Survey of Today's Adolescent Relationships and Transitions (START)

To respond to the increase in HIV infection, particularly among Black and Latino adolescent males who have sex with males (AMSM), CDC’s Division of Adolescent and School Health (DASH), with support from the Secretary’s Minority AIDS Initiative Fundexternal icon, contracted with the National Opinion Research Center (NORC) to develop an innovative, social media-based recruitment and data collection project targeting gay, bisexual, and questioning males (13-18 years old) and transgender youth (13-24 years old). Using the results from the confidential web-based survey and qualitative research, DASH will develop appropriate, effective HIV prevention materials to assist young gay and bisexual men and transgender youth in accessing HIV prevention and testing resources.

There are major gaps in evidence-based prevention tools designed to reach adolescent MSM and engage them in new, innovative HIV prevention efforts, such as pre-exposure prophylaxis (PrEP).

This national project is important because it will—

• increase understanding of the unique individual, interpersonal, and social characteristics of AMSM,
• provide appropriate context to HIV prevention efforts; including the preferences and behaviors of AMSM, and especially AMSM of color,
• inform acceptability and adherence to promising HIV prevention strategies, and
• translate these findings into HIV prevention tools and guidance for preventing HIV among adolescent men who have sex with men.

This research project will help DASH better understand the unique characteristics and behaviors of adolescent MSM in order to develop tools and guidance to inform them of HIV prevention strategies.

START was a four year study that began in 2016. In collaboration with DASH, NORC developed and tested a web-based survey of sexual minority males 13-18 and transgender youth 13-24 with input from research experts and a youth advisory board.  A social media recruitment strategy was also developed in partnership with a social media consulting firm.  The survey was implemented in spring 2018 through Instagram, Snapchat, and Facebook and resulted in over 3,000 respondents.

The Fenway Institute led efforts to collect qualitative data from multiple perspectives.  Adults who served youth at risk for HIV in schools, health care facilities, and community-based organizations provided information about barriers to HIV prevention in their fields.  Sexual minority males and transgender youth also provided information about their experiences accessing HIV prevention services.

Using the information from these surveys and focus groups, the research team developed several tools to improve prevention efforts and research papers for the field.

• Lesbian, Gay, Bisexual, and Transgender Health–Youth
• Fact sheet: HIV and Young Men Who Have Sex With Menpdf icon
• Fact sheet: HIV Among Youth
• Survey of Today’s Adolescent Relationships and Transitions (START)external icon
• Sexually Transmitted Disease Surveillance 2015
• Reported STDs in the United Statespdf icon

• Centers for Disease Control and Prevention. HIV-Related Risk Behaviors Among Male High School Students Who Had Sexual Contact with Males — 17 Large Urban School Districts, United States, 2009–2013. MMWR Morb Mortal Wkly Rep 2016; 65:106–109. DOI: http://dx.doi.org/10.15585/mmwr.mm6505a2external icon.
• Centers for Disease Control and Prevention. HIV Surveillance Report: Diagnoses of HIV Infection in the United States and Dependent Areaspdf icon. 2015; vol. 27
• Centers for Disease Control and Prevention. Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors Among Students in Grades 9–12 in Selected Sites—Youth Risk Behavior Surveillance, United States, 2001–2009pdf icon. MMWR 2011; 60:1-133.