An examination of the social and sexual networks of crack-using AA MSM: Implications for HIV prevention

Background: Little is known about crack-use as an HIV risk factor among African American men who have sex with men (AA MSM), a group disproportionately infected with HIV. From a social network perspective, we sought to examine the relationship between drug use and social capital and sexual risk network characteristics.of AA MSM in Baltimore, Maryland.

Methods: Participants were recruited using street and internet-based outreach, printed advertisements and word-of-mouth. Inclusion criteria were being at least 18 years old, African American/Black race/ethnicity and sex with another male in the prior 90 days. Crack use was operationalized as self-report of crack in the prior 90 days. Logistic regression was used to identify variables that were independently associated with crack use.

Results: Of 230 enrolled AA MSM, 37% (n=84) reported crack use. The sexual networks of crack-using AA MSM were composed of a greater number of HIV-positive sex partners, exchange partners and partners who were both sex and drug partners and fewer networks with whom they always use condoms as compared to non-crack using AA MSM. Crack use was independently associated with increased odds of bisexual identity and networks with a greater number of exchange partners, overlap of drug and sex partners and lesser condom use.

Conclusion: Results of this study highlight sexual network characteristics of crack-smoking AA MSM that may promote transmission of HIV. HIV interventions are needed that are tailored to address the social context of crack-smoking AA MSM risk behaviors.