Due to a 45 percent increase of HIV infections among black men who have sex with men (MSM) ages 17 to 25 in Jackson, Mississippi, the state’s health department teamed with the Centers for Disease Control and Prevention (CDC) to conduct a survey to discover the reason for the surge.

“We need to make sure that HIV infection does not become a rite of passage for young black men who have sex with men,” says Alexandra Oster, MD one of the survey authors.

The two agencies surveyed 29 who self-identified as gay or bisexual and who tested HIV-positive between 2006 and 2008. More than half of the participants reported having unprotected anal sex before they tested positive, and 16 had partners who were 26 or older—a factor researchers say may be linked to the spread of HIV among young African Americans. The majority of the men believed it was unlikely or very unlikely they would contract the virus in their lifetime.

Health officials also expressed concern about the lack of testing among this group. Six men had not been tested for HIV in the two years before being diagnosed, and five had taken only one test in the two years before the positive result. The CDC emphasizes that MSM should be tested at least once a year.