Material hardship and association with sexual risk behavior among adolescent sexual minority males in 3 U.S. cities - National HIV Behavioral Surveillance-Young Men who Have Sex with Men, 2015.

INTRODUCTION Adolescent sexual minority males (ASMM) are disproportionately affected by HIV relative to other youth within the United States. Social determinants of health have been explored among this population; however, economic determinants such as material hardship, remain understudied. We examined the relationship between material hardship and sexual behavior among ASMM ages 13-18 residing in 3 U.S. cities using 2015 data from CDC's National HIV Behavioral Surveillance among Young Men who have Sex with Men. METHODS Young men ages 13-18 residing in 3 U.S. cities were recruited via venue-based, respondent-driven, or Facebook sampling. We estimated adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) for condomless anal intercourse (CAI) with a male sex partner in the past 12 months and with having 4 or more male sex partners in the past 12 months. RESULTS Of 547 ASMM, 27% reported experiencing material hardship in the past 12 months. After adjusting for demographics, household characteristics, and city, ASMM who experienced material hardship were more likely to report CAI with a male partner in the past 12 months (aPR: 1.55, 95% CI: 1.25 - 1.93), and to have had 4 or more male sex partners in the past 12 months (aPR: 1.44, 95% CI: 1.08 - 1.91). DISCUSSION More than a quarter of ASMM experienced material hardship which was associated with increased sexual risk behavior among ASMM. Incorporating services that address all unmet needs is important to consider for HIV prevention efforts for ASMM.