles to
play as part of a comprehensive, unied sexual
public health effort that engages young men,
including self-identied and nonidentied
MSM of color.
In addition, working with health care pro-
viders to reinforce the existing sexual health
and chronic health recommendations can
highlight their importance and strengthen the
culture of routine health screenings for young
men and their providers. Over time, pro-
viders would become more aware of the
importance of routine sexual health so that
they can do their part during clinical visits
with young men, especially young men with
same-sex behaviors, for improved HIV and
other STI prevention efforts. Creating continu-
ing education opportunities for physicians and
nurses can serve as reminders of the impor-
tance of sexual health for young men. Estab-
lishing young mens health report cards for
clinics, hospitals, and community health centers
is also an innovative approach for holding
clinicians and professional organizations ac-
countable in support of improved delivery of
266 | Framing Health Matters | Peer Reviewed | Lanier and Sutton
FRAMING HEALTH MATTERS
preventive sexual health services for young
men.
New opportunities for reframing sexual
health with young men also exist on the policy
front in the context of health care reform. The
Patient Protection and Affordable Care Act
offers new possibilities for routine, preven-
tive assessments for young people who may
otherwise lack health care coverage or regular
access to a health care provider.64 By working
toward goals of improving access to quality
health care for all Americans, strengthening
diversity and cultural competency among
health care providers, and expanding the
health care workforce in underserved com-
munities, the Affordable Care Act will also
help reduce health disparities, including racial/
ethnic health disparities and disparities on the
basis of sexual orientation and young age.64
Under the new law, young adults will be al-
lowed to stay on their parents plan until they
turn age 26 years.64 This increased access
to health care services for young people will
support opportunities to provide routine sexual
health prevention and screening services in
both clinical and nontraditional settings.
As providers increase their engagement in
support of young mens health, health care
provider sensitivity would need to be strength-
ened, especially with young men who may
engage in same-sex behaviors. New efforts to
train health care providers on culturally com-
petent sexual history approaches and routine
HIV and STI screenings and prevention tools
are warranted to help ensure that the work-
force will be ready for the new way forward
under health care reform. Medical, nursing, and
allied health professional schools, professional
organizations, and AIDS Education Training
Centers can help serve these important in-
creased sexual health training needs. Increasing
sexual health education and HIV and STI
screenings are important action steps that can
be implemented in clinical and nonclinical
settings and evaluated with performance mea-
sures over time. As electronic health records
are increasingly utilized and condential elec-
tronic health records procedures help to
streamline patient intake processes in clinical
settings, brief self-administered sexual histories
can be added to intake screens,56 completed
by patients in the preclinical area, and re-
viewed to stimulate HIV and STI awareness
American Journal of Public Health | February 2013, Vol 103, No. 2
and prevention discussions during the clinical
portion of the provider visit.
In addition, the rst-ever National HIV/
AIDS Strategy (NHAS), with its national goals
of reducing HIV incidence, increasing access
to care and services for persons living with
HIV, and reducing HIV-related heath dispar-
ities,65 provides a platform for exploring new
approaches and expanding current HIV testing
and treatment efforts that address the sexual
health needs of underserved populations,
such as young Black MSM. Efforts of NHAS
include increased opportunities to offer HIV
screening, linkage to care, and access to ap-
propriate treatment to more MSM, especially
young MSM of color, and this is an opportunity
to reduce HIV-related health disparities. In-
creasing the likelihood of providers offering
HIV and STI screening once a young man has
accessed services can also be supported by
strengthening reimbursement procedures for
routine screenings. Aligning evidence-based
USPSTF ratings with recommendations for
routine HIV testing will help support efforts
to ensure insurance reimbursements, which
can be a barrier for providers offering
preventive care services.
Finally, school-based condom education ef-
forts have been linked to decreased HIV and
STI diagnoses and increased HIV and STI
knowledge among young men in the United
States,66 and policy efforts that support
school-based sexual education approaches
are warranted with all young men, but espe-
cially young Black MSM, in support of NHAS
efforts.
Because young men of color are dispro-
portionately incarcerated in the United States,67
improved sexual health efforts will also require
new relationships with prison and jail sys-
tems to ensure increased, routine HIV and
STI prevention and screening activities,
while simultaneously supporting social and
structural interventions in support of jobs,
housing, improved education, and increased
cultural sensitivity for law enforcement to
decrease disproportionate incarceration and
increase educational and work opportunities
for young men of color.
Because young men of color have histori-
cally been difcult to access through traditional
health care venues, exploring existing nontra-
ditional models of success is an important

component of reframing the context of pre-
ventive health services and HIV and STI pre-
vention with young Black men. Successful
programs can serve as potential models for
a broader approach with this at-risk and dif-
cult-to-reach population. One example is The
Young Mens Clinic in New York City, which
targets low-income, minority males, and has
been shown to effectively operate as an in-
terdisciplinary program combining research
with service by integrating public health into
clinical care, and including routine reproduc-
tive health assessments that actively engage
and support the young men for continued
care.68 This clinic has been sustained by pro-
viding male-friendly, empowering, and health-
promoting environments for young men and
collaborations with government, nonprot,
and community-based organizations to lever-
age resources and provide comprehensive
services.68
Nontraditional, community-based appro-
aches with Black men and trusted community
opinion leaders also warrant consideration to
access young men for reproductive health
discussions and services. The Black-owned
barber shop has historically been considered
a safe and trusted haven for Black men to
gather and discuss issues important to them,
and many barbers are considered trusted
opinion leaders in the communities in which
they live and work.69,70 A recent randomized
clinical trial of a barber-based intervention
showed signicant improvement in blood
pressure for Black male barber shop patrons
with hypertension, which was likely because
of the trusted, community barbers engaging
with the study participants as health educators
and promoters of physician follow-up.70 Other
effective community-based, nontraditional
efforts describe using a mix of art, hip-hop, and
role-playing as avenues to more effectively
engage young men as early as middle school
and promote prevention of HIV, STIs, and
unplanned pregnancy; healthy decision-making;
and self-esteem building among young Black
men.71,72 For young MSM of color, house and
ball community networks often offer trusted
support mechanisms that can also facilitate HIV
prevention and sexual health efforts.73 Local
faith leaders also have a role to play by con-
tinuing to become more engaged in community
HIV- and STI-prevention efforts with faith
February 2013, Vol 103, No. 2 | American Journal of Public Health
FRAMING HEALTH MATTERS
messages that are encouraging, nonstigma-
tizing, nonhomophobic, and welcoming for
church members and their families, regardless
of a persons sexual orientation.74
Mobilization at a community level is also an
important component of engaging young Black
men in a broader dialogue about preventive
health services. Engaging young men through
intergenerational dialogue, such as parent---
child communication interventions, school-
based efforts, college fraternities, respected
civic organizations, and popular community
venues, with consistent preventive health-
seeking and sexual health messages will help
provide broad support for young men to access
trusted, nonjudgmental, and culturally relevant
sexual health services. Media radio shows
popular in some Black communities have suc-
cessfully promoted taking a loved one to
the doctor to encourage preventive health
checks,75 and young men of color have been
engaged in some of these local efforts. It is also
increasingly important to engage social media,
Internet, and texting-based communication
innovations,76 which have been shown to be
a vital means of delivering health-related in-
formation and to connect with young Black
men, especially MSM, who are increasingly
using the Internet for seeking sexual inter-
course and often have the additional barriers
of homophobia and stigma within their com-
munities and during health-seeking efforts.76
Public---private partnerships can help stimulate
innovative strategies, ensure motivation and
enthusiasm, increase nancial support, de-
crease homophobia and stigma, and maintain
community-level engagement as relevant and
culturally tailored activities are developed in
support of young mens health.
CONCLUSIONS
To date, there has been no comprehensive,
preventive, public health infrastructure that
normalizes the routine reproductive and sexual
health education and prevention needs of
young men, especially young MSM. The ab-
sence of this foundation for young men has
contributed to the disproportionate impact of
HIV and other STIs, particularly incident HIV
infections, in many Black communities, and
warrants that we explore new approaches to
normalize routine, preventive health visits,
Lanier and Sutton | Peer Reviewed | Framing Health Matters | 267
including sexual health discussions and
screenings, for young men as an important
aspect of HIV and STI prevention and control
in the United States.
With the introduction of health reform in the
United States, there is a new opportunity to
set the stage for routine, preventive health
checks for young men that should include
routine HIV and STI screening and nonjudg-
mental sexual health discussions that include
HIV- and STI-prevention messages that are
inclusive of same-sex behaviors. When one also
considers that there is a rst-ever NHAS that
is targeting a reduction in racial/ethnic dis-
parities in HIV disease, the US public health
workforce is historically poised to reframe the
context of HIV and STI vulnerabilities and shift
clinical and public health outcomes by estab-
lishing and supporting collaborations at the
federal, state, and community level in support
of broad sexual health prevention efforts with
young men. The large racial/ethnic HIV and
STI disparity that disproportionately affects
young Black men, especially MSM, requires
that we seize this moment and act on these
unique opportunities now in an effort to reduce
overall sexual health disparities in the United
States. j
About the Authors
Yzette Lanier and Madeline Y. Sutton are with the Division
of HIV/AIDS Prevention, Centers for Disease Control and
Prevention, Atlanta, GA.
Correspondence should be sent to Madeline Sutton, CDC,
Division of HIV/AIDS Prevention, 1600 Clifton Road,
Mail Stop E-45, Atlanta, GA 30333 (e-mail: msutton@
cdc.gov). Reprints can be ordered at http://www.ajph.org by
clicking the Reprints link.
This article was accepted May 28, 2012.
Note. The ndings and conclusions in this report are
those of the authors and do not necessarily represent the
views of the Centers for Disease Control and Prevention.
Contributors
Both authors contributed to the conceptualization, liter-
ature review, data analysis, and writing of the article.
Human Participant Protection
No protocol approval was needed for this study because
no human participants were involved.
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