Abstract
Black men who have sex with men (MSM) are at increased risk for HIV infection in the United States compared to other MSM. The aim of this study was to investigate Black MSM’s sexual mixing patterns and partner characteristics in relation to sexual risk taking, as a possible explanation for this observed increase in HIV incidence. Between January and July 2008, 197 Black MSM were recruited via modified respondent-driven sampling and completed optional pretest and post-test HIV serological testing, counseling, and a demographic, behavioral, and psychosocial assessment battery. Bivariate and multivariable logistic regression procedures were used to examine predictors of risky sex across partner types. Overall, 18% of the sample was HIV-infected; 50% reported unprotected intercourse with men, 30% with women, and 5% with transgender partners. Fifty-three percent identified as bisexual or straight, although all reported oral or anal sex with another man in the prior 12 months. Significant predictors of engaging in at least one episode of: (1) serodiscordant unprotected anal sex (UAS) with a male partner in the past 12 months: individuals at risk for social isolation (AOR = 4.23; p = 0.03), those with unstable housing (AOR = 4.19; p = 0.03), and those who used poppers at least weekly during sex (AOR = 5.90; p = 0.05); (2) UAS and/or unprotected vaginal intercourse with a female partner in the past 12 months: those with unstable housing (AOR = 4.85; p = 0.04), those who used cocaine at least weekly during sex (AOR = 16.78; p = 0.006), being HIV-infected (AOR = 0.07; p = 0.02), and feeling social norms favor condom use (AOR = 0.60; p = 0.05); (3) UAS with the participants’ most recent nonmain male sex partner: use of alcohol and drugs during last sex by participant (AOR = 4.04; p = 0.01), having sex with a Hispanic/Latino male (AOR = 2.71; p = 0.04) or a Black male (AOR = 0.50; p = 0.05) compared to a White male, and lower education (AOR = 1.31; p = 0.02). Findings suggest that sexual risk behaviors of Black MSM differ across partner type and by the characteristics of their sexual networks and that this subpopulation of MSM are at high risk for HIV acquisition and transmission. Effective prevention strategies need to address the distinct sexual and behavioral risk patterns presented by different sexual partnerships reported by Black MSM.
Similar content being viewed by others
References
Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2006. vol. 18, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2008.
U.S. Census Bureau. State and county quickfacts; 2006. Accessed on: October 1, 2008. Available at: http://quickfacts.census.gov/qfd/states/00000.html.
Beatty LA, Wheeler D, Gaiter J. HIV prevention research for African Americans: current and future directions. J Black Psychol. 2004; 30: 40–58. doi:10.1177/0095798403259245.
Fullilove RE. African Americans, Health Disparities and HIV/AIDS: Recommendations for Confronting the Epidemic in Black America. New York, NY: National Minority AIDS Council; 2006.
Hall HI, Byers RH, Ling Q, Espinoza L. Racial/ethnic and age disparities in HIV prevalence and disease progression among men who have sex with men in the United States. Am J Public Health. 2007; 97(6): 1060–1066. doi:10.2105/AJPH.2006.087551.
Mays VM, Cochran SD, Zamudio A. HIV prevention research: are we meeting the needs of African American men who have sex with men? J Black Psychol. 2004; 30(1): 78–105. doi:10.1177/0095798403260265.
Heckman TG, Kelly JA, Bogart LM, Kalichman SC, Rompa DJ. HIV risk differences between African-American and white men who have sex with men. J Natl Med Assoc. 1999; 91: 92–100.
Institute of Medicine. Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: National Academy Press; 1997.
Malebranche DJ, Peterson JL, Fullilove RE, Stackhouse RW. Race and sexual identity: perceptions about medical culture and healthcare among black men who have sex with men. J Natl Med Assoc. 2004; 96(1): 97–107.
Millett GA, Peterson JL, Wolitski RJ, Stall R. Greater risk for HIV infection of black men who have sex with men: a critical literature review. Am J Public Health. 2006; 96: 1007–1019. doi:10.2105/AJPH.2005.066720.
Peterson JL, Coates TJ, Catania JA, et al. High-risk sexual behavior and condom use among gay and bisexual African-American men. Am J Public Health. 1992; 82: 1490–1494. doi:10.2105/AJPH.82.11.1490.
Millett GA, Flores SA, Peterson JL, Bakeman R. Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors. AIDS. 2007; 21: 2083–2091. doi:10.1097/QAD.0b013e3282e9a64b.
Bingham TA, Harawa NT, Johnson DF, Secura GM, MacKellar DA, Valleroy LA. The effect of partner characteristics on HIV infection among African American men who have sex with men in the Young Men’s Survey, Los Angeles, 1999–2000. AIDS Educ Prev. 2003; 15: 39–53. doi:10.1521/aeap.15.1.5.39.23613.
Harawa NT, Greenland S, Bingham TA, et al. Associations of race/ethnicity with HIV prevalence and HIV-related behaviors among young men who have sex with men in 7 urban centers in the United States. J Acquir Immune Defic Syndr. 2004; 35: 526–536. doi:10.1097/00126334-200404150-00011.
Koblin BA, Husnik MJ, Colfax G, et al. Risk factors for HIV infection among men who have sex with men. AIDS. 2006; 20: 731–939. doi:10.1097/01.aids.0000216374.61442.55.
Malebranche DJ. Black men who have sex with men and the HIV epidemic: next steps for public health. Am J Public Health. 2003; 93(6): 862–865. doi:10.2105/AJPH.93.6.862.
Sifakis F, Hylton JB, Flynn C, et al. Racial disparities in HIV incidence among young men who have sex with men: the Baltimore young men’s survey. J Acquir Immune Defic Syndr. 2007; 46: 343–348. doi:10.1097/QAI.0b013e31815724cc.
Ford K. Social differences in partners of American adults: association with condom use and sexually transmitted infections. Can J Hum Sex. 2003; 12(3/4): 129–135.
Havanon N, Bennett A, Knodel J. Sexual networking in provincial Thailand. Stud Fam Plann. 1993; 24: 1–17. doi:10.2307/2939210.
Morris M, Zavisca J, Dean L. Social and sexual networks: their role in the spread of HIV/AIDS among young gay men. AIDS Educ Prev. 1995; 7: 24–35.
Service S, Blower SM. HIV transmission in sexual networks: an empirical analysis. Proc R Soc Lond B Biol Sci. 1995; 260: 237–244. doi:10.1098/rspb.1995.0086.
Laumann EO, Youm Y. Racial/ethnic group differences in the prevalence of sexually transmitted diseases in the United States: a network explanation. Sex Transm Dis. 1999; 26(5): 250–261. doi:10.1097/00007435-199905000-00003.
Choi KH, Operanio D, Gregorich SE, Han L. Age and race mixing patterns of sexual partnerships among Asian men who have sex with men: implications for HIV transmission and prevention. AIDS Educ Prev. 2003; 15: 53–65. doi:10.1521/aeap.15.1.5.53.23609.
Berry M, Raymond HF, MacFarland W. Same race and older partner selection may explain higher HIV prevalence among black men who have sex with men. AIDS. 2007; 21(17): 2349–2350. doi:10.1097/QAD.0b013e3282f12f41.
Heckathorn DD. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997; 44: 174–199. doi:10.1525/sp.1997.44.2.03x0221m.
Mayer KH, Mimiaga MJ, VanDerwarker R, Goldhammer H, Bradford JB. Fenway Community Health’s model of integrated community-based LGBT care, education, and research. In: Meyer IH, Northridge ME, eds. The Health of Sexual Minorities. New York, NY: Springer Science & Business Media, LLC; 2007: 693–715.
Mimiaga MJ, Goldhammer H, Belanoff C, Tetu AM, Mayer KH. Men who have sex with men: perceptions about sexual risk, HIV and sexually transmitted disease testing, and provider communication. Sex Transm Dis. 2007; 34: 113–119. doi:10.1097/01.olq.0000225327.13214.bf.
Mimiaga MJ, Reisner SL, Tetu AM, et al. Psychosocial and behavioral predictors of partner notification after HIV and STI exposure and infection among MSM. AIDS Behav. In press.
Heckathorn DD. Respondent-driven sampling II: deriving valid population estimates from chain-referral samples of hidden populations. Soc Probl. 2002; 49: 11–34. doi:10.1525/sp.2002.49.1.11.
Sanchez T, Finlayson T, Drake A, et al. Human Immunodeficiency Virus (HIV) risk, prevention, and testing behaviors—United States, National HIV Behavioral Surveillance System: men who have sex with men, November 2003–April 2005. MMWR Surveill Summ. 2006; 55: 1–16.
Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984; 252: 1905–1907. doi:10.1001/jama.252.14.1905.
Knowlton R, McCusker J, Stoddard A, et al. The use of the CAGE questionnaire in a cohort of homosexually active men. J Stud Alcohol. 1994; 55: 692–694.
Mayfield D, McLeod G, Hall P. The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psychiatry. 1974; 131: 1121–1123.
Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977; 1: 385–401. doi:10.1177/014662167700100306.
U.S. Department of Health and Human Services. CES-D Scale. Bethesda, MD: Department of Health and Human Services, National Institute of Health; 2004.
Lubben J, Blozik E, Gillmann G, et al. Performance of an abbreviated version of the Lubben social network scale among three European community-dwelling older adult populations. Gerontologist. 2006; 46: 503–513.
Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess. 2008; 52: 30–41. doi:10.1207/s15327752jpa5201_2.
Zimet GD, Powell SS, Farley GK, Werkman S, Berkoff KA. Psychometric characteristics of the multidimensional scale of perceived social support. J Pers Assess. 1990; 55: 610–617. doi:10.1207/s15327752jpa5503&4_17.
Van de Ven P, Crawford J, Kippax S, et al. A scale of optimism–skepticism in the context of HIV treatments. AIDS Care. 2000;12:171–176. doi:10.1080/09540120050001841.
Catania JA, Coates TJ, Kegeles S. A test of the AIDS risk reduction model: psychosocial correlates of condom use in the AMEN Cohort Survey. Health Psychol. 1994; 13(6): 548–555. doi:10.1037/0278-6133.13.6.548.
Carey MP, Schroder KE. Development and psychometric evaluation of the brief HIV knowledge questionnaire. AIDS Educ Prev. 2002; 14(2): 172–182. doi:10.1521/aeap.14.2.172.23902.
Jaworski BC, Carey MP. Development and psychometric evaluation of a self-administered questionnaire to measure knowledge of sexually transmitted diseases. AIDS Behav. 2007; 11(4): 557–574. doi:10.1007/s10461-006-9168-5.
SAS Institute Inc. SAS® Version 9.1.3. Cary, NC: SAS Institute Inc.; 2003.
Afifi AA, Clark V, May S. Computer-Aided Multivariate Analysis. 4th edn. New York: Chapman and Hall; 2004.
Stall R, Mills TC, Williamson J, et al. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. Am J Public Health. 2003; 93: 939–942. doi:10.2105/AJPH.93.6.939.
Stall R, Paul JP, Greenwood G, et al. Alcohol use, drug use, and alcohol-related problems among men who have sex with men: the Urban Men’s Health Study. Addiction. 2001; 96: 1589–1601. doi:10.1046/j.1360-0443.2001.961115896.x.
Darbes LA, Lewis MA. HIV-specific social support predicts less sexual risk behavior in gay male couples. Health Psychol. 2005; 24(6): 617–622. doi:10.1037/0278-6133.24.6.617.
O’Donnell L, Agronick G, San Doval, et al. Ethnic and gay community attachments and sexual risk behaviors among urban Latino young men who have sex with men. AIDS Educ Prev. 2002; 14(6): 457071. doi:10.1521/aeap.14.8.457.24109.
Peterson JL, Rothenberg R, Kraft JM, Beeker C, Trotter R. Perceived condom norms and HIV risks among social and sexual networks of young African American men who have sex with men. Health Educ Res. 2008; 24: 119–127.
Peterson JL, Folkman S, Bakeman R. Stress, coping, HIV status, psychosocial resources, and depressive mood in African American gay, bisexual, and heterosexual men. Am J Community Psychol. 1996; 24(4): 461–487. doi:10.1007/BF02506793.
Crosby RA, DiClemente RJ, Wingwood GM, et al. HIV/STD-protective benefits of living with mothers in perceived supportive families: a study of high-risk African American female teens. Prev Med. 2001; 33(3): 175–178. doi:10.1006/pmed.2001.0868.
Ennett ST, Bailey SL, Federman E. Social network characteristics associated with risky behaviors among runaway and homeless youth. J Health Soc Behav. 1999; 40: 63–78. doi:10.2307/2676379.
Gore-Felton C, Koopman C, Turner-Cobb JM, Duran R, Israelski D, Spiegel D. The influence of social support, coping and mood on sexual risk behavior among HIV-positive men and women. J Health Psychol. 2002; 7(6): 713–722. doi:10.1177/1359105302007006874.
Heckman TG, Kelly JA, Somlai AM. Predictors of continued high-risk sexual behavior in a community sample of persons living with HIV/AIDS. AIDS Behav. 1998; 2(2): 127–135. doi:10.1023/A:1022194829791.
Henrich CC, Brookmeyer KA, Shrier LA, Shahar G. Supportive relationships and sexual risk behavior in adolescence: an ecological–transactional approach. J Pediatr Psychol. 2006; 31(3): 286–297. doi:10.1093/jpepsy/jsj024.
St. Lawrence JS, Brasfield TL, Jefferson KW, et al. Social support as a factor in African-American adolescents’ sexual risk behavior. J Adolesc Res. 1994; 9(3): 292–310. doi:10.1177/074355489493002.
Clements K, Gleghorn A, Garcia D, Katz M, Marx R. A risk profile of street youth in northern California: implications for gender-specific human immunodeficiency virus prevention. J Adolesc Health. 1997; 20: 343–353. doi:10.1016/S1054-139X(97)00033-5.
Halcon LL, Lifson AR. Prevalence and predictors of sexual risks among homeless youth. J Youth Adolesc. 2004; 33: 71–80. doi:10.1023/A:1027338514930.
Rotheram-Borus MJ, Koopman C, Haignere C, Davies M. Reducing HIV sexual risk behaviors among runaway adolescents. JAMA. 1991; 266: 1237–1241. doi:10.1001/jama.266.9.1237.
Rotheram-Borus MJ, Song J, Gwadz M, Lee M, Van Rossem R, Koopman C. Reductions in HIV risk among runaway youth. Prev Sci. 2003; 4: 173–187. doi:10.1023/A:1024697706033.
Diaz RM, Stall RD, Hoff C, Daigle D, Coates TJ. HIV risk among Latino gay men in the Southwestern United States. AIDS Educ Prev. 1996; 8: 415–429.
Hogg RS, Craib KJ, Willoughby B, Sestak B, Montaner JS, Schechter MT. Sociodemographic correlates for risk-taking behaviour among HIV seronegative homosexual men. Can J Public Health. 1993; 84: 423–426.
Hope VD, MacArthur C. Safer sex and social class: findings from a study of men using the ‘gay scene’ in the West Midlands Region of the United Kingdom. AIDS Care. 1998; 10: 81–88.
Janssen M, de Wit J, Stoebbe W, van Griensven F. Educational status and risk of HIV in young gay men. J Health Psychol. 2000; 5: 487–499.
Janssen M, de Wit J, Hospers HJ, van Griensven F. Educational status and young Dutch gay men’s beliefs about using condoms. AIDS Care. 2001; 13: 41–56. doi:10.1080/09540120020018170.
Kippax S, Crawford J, Rodden P, Noble J. Predictors of unprotected male-to-male anal intercourse with casual partners in a national sample. Aust J Public Health. 1995; 19: 132–138.
Rawstorne P, Fogarty A, Crawford J, et al. Differences between HIV-positive gay men who ‘frequently’, ‘sometimes’ or ‘never’ engage in unprotected anal intercourse with serononconcordant casual partners: positive Health Cohort, Australia. AIDS Care. 2007; 19(4): 514–522. doi:10.1080/09540120701214961.
Grulich A, Prestage GP, Kippax SC, Crawford JM, Van de Ven PG. HIV serostatus of sexual partners of HIV-positive and HIV-negative homosexual men in Sydney. AIDS. 1998; 12: 2508. letter.
Hoff CC, Stall R, Paul J, et al. Differences in sexual behavior among HIV discordant and concordant gay men in primary relationships. J Acquir Immune Defic Syndr Hum Retrovirol. 1997; 14: 72–78.
Van de Ven P, Rawstorne P, Treloar C, Richters J. HIV/AIDS, Hepatitis Sexually Transmissible Infections in Australia: Annual Report of Behaviour, 2004. Sydney, Australia: National Centre in HIV Social Research, University of New South Wales; 2004.
Acknowledgements
We would like to thank the following individuals who contributed time and energy to this project: Tom Barker, William Graves, Pam McMorrow, Brandon Perkovich, and Ashley Tetu.
This work was funded by the HIV/AIDS Bureau, Massachusetts Department of Public Health. Some of the investigator time on this project was support by grant number R03DA023393 from the National Institute on Drug Abuse (PI: M. Mimiaga). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mimiaga, M.J., Reisner, S.L., Cranston, K. et al. Sexual Mixing Patterns and Partner Characteristics of Black MSM in Massachusetts at Increased Risk for HIV Infection and Transmission. J Urban Health 86, 602–623 (2009). https://doi.org/10.1007/s11524-009-9363-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11524-009-9363-6