Communication between pediatricians and adolescent boys who engage in same-sex sexual intercourse may be a potential avenue to increase HIV testing in this population, according to a study published in Pediatrics.

Although it is estimated that 14.5% of HIV infections are undiagnosed in the United States, this estimation is 51.4% (>3.5-times higher) in individuals aged 13 to 24 years because of poor testing rates among those who are aged <18 years. There have been few studies that have described HIV testing rates among minors; these data are needed to reveal opportunities for pediatrician-adolescent communication about HIV and sexual orientation, which could increase the odds of testing. This study described HIV testing rates and identified salient individual, family, school, and healthcare influences among adolescent boys who engage in same-sex sexual intercourse ( identifier: NCT03511131).

In total, 699 participants aged 13 to 18 years who identified as gay, bisexual, or queer or who reported attraction to cisgender men and who had some sexual experience were included and were largely recruited via social media campaigns. Data were collected as part of the SMART trial in 2018 and 2019, which is one of many ongoing online pragmatic trials of interventions for HIV prevention for adolescent boys who engage in same-sex sexual intercourse. Data measures that were collected included demographics, sexual behaviors, condom use, sexual health communication with physicians, HIV knowledge, HIV education from school and family, and lifetime HIV testing. To assess whether each independent variable was associated with receiving an HIV test, logistic regression models were used.

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Among the study cohort, 23.3% had ever had an HIV test despite the higher risk in this population. However, the testing rates increased with age: 5.6% in patients aged 13 to 14 years, 15.8% in those aged 15 to 16 years, and 37.8% in those aged 17 to 18 years (adjusted odds ratio [aOR] of receiving testing, 2.41 and 5.48 for those aged 15-16 and 17-18 years, respectively; P <.01). In addition, youth who reported a history of sexual intercourse (vaginal or anal) and those who reported condom-less sexual encounters were more likely to have received an HIV test (aOR, 3.24 and 1.47, respectively). Further, results also showed that each percent increase in HIV knowledge assessment score was linked to a 3% increase in the odds of HIV testing (aOR, 1.03; P <.001), increasing level of outness regarding their sexuality (aOR, 1.5).

In total, 67.5% of participants had a regular physician, but less than half of these participants reported having had conversations with their physician about HIV testing (19.2%), same-sex sexual behaviors (21.3%), or sexual orientation (29.2%). Participants who had spoken with their physician about HIV testing were more likely to have received testing (75.4%) vs those who had not (10.8%), which highlights the large role pediatricians play in HIV testing for this population.

Results highlighted that “Physician discussions about sexual orientation or sex with a male partner had the largest effect on HIV testing” (OR, 25.29; P <.001)..

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Overall, the study authors concluded that, “Data indicate pediatricians are an important, but largely untapped source of testing and could be integral to achieving testing rates needed to end the epidemic.”


Mustanski B, Moskowitz DA, Moran KO, Rendina HJ, Newcomb ME, Macapagal K. Factors associated with HIV testing in teenage men who have sex with men. Pediatrics. 2020;145(3):e20192322.