Associations between economic dependence, sexual behaviours, and sexually transmitted infections among young, Black, gay, bisexual and other men who have sex with men living with and without HIV in Jackson, Mississippi, USA
Kalysha Closson A B E , Rachel Vickers Smith C , Gbolahan Olarewaju A and Richard Crosby DA British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, BC V6Z 1Y6.
B Simon Fraser University, 8888 University Drive, Burnaby BC V5A1S6.
C School of Nursing, University of Louisville, 555 S Floyd St, Louisville, KY 40202, USA.
D College of Public Health, University of Kentucky, 121 Washington Ave, Lexington, KY 40508, USA.
E Corresponding author. Email: kclosson@cfenet.ubc.ca
Sexual Health 15(5) 473-476 https://doi.org/10.1071/SH17218
Submitted: 16 December 2017 Accepted: 1 May 2018 Published: 16 August 2018
Abstract
Background: In the USA, young Black gay, bisexual or other men who have sex with men (YBMSM) bear the largest burden of HIV incidence. The aim of this study is to examine the independent associations between economic dependency on a sexual partner and several HIV risk behaviours and sexual health outcomes among YBMSM living in Jackson, Mississippi, USA. Methods: Baseline data from 589 YBMSM, with a median age of 22.0 years (IQR = 15–25) participating in a brief sex-positive HIV and STI prevention intervention, were used to measure the association between six sexual behaviours, sexually transmissible infections (STIs) status at baseline and economic dependence. Bivariate χ2 associations were tested and regression models adjusted for education level (≤ high school), employment and HIV-status. Results: In regressions, of the six sexual behaviours reported in the last 90 days and six STIs tested at baseline, economically dependent YBMSM were more likely to report condomless anal receptive sex (aOR = 2.19, 95%CI = 1.25–3.83), ≥3 partners as a top (aOR = 1.99, 95%CI = 1.17–340), ≥3 sex partners as a bottom (aOR = 2.07, 95%CI = 1.24–3.45), ≥3 sex acts as a bottom (aOR = 2.10, 95%CI = 1.16–3.82) and testing positive for oral gonorrhoea (aOR = 2.39, 95%CI = 1.18–4.83) after controlling for HIV status, employment and education. Conclusions: Interventions should consider how poverty, unemployment and economic dependence interact to influence relationship power imbalances, condom use and sexual positioning agency, and sexual health for key populations of MSM.
References
[1] National Center for HIV/AIDS Viral Hepatitis STD, and TB Prevention, Centers for Disease Control and Prevention, USA. HIV among youth division of HIV/AIDS Prevention. Atlanta, Georgia: Centre for Disease Control (CDC); 2017.[2] Mississippi State Department of Health. Mississippi HIV Statistics. Jackson, Mississippi: Mississippi State Department of Health; 2015.
[3] Hurt CB, Matthews DD, Calabria MS, Green KA, Adimora AA, Golin CE, Hightow-Weidman LB. Sex with older partners is associated with primary HIV infection among men who have sex with men in North Carolina. J Acquir Immune Defic Syndr 2010; 54 185–90.
[4] Anema A, Marshall BD, Stevenson B, Gurm J, Montaner G, Small W, Roth EA, Lima VD, Montaner JS, More D, Hogg RS. Intergenerational sex as a risk factor for HIV among young men who have sex with men: a scoping review. Curr HIV/AIDS Rep 2013; 10 398–407.
| Intergenerational sex as a risk factor for HIV among young men who have sex with men: a scoping review.Crossref | GoogleScholarGoogle Scholar |
[5] Celentano DD, Sifakis F, Hylton J, Torian LV, Guillin V, Koblin BA. Race/ethnic differences in HIV prevalence and risks among adolescent and young adult men who have sex with men. J Urban Health 2005; 82 610–21.
| Race/ethnic differences in HIV prevalence and risks among adolescent and young adult men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[6] Arrington-Sanders R, Leonard L, Brooks D, Celentano D, Ellen J. Older partner selection in young African-American men who have sex with men. J Adolesc Health 2013; 52 682–8.
| Older partner selection in young African-American men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[7] Tladi LS. Poverty and HIV/AIDS in South Africa: an empirical contribution. SAHARA-J 2006; 3 369–81.
| Poverty and HIV/AIDS in South Africa: an empirical contribution.Crossref | GoogleScholarGoogle Scholar |
[8] Baird SJ, Garfein RS, McIntosh CT, Ozler B. Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial. Lancet 2012; 379 1320–9.
| Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial.Crossref | GoogleScholarGoogle Scholar |
[9] Crosby RA, Mena L, Arnold T. Disclosure of newly diagnosed HIV infection and condom use at first sex after diagnosis: a study of young Black men who have sex with men. Sex Health 2017; 14 325–330.
| Disclosure of newly diagnosed HIV infection and condom use at first sex after diagnosis: a study of young Black men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[10] Crosby RA, Mena L, Salazar LF, Hardin JW, Brown T, Vickers Smith R. Efficacy of a clinic-based safer sex program for HIV-uninfected and HIV-infected young Black MSM: a randomized controlled trial. Sex Transm Dis 2017; 45 169–176.
| Efficacy of a clinic-based safer sex program for HIV-uninfected and HIV-infected young Black MSM: a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar |
[11] Kenyon C, Osbak KK, Crucitti T, Kestens L. The immunological response to syphilis differs by HIV status; a prospective observational cohort study. BMC Infect Dis 2017; 17 111–120.
| The immunological response to syphilis differs by HIV status; a prospective observational cohort study.Crossref | GoogleScholarGoogle Scholar |
[12] Kenyon C, Tsoumanis A, Osbak K, Van Esbroeck M, Florence E, Crucitti T, Kestens L. Repeat syphilis has a different immune response compared with initial syphilis: an analysis of biomarker kinetics in two cohorts. Sex Transm Infect 2018; 94 180–186.
| Repeat syphilis has a different immune response compared with initial syphilis: an analysis of biomarker kinetics in two cohorts.Crossref | GoogleScholarGoogle Scholar |
[13] Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect 1999; 75 3–17.
[14] Mayer KH, Venkatesh KK. Interactions of HIV, other sexually transmitted diseases, and genital tract inflammation facilitating local pathogen transmission and acquisition. Am J Reprod Immunol 2011; 65 308–16.
| Interactions of HIV, other sexually transmitted diseases, and genital tract inflammation facilitating local pathogen transmission and acquisition.Crossref | GoogleScholarGoogle Scholar |
[15] Johns MM, Pingel E, Eisenberg A, Santana ML, Bauermeister J. Butch tops and femme bottoms? Sexual positioning, sexual decision making, and gender roles among young gay men. Am J Mens Health 2012; 6 505–18.
| Butch tops and femme bottoms? Sexual positioning, sexual decision making, and gender roles among young gay men.Crossref | GoogleScholarGoogle Scholar |
[16] Wegesin DJ, Meyer-Bahlburg HFL. Top/bottom self-label, anal sex practices, HIV risk and gender role identity in gay men in New York City. J Psychol Human Sex 2000; 12 43–62.
| Top/bottom self-label, anal sex practices, HIV risk and gender role identity in gay men in New York City.Crossref | GoogleScholarGoogle Scholar |
[17] Hoppe T. Circuits of power, circuits of pleasure: sexual scripting in gay men’s bottom narratives. Sexualities 2011; 14 193–217.
| Circuits of power, circuits of pleasure: sexual scripting in gay men’s bottom narratives.Crossref | GoogleScholarGoogle Scholar |
[18] Carballo‐Diéguez A, Dolezal C, Nieves L, Díaz F, Decena C, Balan I. Looking for a tall, dark, macho man … sexual‐role behaviour variations in Latino gay and bisexual men. Cult Health Sex 2004; 6 159–71.
| Looking for a tall, dark, macho man … sexual‐role behaviour variations in Latino gay and bisexual men.Crossref | GoogleScholarGoogle Scholar |
[19] Gibbs A, Jewkes R, Sikweyiya Y, Willan S. Reconstructing masculinity? A qualitative evaluation of the Stepping Stones and Creating Futures interventions in urban informal settlements in South Africa. Cult Health Sex 2015; 17 208–22.
| Reconstructing masculinity? A qualitative evaluation of the Stepping Stones and Creating Futures interventions in urban informal settlements in South Africa.Crossref | GoogleScholarGoogle Scholar |
[20] Jewkes R, Gibbs A, Jama-Shai N, Willan S, Misselhorn A, Mushinga M, Washington L, Mbatha N, Skiweyiya Y. Stepping Stones and Creating Futures intervention: shortened interrupted time series evaluation of a behavioural and structural health promotion and violence prevention intervention for young people in informal settlements in Durban, South Africa. BMC Public Health 2014; 14 1325–1335.
| Stepping Stones and Creating Futures intervention: shortened interrupted time series evaluation of a behavioural and structural health promotion and violence prevention intervention for young people in informal settlements in Durban, South Africa.Crossref | GoogleScholarGoogle Scholar |
[21] Jewkes RK, Dunkle K, Nduna M, Shai N. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet 2010; 376 41–8.
| Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study.Crossref | GoogleScholarGoogle Scholar |
[22] Gibbs A, Willan S, Misselhorn A, Mangoma J. Combined structural interventions for gender equality and livelihood security: a critical review of the evidence from southern and eastern Africa and the implications for young people. J Int AIDS Soc 2012; 15 1–10.
| Combined structural interventions for gender equality and livelihood security: a critical review of the evidence from southern and eastern Africa and the implications for young people.Crossref | GoogleScholarGoogle Scholar |
