1
|
Chandler CJ, Meunier É, Eaton LA, Andrade E, Bukowski LA, Matthews DD, Raymond HF, Stall RD, Friedman MR. Syndemic Health Disparities and Sexually Transmitted Infection Burden Among Black Men Who Have Sex with Men Engaged in Sex Work in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1627-1640. [PMID: 33159237 PMCID: PMC8099930 DOI: 10.1007/s10508-020-01828-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/17/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Abstract
Black men who have sex with men (MSM) engaged in sex work (BMSM-SW) experience elevated HIV and sexually transmitted infection (STI) prevalence. Further, BMSM-SW have been shown to have higher rates of syndemic psychosocial health conditions which contribute to HIV risk behavior and incidence, and poorer care outcomes than other groups of men who have sex with men. However, syndemic perspectives have not been applied to understanding past-year STI burden among BMSM-SW in the U.S. Sexually active Black MSM ≥ 18 years old were recruited from Black Pride events in six U.S. cities (n = 4421) between 2014 and 2017. Multivariable logistic regressions assessed correlates of past-year sex work engagement; whether BMSM-SW had higher odds of syndemic conditions; and whether BMSM-SW had higher odds of self-reported, past-year STI diagnoses. Structural equation models assessed relationships between sex work engagement, syndemic conditions, and STI controlled for sociodemographics and number of sexual partners. A total of 254 (5.7%) Black MSM reported past-year sex work, of whom 45.3% were HIV positive. BMSM-SW were significantly more likely to be Hispanic, to report past-year bisexual behavior, and to report annual income < $10,000. In multivariable models, BMSM-SW were significantly more likely to report intimate partner violence, assault victimization, polydrug use, and depression symptoms; they were also more likely to report past-year gonorrhea, chlamydia, and syphilis. Syndemic conditions mediated the relationship between past-year sex work and past-year STI burden, constituting a significant indirect effect. BMSM-SW in the U.S. face severe biopsychosocial health disparities. Interventions developed for BMSM engaged in sex work are lacking. Our results suggest that interventions containing safer sex work education and sex-positive biobehavioral HIV/STI prevention alongside substance use, mental health, employment, and education components will be most effective.
Collapse
Affiliation(s)
- Cristian J Chandler
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA.
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Étienne Meunier
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Elí Andrade
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Leigh A Bukowski
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Henry F Raymond
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Ronald D Stall
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
2
|
Ricks J, Crosby RA, Graham CA, Sanders SA, Milhausen RR, Yarber WL. A home-practice intervention for increasing condom use among university undergraduates. Int J STD AIDS 2020; 31:1149-1153. [PMID: 32883172 DOI: 10.1177/0956462420933056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The consistently high rate of sexually transmitted infections among people 18-24 years old warrants novel strategies promoting condom use among large segments of this population. Ample opportunity exits to employ such strategies in university settings. This study evaluated a sex-positive, home-practice intervention designed to promote condom use among university undergraduates engaging in penile-vaginal intercourse (PVI). A sample of 29 opposite-sex undergraduate couples, engaging in PVI, was recruited from a large university. After teaching couples about condom use, a health educator helped couples select condoms/lubricants from options comprising various sizes, fits, shapes, textures, and other features. A 30-day 'homework assignment' was made to use these products while reducing condom use errors/problems and enhancing sexual pleasure. A repeated measures design, with a six-month observation period, was used to evaluate the program. Over the six-month period, the mean frequency of condomless PVI decreased from 26.4 to 3.9 times (P < .001). Significant and favorable changes were also found relative to attitudes toward condom use (P = .027) and in condom use self-efficacy (P < .001). Most students completing the follow-up assessment indicated the intervention would favorably impact their future condom use. Findings suggest this intervention program may be important to promoting condom use among university couples engaging in PVI.
Collapse
Affiliation(s)
- JaNelle Ricks
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Richard A Crosby
- The Kinsey Institute, Indiana University, Bloomington, IN, USA.,Department of Health Behavior, University of Kentucky, Lexington, KY, USA.,The Rural Center for AIDS and STD Prevention, Indiana University, Bloomington, IN, USA
| | - Cynthia A Graham
- The Kinsey Institute, Indiana University, Bloomington, IN, USA.,The Rural Center for AIDS and STD Prevention, Indiana University, Bloomington, IN, USA.,Department of Psychology, Southampton University, Southampton, UK
| | - Stephanie A Sanders
- The Kinsey Institute, Indiana University, Bloomington, IN, USA.,The Rural Center for AIDS and STD Prevention, Indiana University, Bloomington, IN, USA.,Department of Gender Studies, Indiana University, Bloomington, IN, USA
| | - Robin R Milhausen
- The Kinsey Institute, Indiana University, Bloomington, IN, USA.,The Rural Center for AIDS and STD Prevention, Indiana University, Bloomington, IN, USA.,Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Canada
| | - William L Yarber
- The Kinsey Institute, Indiana University, Bloomington, IN, USA.,The Rural Center for AIDS and STD Prevention, Indiana University, Bloomington, IN, USA.,School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| |
Collapse
|
3
|
Li DH, Newcomb M, Macapagal K, Remble T, Mustanski B. Condom-Associated Erectile Function, But Not Other Domains of Sexual Functioning, Predicts Condomless Insertive Anal Sex Among Young Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:161-174. [PMID: 31980999 PMCID: PMC7018619 DOI: 10.1007/s10508-020-01642-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/10/2020] [Accepted: 01/11/2020] [Indexed: 05/09/2023]
Abstract
Condoms effectively prevent against HIV, especially when used in conjunction with biomedical strategies such as PrEP and viral suppression. However, consistent use of condoms in the real world has been a continual health promotion challenge, even among populations at highest risk, such as young men who have sex with men (YMSM). Inconsistent condom use may be related to poor sexual functioning, but limited research exists. The analytic sample comprised 688 racially diverse YMSM aged 16-29 (M = 22.9 years) living in Chicago, IL (19.2% living with HIV). Using multivariable logistic regression, we examined longitudinal associations between condom-associated sexual functioning (erectile function, orgasm satisfaction, global satisfaction, and anal discomfort) and condomless insertive anal sex (CIAS) and condomless receptive anal sex (CRAS) 6 months later. CIAS at Time 2 was associated with condom-associated erectile function at the bivariate and multivariable levels, even after controlling for CIAS at Time 1 (p < .05). Condom-associated erectile function, orgasm satisfaction, and global satisfaction predicted Time 2 CRAS in bivariate models, but none remained significant in the multivariable models. Age, having had a serious partner in the past 6 months, and HIV/PrEP status at Time 2 were significant predictors of CIAS/CRAS in some but not all models. Future interventions to improve consistent condom use should specifically highlight information and skills on how to use condoms within real-world contexts rather than from a clinical perspective. Our results also support the importance of biomedical strategies for those who have continued problems with sexual functioning when using condoms.
Collapse
Affiliation(s)
- Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA.
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Michael Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kathryn Macapagal
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Thomas Remble
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
4
|
Lachowsky NJ, Fulcher K, Lal A, Crosby R. Adaptation, feasibility and performance of a brief clinic-based intervention to improve prevention practices among sexual minority men. CANADIAN JOURNAL OF HUMAN SEXUALITY 2019. [DOI: 10.3138/cjhs.2018-0043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Nathan J. Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, BC
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Karyn Fulcher
- School of Public Health and Social Policy, University of Victoria, Victoria, BC
| | - Allan Lal
- School of Public Health and Social Policy, University of Victoria, Victoria, BC
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | | |
Collapse
|
5
|
Ward LM, Bruce MA, Thorpe RJ, Mena L, Nunn A, Crosby R. Correlates Associated With Willingness to Start Pre-exposure Prophylaxis Among Young Black Men Who Have Sex With Men (MSM) in Jackson, Mississippi. FAMILY & COMMUNITY HEALTH 2019; 42:189-196. [PMID: 31107729 DOI: 10.1097/fch.0000000000000225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Black men who have sex with men have the greatest risk for human immunodeficiency virus infection. Pre-exposure prophylaxis (PrEP) is a highly effective prevention method. However, uptake in this group is extremely low. Data from a sample of 225 human immunodeficiency virus-negative young black men who have sex with men residing in Jackson, Mississippi, were analyzed to examine correlates associated with willingness to start PrEP. Consistent condom users for both insertive and receptive sex were more likely to be willing to start PrEP than inconsistent condom users. Heterogeneity among this high-risk population is an important consideration for future studies assessing PrEP uptake and evaluating prevention efforts.
Collapse
Affiliation(s)
- Lori M Ward
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson (Drs Ward, Bruce, Thorpe, and Mena); Program for Research on Faith and Health, Center for Research on Men's Health, and Center for Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee (Dr Bruce); Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, and Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Thorpe); Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson (Dr Mena); Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island (Dr Nunn); and Department of Health Behavior, College of Public Health, University of Kentucky, Lexington (Dr Crosby)
| | | | | | | | | | | |
Collapse
|