Objective. To examine human immunodeficiency virus (HIV)-related knowledge, attitudes, and behaviors and predictors of unprotected anal intercourse.

Design. Structured interviews and paper-and-pencil instruments.

Setting. Community sites in Minnesota during 1989 to 1991.

Subjects. Two hundred thirty-nine gay and bisexual male adolescent volunteers.

Outcome measures. AIDS knowledge and beliefs, self-reported substance use, and sexual behavior.

Results. Subjects demonstrated accurate knowledge and beliefs about HIV; but 63% were found to be at "extreme risk" for prior HIV exposure, based on histories of unprotected anal intercourse and/or intravenous drug use. Thirty-four percent of subjects reported unprotected anal sex with at least one of the last three partners in the previous year. Perceived likelihood of HIV acquisition, substance abuse, having a steady partner, noncommunication with partners about risk reduction, and frequent intercourse were found to be significantly associated (P < .05) with unprotected anal sex in the previous year.

Conclusions. Programs for gay and bisexual youth should focus on preventing unprotected anal intercourse. Other goals are to promote: communication with sexual partners, consistent condom use during oral and vaginal sex, low risk sexual practices, avoidance of substance use in sexual situations, and developmentally appropriate HIV antibody counseling and testing services.

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