Diversity of Psychosocial Syndemic Indicators and Associations with Sexual Behavior with Male and Female Partners Among Early Adolescent Sexual Minority Males

Purpose: Psychosocial syndemic indicators (e.g., internalizing symptoms, alcohol/substance use, and violence exposure) have been associated with increased risk for HIV among older adolescent sexual minority males and adult sexual minority men. No studies have examined these concerns among early adolescents (<16 years old). The purpose of this study was to examine syndemic indicators among early adolescent sexual minority males and their associations with sexual behavior. Methods: Sexual minority males (N = 207; ages 14-17; drawn from 40 U.S. states) completed a cross-sectional online survey. Descriptive statistics were used to document profiles of syndemic indicators. Firth logistic regressions tested the associations between count of syndemic indicators and sexual behavior with male and female partners. Results: Psychosocial syndemic indicators were highly prevalent and co-occurring, with diverse psychosocial profiles. After controlling for age, race, and ethnicity, having more syndemic indicators was significantly positively associated with condomless anal sex with male partners (adjusted odds ratio [AOR] = 1.37, 95% confidence interval [CI] 1.02-1.84) and vaginal and/or anal sex with females (AOR = 1.75, 95% CI 1.25-2.47). Conclusions: This study documents the psychosocial profiles of syndemic indicators with a sample of early adolescent sexual minority males and the association of syndemic indicators with sexual behavior. Among early adolescent sexual minority males, psychosocial concerns were prevalent, similar to rates seen among adult sexual minority males, and conferred vulnerability to HIV transmission. Behavioral and psychosocial interventions must reach sexual minority males in early adolescence to address mental health and substance use concerns and to help reduce the risk of HIV acquisition.