Correlates of sexual risk behavior with male and female partners among African American men who have sex with both men and women (AAMSM/W): Baseline findings from the bruthas project

Background: African American men continue to be disproportionately impacted by HIV, primarily through sexual contact with other men. AAMSM/W may be difficult to recruit into HIV prevention services designed for gay-identified men. The Bruthas Project is an intervention developed for AAMSM/W through a community collaborative process and is now being tested using a randomized controlled trial (RCT).

Methods: From February 2011- December 2012, we recruited 227 AAMSM/W in the San Francisco Bay Area. A survey administered at baseline assessed: sexual risk behavior with male, female, transgender partners, substance use, homelessness, incarceration, and a number of psychosocial factors. Multivariate analysis was completed looking at risk factors for our primary outcomes, any unprotected anal intercourse with male/transgender partners (UAI) and any unprotected vaginal intercourse with female partners (UVI) in the past 3 months.

Results: We used multivariate logistic regression to identify risk factors for 3-month UAI and UVI. Independent correlates of 3-month UAI were having sex with a woman during the past 3 months, higher number of male sex partners during the past 3 months, low condom use self-efficacy, lifetime history of incarceration, and any STI diagnosis during the past year. Independent correlates of 3-month UVI were higher number of female sex partners during the past 3 months and low self-esteem.

Conclusions: Interventions that provide private, individualized sessions that address the complexities of the lives of AAMSM/W have potential to impact HIV transmission for this population. Interventions must consider unique risk factors for unprotected sex with male versus female partners.