205978 Contextual and psychosocial factors surrounding HIV risk behavior among Black men who engage in transactional sex with other men, Boston, Massachusetts

Monday, November 9, 2009

Matthew J. Mimiaga, ScD, MPH , Psychiatry, Harvard Medical School and The Fenway Institute, Fenway Health, Boston, MA
Sari L. Reisner, MA , The Fenway Institute, Fenway Health and Harvard School of Public Heatlh, Boston, MA
Sean Bland, BA , The Fenway Institute, Fenway Community Health, Boston, MA
Kevin Cranston, MDiv , HIV/AIDS Bureau, Massachusetts Department of Public Health, Boston, MA
Deborah Isenberg, MPH , HIV/AIDS Bureau, Massachusetts Department of Public Health, Boston, MA
Kenneth Mayer, MD , Brown University/Miriam Hospital and The Fenway Institute, Fenway Health, Boston, MA
Background: Transactional sex has been associated with elevated risk for HIV infection among men who have sex with men (MSM), but little is known about these behaviors among Black MSM (BMSM).

Methods: BMSM (n=197) recruited via modified respondent-driven sampling between January-July 2008 completed an interviewer-administered quantitative assessment and optional pre- and post-test HIV counseling and testing. Logistic regression procedures examined the associations of demographics, behavioral HIV risk factors, and other psychosocial variables to having engaged in sex work.

Results: 11% of the sample reported having ever exchanged sex for money with a male sex partner; 82% of them did so in the past year with more than 1 in 5 (22%) reporting serodiscordant unprotected anal sex during their last sexual encounter with a transactional partner. Factors associated with having engaged in sex work in bivariate analyses: being HIV-infected (OR=6.94; p=0.0001), diagnosed with an STD in the past 12 months (OR=11.46; p=0.0002), serodiscordant unprotected anal sex during last casual encounter (OR=2.82; p=0.05), drug use (crystal, cocaine, crack, heroin, or marijuana) during sex in the past 12 months (OR=3.77; p=0.03), and elevated levels of clinically significant depressive symptoms at study enrollment (higher CES-D scores; OR=1.03; p=0.05).

Conclusions: BMSM who engage in sex work are more likely to be HIV-infected and are at increased risk for HIV transmission or acquisition. Interventions that engage at-risk individuals with mental health counseling, substance abuse treatment, and HIV/STD testing, may be particularly useful in decreasing sexual risk among BMSM who exchange sex for money with other men.

Learning Objectives:
Identify the contextual, psychosocial, and risk behaviors of Black men who engage in sex work with other men.

Keywords: HIV Risk Behavior, African American

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Matthew J. Mimiaga, ScD, MPH, is an Instructor in Psychiatry at Harvard Medical School/Massachusetts General Hospital, and a Research Scientist at The Fenway Institute, Fenway Community Health. He completed his Post-Doc training in Behavioral Medicine at Harvard Medical School/Massachusetts General Hospital and received his Doctorate from Harvard School of Public Health, majoring in Psychiatric Epidemiology, with minors in Infectious/Chronic Disease Epidemiology and Biostatistics, and was awarded the Harvard University Presidential Scholarship. He received his Master of Public Health from Boston University School of Public Health, majoring in Epidemiology and Behavioral Sciences. He has co-authored more than 50 articles, chapters and other publications on HIV/AIDS and related infectious disease topics and was recently awarded a grant from NIDA to develop a behavioral treatment for crystal methamphetamine addiction in HIV-uninfected MSM. Dr. Mimiaga is also the PI on a MA Department of Public Health funded study examining the social and sexual network characteristics and associated HIV risks of Black/African American MSM and is the co-PI (PI: Dr. Kenneth Mayer) on a Gilead funded project to study the barriers and facilitators to implementing recent CDC guidelines on routine HIV testing in primary care settings. In addition, he is currently a member of the protocol development team for HPTN 063 (PI: Dr. Steven Safren) a proposal to develop international prevention trials for HIV-infected individuals in care settings. His main research interests include HIV/AIDS, mental health and substance use disorders, psychiatric and infectious disease epidemiology, and global health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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