Intersectional analysis of life stress, incarceration and sexual health risk practices among cisgender Black gay, bisexual and other men who have sex with men in the Deep South of the US: the MARI Study
Dustin T. Duncan A G H * , Denton Callander A * , Lisa Bowleg B , Su Hyun Park A , Lauren Brinkley-Rubinstein C , Katherine P. Theall D and DeMarc A. Hickson E F
+ Author Affiliations
- Author Affiliations
A Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
B Department of Psychology, Columbian College of Arts and Sciences, George Washington University, Washington, DC 20052, USA.
C Department of Social Medicine, University of North Carolina, Chapel Hill, NC 27516, USA.
D Department of Global Community Health and Behavioral Sciences, Tulane University of School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.
E Center for Research, Evaluation and Environmental and Policy Change, My Brother’s Keeper Inc., Jackson, MS 39211, USA.
F Us Helping Us, People Into Living, Washington, DC 20010, USA.
G Present address: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA.
H Corresponding author. Email: dd3018@columbia.edu
Sexual Health 17(1) 38-44 https://doi.org/10.1071/SH19062
Submitted: 29 March 2019 Accepted: 5 August 2019 Published: 24 January 2020
Abstract
Objectives: The purpose of the present study was to examine associations between life stress and incarceration history in relation to sexual health risk practices among a sample of cisgender Black gay, bisexual and other men who have sex with men (MSM) in the Deep South. Methods: Using data from a sample of 355 cisgender Black MSM in Mississippi and Georgia, multivariable logistic regression analyses were conducted to examine associations between life stress and sexual risk practices. In addition, we assessed whether stress may interact with experiences of incarceration to influence sexual health risk practices. Results: After controlling for sociodemographic characteristics, stress was associated with some sexual risk practices (e.g. alcohol and drug use during sex and group sex). Further, when an interaction with incarceration was assessed, among participants who had been incarcerated, high compared with low levels of stress were associated with alcohol use during sex (adjusted odds ratio (aOR) 4.59, 95% confidence interval (CI) 2.11–9.99, P < 0.001), drug use during sex (aOR 3.92, 95% CI 1.79–8.60, P < 0.001), condomless sex with casual partners (aOR 2.83, 95% CI 1.31–6.12, P < 0.001), having six or more casual partners (aOR 2.77, 95% CI 1.09–7.06, P = 0.02) and participating in group sex (aOR 5.67, 95% CI 2.07–15.51, P < 0.001). Stress and incarceration produced a dose–response effect for each association; similar associations with stress were not observed among men who had not been incarcerated. Conclusions: Among people with experiences of incarceration, there are several possible ways our findings could be applied practically, including through safer sex and stress management interventions designed specifically for Black MSM following their release.
Additional keywords: health disparities, HIV, intersectionality.
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