310472
Social Discrimination and Sexual HIV Acquisition Risk Behavior among Urban MSM
METHODS: In NYCM2M, 1503 MSM who reported past-three month (P3M) anal sex were enrolled between 2010 and 2013, using a modified venue- and web-based time-space sampling methodology; 1369 are included in analyses. Multivariable analyses, controlling for sociodemographic and psychosocial factors, assessed mediation via risky sexual situations, psychological distress and internalized homophobia.
RESULTS: Of the HIV-negative MSM (992), 11% (110) reported P3M receptive anal intercourse without a condom and with an HIV-positive/unknown status partner (“HIV acquisition risk”). Just 29 (7.7%) of HIV-positive men/unknown MSM (377) engaged in insertive anal intercourse without a condom and with an HIV-negative/unknown partner (“HIV transmission risk behavior”). 96% and 25% reported lifetime and P3M sexual orientation-based discrimination. Recent sexual orientation-based discrimination was associated with HIV acquisition risk (UOR=1.3; 95% CI 1.11, 1.52). Race-based discrimination was not (UOR=1.67; 95% CI 0.76, 3.68). Financial insecurity, condom use self-efficacy, perceived condom-use peer norms and mediators were associated with HIV acquisition risk behavior; gay community attachment was not. In multivariable analyses, psychological distress (aOR=1.41; 95% CI 1.14, 1.73) mediated the association between discrimination and HIV acquisition risk behavior; drug or alcohol use at last sex (aOR=1.87; 95% CI 1.21, 2.88) was independently associated. Results among African American and Latino MSM were similar.
CONCLUSIONS: Decreasing exposure to sexual orientation-based discrimination and related psychological distress among MSM is an important HIV prevention goal.
Learning Areas:
Diversity and cultureEpidemiology
Social and behavioral sciences
Learning Objectives:
Describe the role of social discrimination in sexual behavior among gay, bisexual and other men who have sex with men (MSM).
Identify correlates of sexual HIV acquisition risk behavior among MSM in New York City (NYC), including differences by race/ethnicity, and mediators of the relationship.
Discuss the impact of social discrimination on sexual health and well-being among MSM in NYC.
Keyword(s): Lesbian, Gay, Bisexual and Transgender (LGBT), HIV/AIDS
Qualified on the content I am responsible for because: I am an HIV prevention scientist who has conducted numerous studies to identify HIV risk and protective factors to inform HIV prevention interventions for diverse populations in New York City. I possess an MPH in epidemiology and a DrPH in sociomedical sciences. I am the Head of the Laboratory of Social and Behavioral Sciences at the New York Blood Center and a clinical faculty member at the Mailman School of Public Health of Columbia University.
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.