Differences in Substance Use, Psychosocial Characteristics and HIV-Related Sexual Risk Behavior Between Black Men Who Have Sex with Men Only (BMSMO) and Black Men Who Have Sex with Men and Women (BMSMW) in Six US Cities

Abstract

We assessed associations in substance use, psychosocial characteristics, and HIV-related sexual risk behaviors, comparing characteristics of Black men who only have sex with other men only (BMSMO; n = 839) to Black men who have sex with men and women (BMSMW; n = 590). The study analyzed baseline data from the HIV Prevention Trials Network Brothers Study (HPTN 061), a feasibility study of a multi-component intervention for Black MSM in six US cities. Bivariate analyses compared BMSMO to BMSMW along demographics, substance use, psychosocial characteristics, and HIV-related sexual risk behaviors. Logistic regression models then assessed multivariable associations between being BMSMW and the odds of engaging in HIV-related sexual risk behaviors. Adjusted analyses revealed that BMSMW remained more likely to have unprotected anal intercourse while under the influence of alcohol (AOR: 1.45; 95 % CI:1.11-1.90) and were more likely to receive money/drugs for sex (AOR: 2.11; 95 % CI:1.48-3.03), compared to BMSMO. Substance use is an important factor to be considered when developing risk-reduction interventions for BMSMW. Structural interventions that address factors that may contribute to exchange sex among these men are also warranted.

Psychosocial Vulnerability and HIV-Related Sexual Risk Among Men who have Sex with Men and Women in the United States

“…High HIV incidence observed among MSMW in HPTN061 corroborated studies that have documented high levels of HIV risk behaviors among MSMW (Dyer et al, 2013; Friedman, 2013a, 2013b; Friedman et al, 2013; Maulsby, Sifakis, German, Flynn, & Holtgrave, 2013; Tieu et al, 2012). Some studies have suggested that MSMW report higher numbers of partners, more involvement in exchange sex, and partners who were substance users than men who have sex with women (MSW) yet lower levels of these outcomes compared with MSMO (Gorbach, Murphy, Weiss, Hucks-Ortiz, & Shoptaw, 2009).…”

“…There is evidence to suggest that MSMW exhibit elevated levels of sexual risk compared to both MSMO and MSW because they are psychologically and socially vulnerable (Dyer et al, 2013; Eaton et al, 2013; Friedman et al, 2013; Harawa et al, 2012). Psychosocial vulnerability factors are considered stressors that result in increased risk for adverse health outcomes, including HIV (Dyer et al, 2012; Halkitis & Figueroa, 2013; Halkitis et al, 2013; Pitpitan et al, 2013).…”

“…Psychosocial vulnerability factors are considered stressors that result in increased risk for adverse health outcomes, including HIV (Dyer et al, 2012; Halkitis & Figueroa, 2013; Halkitis et al, 2013; Pitpitan et al, 2013). Psychosocial vulnerability among MSMW is likely a result of stigma and discrimination this group experiences because they traverse two worlds that often do not converge–one of homosexual behavior and one of heterosexual identity (Allen, Myers, & Williams, 2012; Brooks, Rotheram-Borus, Bing, Ayala, & Henry, 2003; Dyer et al, 2013; Saleh, Operario, Smith, Arnold, & Kegeles, 2011). Specifically, stigma leads to psychosocial vulnerabilities, including distress, psychopathology (e.g., depression and suicidality), and, in turn, substance use.…”

Correlates of selling sex among male injection drug users in New York City

“…Although women may be more likely to sell sex than men (Jenness et al, 2011), the frequency of men selling sex to women found in this study challenges the conventional perception of the gendered direction of exchange sex. Other research has found that men who have sex with both men and women are more likely to sell sex, compared to those who only have sex with men (Dyer et al, 2013;Weber et al, 2001).…”

Types of Female Partners Reported by Black Men Who Have Sex with Men and Women (MSMW) and Associations with Intercourse Frequency, Unprotected Sex and HIV and STI Prevalence

“…Individuals like these participants, who were selected because of recent unprotected sex with men, may move in and out of researcher-defined categories regarding the gender and type of their sexual partners [37]. Hence, prevention strategies designed to reach behaviorally bisexual men and the women in primary partnerships with them may need to employ a broad reach [38].…”