The American Association of Physicians
for Human Rights
Dallas Prevention Summit
 July 15, 1994

By Walt Odets

Overview

While effective AIDS education for gay and bisexual youth is critically important for the young themselves, the future of the gay community, and the epidemiological course of the AIDS epidemic, this is the group that presents the most difficult problems for AIDS educators.  Because they have grown up into an established epidemic with its long-standing education and changed community behaviors, many believed - or assumed - that young men would remain relatively free of HIV.  Younger men thus engaged our hopes that they would not have to suffer with AIDS, and they have been burdened with our expectations that the epidemic could be brought to an end in the gay and bisexual communities.  By 1990 it had become clear that very young men would suffer with AIDS.  In 1992 the San Francisco Department of Health estimated (by means of a voluntary enlistment study) that 15 percent of 20 to 24 year old gay-identified men were already HIV infected, and young gay and bisexual men seeking services at San Francisco city STD clinics have shown an astonishing 40 percent infection rate.  Because the young, in general, seek fewer medical services than older individuals, the level of ELISA testing among young men is unknown.  It is thus possible that infection rates are higher than those seen in the self-selected study groups that generate our current figures.  The projections we do have suggest that 30 percent of 20 year old gay men will be infected with HIV or dead of AIDS by age 30, and that a majority will become HIV infected during their lifetimes.

Discussion

The problems that youth - roughly speaking, ages 15 to 25 - present to AIDS education can be understood only in the context of psychosocial development tasks characteristic of this time in life.  Adolescent and post-adolescent development are characterized by an effort to define personal and social identities and to reconcile the relationship between the two.  A young person emerging from childhood and puberty must create a subjective experience of self that is authentic and important and is, at the same time, valued by those who are important to him - peers, older adults, and parents.  The task is always a complex and volatile one, but for gay or bisexual youth it can be particularly conflicted and destructive.  With many fewer apparent adult role models, little peer support, a society that does not allow the development of social and interpersonal skills (with members of the same sex), and a sense of a homosexual or bisexual self that is rarely valued, and often abhorred or prohibited, the gay or bisexual youth is left largely to whatever internal resources he or she may possess.  While many youth are handicapped in this developmental task by cultural, social, and family inadequacies, the gay or bisexual youth is especially so.  The development of a sexual identity, and of the interpersonal and social possibilities allowed by that sexuality is a central component of identity development.  Particularly for the gay or bisexual youth the effort is typically completely unsupported by family or formal education, and is usually something that cannot be spoken about, even with peers (a developmental resource that is much more available to heterosexual youth).  To accomplish necessary life experience, the emerging gay or bisexual youth is thus often completely reliant on poorly understood, secretive, and conflicted social and sexual interactions with older gay people, who - as products themselves of difficult, conflicted, and often exploited developmental experience - may not always be the best mentors.  Characteristic adolescent and post-adolescent assertions of self-directedness and autonomy - which usually mask uncertainty and vulnerability - are too easily taken at face value, providing assurances to the needy adult, who may inadvertently or intentionally exploit the youth's developmental needs to meet his or her own very different needs.  The imbalance of personal and social power common in such relationships enhances the possibility of exploitation.  Whether such interactions are exploitative or not - and they sometimes are conducted with respect for the youth's developmental needs - they are often a necessary part of psychosocial development for the otherwise unsupported and unguided youth.  Unfortunately, these are precisely the relationships that often expose the young man to HIV at a time when the overwhelming complexity of his developmental tasks make it difficult or impossible for him to manage this significant additional issue.

The personal specter of AIDS and a gay community ensnared in an epidemic are simply facts of life for the emerging gay or bisexual man.  He has never known a personal identity or gay community without these problems.  Thus the young gay or bisexual man's sexual identity is often poorly differentiated from his identification with AIDS, and he often experiences contracting HIV as plausible or inevitable.  Such feelings are exacerbated by public attitudes that overly-identify the gay community with AIDS and often imply that AIDS is the just fate of the gay man.  Whether interpreted as concerned warning or punitive prediction, the adolescent is repeatedly made to feel that if he "becomes" gay, he will get AIDS.  Usually experienced by the young man as punitive prediction, such assertions are supported by much of our AIDS education, which too often blurs the identities of HIV-positive and negative men, and by the young man's longing to be accepted in a community that is not only publicly associated with AIDS, but is internally identified with it as well.  The young man correctly perceives that in having HIV he gains an assured - an irrevocable -  connection to a group identity, and that he will receive social and psychological support and services that are otherwise unavailable.  For the troubled, poorly identified youth, contracting HIV can provide clear personal identity and social affiliation, apparent focus and purpose in life, and considerable social support and validation.  In contrast, young, HIV-negative gay and bisexual men continue to suffer an exaggerated version of the social indifference and neglect that we direct to all youth.

Conclusions

AIDS education for the young must account for their developmental complexities and unique issues.  It must be conceived to specifically assist the developmentally important, experimental sexuality of young men; the clarification of confused identifications of sexuality and AIDS; and the elucidation of authentic motivations for the young man to remain HIV-negative.  To date, education for the young has been little more than a repetition of education for older gay and bisexual men with youthful "visuals."  In addition to public education, the developmental vulnerabilities of young gay and bisexual men demands that we provide broad social and psychological services and more one-on-one interventions than to older populations.  On behalf of younger men, older gay and bisexual men must be helped by public education to understand the needs and problems of gay and bisexual youth and the significance of their developmental issues in putting them at additional risk for HIV.

The psychosocial development of youth should not and cannot be sacrificed to the needs of simplistic HIV prevention approaches - especially those that express disapproval, ambivalence about, or mere tolerance of youthful sexuality.  Youth will continue to experiment sexually and interpersonally whether we support them in this important human effort or not.  If gay and bisexual youth are forced by our neglect or prejudice to continue their developmental work unapproved and unsupported, the consequences will be what they have always been.  We will pay the costs for many generations to come - this time with an enduring, virulent epidemic that will take young men to tortured and early deaths in numbers that did not seem possible in 20th century America.

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