Risk Among Youth with Discordant Sexual Identity and Sexual Behavior: Representative Data From the 2005-2009 New York City Youth Risk Behavior Surveys

Background: Sexual identity may not be congruent with reported sex of partners (sexual behavior). Little is known about risk behaviors among youth with identity-behavior discordance.

Objectives: We quantify identity-behavior discordance among a population-based sample of adolescents, and sexual and substance use behaviors among concordant and discordant groups.

Methods: Sexually active male and female respondents to the 2005-2009 NYC Youth Risk Behavior Surveys were categorized into 2 groups based on 9 permutations of sexual identity (straight, gay/lesbian, bisexual) and the sex of lifetime sexual contacts (males, females, males and females): concordant (e.g., includes gay-identifying males reporting male partners) and discordant (e.g., includes bisexual-identified females reporting only male partners). We present weighted prevalence and adjusted risk estimates of risk behaviors among these groups.

Results: Ten percent of 5279 females and 3.8% of 5597 males had identity-behavior discordance. Among females, the discordant reported more risk than the concordant group regarding most indicators, including age <13 years at first sex (43% vs. 23%, p<.0001), >2 partners in last 3 months (22% vs. 12%, p=.018), alcohol/drugs at last sex (21% vs. 11%,p=.007), age <13 at first alcoholic drink (46% vs. 29%,p<.0001). Male discordant and concordant groups differed in number of recent partners and condom use at last sex (63% vs. 79%, p=.004). Males with discordance were less likely to report condom use at last sex (aOR=0.47; 95%CI=0.29-0.74) and females with discordance were more likely to report >2 recent partners (aOR=1.83; 95%CI=1.17-2.87), compared to concordant groups and adjusted for potential confounders.

Conclusions: Youth with discordant sexual identity and behavior exhibit risky behaviors associated with STD/HIV.

Implications for Programs, Policy, and Research: Knowledge of discordance between identity and behavior will inform health care providers’ assessment of STD/HIV risk. Reducing social stigma experienced by youth of minority sexual identities may reduce identity-behavior discordance and its associated risk behaviors.