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

Abstract

In the U.S., HIV is concentrated among men who have sex with men (MSM), some of whom have had female partners (MSMW). MSMW are disproportionately impacted by psychosocial vulnerabilities, like depression and substance use that increase sexually transmitted infection (STI) and HIV risk. Research on psychosocial vulnerability and HIV-related sexual risk among MSMW is warranted to reduce infection transmission among MSM and to prevent bridging to female partners. We analyzed data from Wave IV (2007)(2008) of the National Longitudinal Study of Adolescent Health to assess psychosocial vulnerability and HIV risk-taking among MSMW. Using lifetime and past year sexual activity, we classified men as ever having sex with: women only (MSW), men only (MSMO) or MSMW, with further refined categorization of MSMW with male only partners in the past 12 months, only female partners in the past 12 months, and both male and female partners in the past 12 months (N = 6,945). We compared psychosocial vulnerability characteristics and HIV-related risk behaviors among the five categories of men. MSMW were more likely to report depression, suicidality, substance use, and incarceration than MSW and MSMO. Compared to MSW, MSMW with current female partners had greater odds of unprotected sex, exchange sex, and STI. MSMW with male partners in the past year had greater odds of multiple or concurrent partners in the past year. HIV risk and psychosocial vulnerability factors are elevated among MSMW, a priority population for HIV risk reduction. HIV risk reduction interventions should address this and heterogeneity of sexual partnerships among MSMW.

Correlates of Sexual Violence Among Men Who Have Sex With Men in Tijuana, Mexico

“…Thus, in the final model, more experiences of sexual violence in the past 12 months were independently associated with not living with a spouse or steady partner, having a history of childhood sexual abuse, more adult experiences of homophobia, and higher scores on depression and hostility symptoms (see Table 2). Since previous research has shown differences between MSM and men who have sex with men and women (MSMW) in terms of sexual violence and other psychosocial factors (Davis et al, 2015; Dyer, Regan, Pacek, Acheampong, & Khan, 2015; Wang et al, 2015), we re-ran the hierarchical regression model excluding 48 participants who reported sex with women in the past two months. The substantive findings were mostly unchanged.…”

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

“…Consistent with other research, our study found that fewer BMSMW were HIV infected compared to BMSMO. 17,28,29 This could reflect the comparatively lowered risks for HIV transmission per sexual event as BMSMW have sex with some high-risk men and low-risk heterosexual women, while BMSMO engage in sex with other men, exclusively. 40 Specifically, female partners for BMSMW have lower HIV prevalence than that of male partners, which may explain the comparatively lower HIV prevalence for this group.…”

“…9 While BMSMW have lower HIV prevalence compared to BMSMO, they often report elevated levels of compound, interconnected factors (e.g., internalized homophobia, cocaine use) that correspond with increased risk and frequency of potential exposure to HIV, which places their male and female partners at increased risk, as well. 17,28,29 To best understand how to reduce disproportionate infection among BMSMW and to prevent transmission from these men to their male and female partners, research is needed to compare BMSMO and BMSMW on substance use, psychosocial factors, and behaviors that correspond with HIV risk. Therefore, there is a need to utilize existing data to develop an understanding of risk in order to tailor interventions for BMSMW.…”

Socio-demographic Characteristics, Sexual and Test-Seeking Behaviours Amongst Men Who have Sex with Both Men and Women: Results from a Bio-behavioural Survey in 13 European Cities

“…Psychosocial factors can play a crucial role in determining MSMW vulnerability, particularly in terms of risk behaviour, and for these reasons this sub-population can be identified as a priority population for targeted HIV and STI prevention interventions (9) (10).…”