Involvement with street violence, incarceration, and sex while incarcerated among African-American men who have sex with men (MSM) and non-MSM enrolled at urban health clinics

While previous studies suggest that MSM are at increased risk for early life sexual and physical abuse, little is known about adult violent behaviors among MSM. We conducted a cross-sectional study of 703 adult African-American non-monogamous men who were sequentially enrolled at four Boston clinics. Data were collected on: sexual behaviors; participation in street violence; incarceration; sex with men while incarcerated; demographics, alcohol/drug use, HIV infection status, and early life (<21 years old) physical or sexual abuse. Three subgroups were identified: MSM readily acknowledging male sex partners (n=72; 67% gay/bisexual), MSM initially denying male partners but subsequently reporting sex with men (n=56; 9% gay/bisexual), and non-MSM (n=575; 2% gay/bisexual). MSM readily acknowledging male partners were 53% less likely (adjustedOR:0.46; 95% CI:0.23,0.95) to have joined gangs, 1.8-fold as likely (adjustedOR:1.83;95% CI:1.05,3.19) to believe that neighborhood men need to fight to survive, and during incarceration MSM were 13.7-fold as likely to have had oral sex (adjustedOR:13.65;95% CI:5.91,31.52), 16.6-fold as likely to have had anal sex (adjustedOR:16.55; 95% CI:5.63,48.61), and 13.6-fold as likely to have been raped (adjustedOR:13.59; 95% CI:3.11,59.48) versus non-MSM. MSM initially denying male sex partners were 1.9-fold as likely to ever have been incarcerated (OR:1.85; 95%CI:1.02,3.35) versus non-MSM (55% incarcerated). In this sample of men reporting high levels of participation in street violence (16%), African-American MSM are at greatest risk for incarceration, or having sex with other men or being raped once incarcerated. These findings suggest that African-American MSM may be at increased risk for HIV/STI infection once incarcerated.