Sexual orientation and social network size moderate associations between stigma and problematic alcohol use among male sex workers in the US Northeast: an observational study
Pablo K. Valente
A B , Alberto Edeza A B , Lynne Klasko-Foster B , Matthew J. Mimiaga A B C D E , Kenneth H. Mayer E F G , Steven A. Safren H and Katie B. Biello A B C E I
+ Author Affiliations
- Author Affiliations
A Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA.
B Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA.
C Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, 2nd Floor, Providence, RI 02912, USA.
D Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, 700 Butler Drive, Box G-BH, Providence, RI 02906, USA.
E The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA.
F Harvard University Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
G Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
H Department of Psychology, University of Miami, PO Box 248185, Coral Gables, FL 33124, USA.
I Corresponding author. Email: katie_biello@brown.edu
Sexual Health 17(5) 429-436 https://doi.org/10.1071/SH20137
Submitted: 29 July 2020 Accepted: 14 September 2020 Published: 12 November 2020
Abstract
Background: Stigma is associated with poor health among sexual minority individuals. However, no studies have examined the relationship between stigma and problematic drinking among male sex workers (MSWs). This study examined the relationship between sex work stigma and problematic alcohol use among MSWs. Methods: Using baseline data from a cohort of 98 MSWs in the US Northeast enrolled between 2015 and 2016, we used logistic regression to examine associations between sex work stigma and hazardous drinking (Alcohol Use Disorders Identification Test (AUDIT) score ≥8) and sex work while drunk, and tested whether sexual orientation (gay vs non-gay identified) and social network size moderated these associations. Results: Almost half the sample (n = 46; 44%) reported hazardous drinking and 56 MSWs (57%) reported engaging in sex work while drunk. Sex work stigma was associated with hazardous drinking (adjusted odds ratio (aOR) 1.2, 95% confidence interval (CI) 1.05–1.36). Sexual orientation marginally moderated this relationship (P = 0.07), such that it was only significant among gay-identified MSWs (aOR 1.91, 95% CI 1.11–3.28), not among non-gay MSW. Similarly, sexual orientation moderated the effect of sex work stigma on sex work while drunk (P = 0.02), which was only significant among gay-identified MSWs (aOR 1.65, 95% CI 1.05–1.60). Social network size also moderated the effect of sex work stigma on sex work while drunk (P = 0.02), which was only significant among MSWs with small networks (aOR 1.26, 95% CI 1.00–1.58), suggesting large networks can be protective. Conclusions: Gay MSWs may be particularly vulnerable to alcohol-related effects of stigma. Future interventions should consider engaging social networks to curb problematic drinking among MSWs.
Keywords: alcohol-related disorders, men who have sex with men, sex workers, sexual orientation, social support, stigma.
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