Syndemic Health Disparities and Sexually Transmitted Infection Burden Among Black Men Who Have Sex with Men Engaged in Sex Work in the U.S.

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.

Associations of past-year stigma and psychosocial syndemic conditions: Considerations for intersectional stigma measures among Black sexual minority men.

“…For this analysis, the syndemic conditions cluster included conditions of violence (physical assault, intimate partner violence), substance use (polydrug use in the past 3 months), and depression symptomology (past-week likelihood of moderate to depression based on symptomology) as identified in this data previously (Chandler et al, 2021). For these analyses, results were coded dichotomously for each category (e.g., no intimate partner violence [IPV] vs. IPV) in order to create a latent psychosocial syndemic variable, which has been used previously in published literature (Chandler et al, 2021, 2022).…”

Cultural acceptability of STI screening guidelines and sexual positioning assessments among black sexual minority men

“…Black sexual minority men (SMM) have been inequitably impacted by HIV/STIs for almost two decades partly due to multilevel factors including racism, stigma, discrimination and limited resource access (Centers for Disease Control and Prevention [CDC], 2022; Maulsby et al, 2013;Millett et al, 2006). In 2019, Black SMM accounted for 26% of U.S. HIV incidence and 37% of new diagnoses among American gay and bisexual men (CDC, 2020a(CDC, , 2020b.…”

“…Between 2015 and 2019, HIV incidence among Black SMM overall remained stable and increased by 6% among those who were ages 25-34 years (CDC, 2020a(CDC, , 2020b. Data among Black SMM from five U.S. cities showed that 5.6% tested positive for rectal gonorrhoea and 7% tested positive for pharyngeal gonorrhoea (Johnson Jones et al, 2019).…”

“…Some SMM also practice oral sex, which confers risk for extragenital STIs (Cornelisse et al, 2018;Dangerfield II et al, 2018). However, STI screening and testing among Black SMM is suboptimal partly because clinicians do not fully assess sexual positioning practices (Amin et al, 2017;CDC, 2020aCDC, , 2020b. Therefore, the hope of achieving World Health Organization targets of reducing STI incidence globally by 90% by 2030 (World Health Organization, 2016) is compromised without adequate screening and treatment for this community.…”

Social Determinants of Transactional Sex in a Sample of Young Black and Latinx Sexual Minority Cisgender Men and Transgender Women

“…Black and Latinx transgender women may be more likely than black, Latino cisgender men to engage in transactional sex for economic survival and gender affirmation resulting from community-level stigma and structural-level discrimination [8]. To end the HIV epidemic, more work is needed to specifically understand the structural and social determinants of transactional sex work that predispose young black and Latinx cisgender men who have sex with men and transgender women to HIV [14,15].…”