Sean Bland

Walking the line: Stimulant use during sex and HIV risk behavior among Black urban MSM

BACKGROUND Although the association of stimulant use to sexual risk taking and HIV transmission has been well documented among white gay men, stimulant use during sex continues to be under-explored among Black men who have sex with men (MSM). METHODS Black MSM (n=197) recruited via modified respondent-driven sampling between January and July 2008 completed an interviewer-administered quantitative assessment and optional HIV counseling and testing. Bivariate logistic regression procedures were employed to examine the association of demographics, sexual risk, and other psychosocial factors with stimulant use (at least monthly during sex in the past 12 months). Variable elimination using the backward selection process was used to fit two separate final multivariable logistic regression models examining stimulant use as the outcome and HIV sexual risk in the past 12 months by gender as the primary predictor: (1) Model 1: HIV sexual risk behavior with a casual male sex partner as a primary, forced predictor; (2) Model 2: HIV sexual risk behavior with a female sex partner as primary, forced predictor. RESULTS One-third (34%) of Black MSM reported using stimulants monthly or more frequently during sex in the past 12 months. The following factors were independently associated with stimulant use during sex: (1) Model 1: unprotected anal sex with a casual male sex partner in the past 12 months (AOR=2.61; 95% CI=1.06-6.42; p=0.01), older age (AOR=1.09; 95% CI=1.05-1.15; p<0.001), erectile dysfunction (ED) medication use monthly or more during sex in the past 12 months (AOR=7.81; 95% CI=1.46-41.68; p=0.02), problematic alcohol use (AOR=3.31; 95% CI=1.312-8.38; p=0.005), and higher HIV treatment optimism (AOR=0.86; 95% CI=0.76-0.97; p=0.01). (2) Model 2: unprotected vaginal or anal sex with a female partner in the past 12 months (AOR=3.54; 95% CI=1.66-7.56; p=0.001), older age (AOR=1.10; 95% CI=1.05-1.14; p<0.001), ED use monthly or more during sex in the past 12 months (AOR=3.70; 95% CI=1.13-12.13; p=0.03), clinically significant depressive symptoms (CES-D) at the time of study enrollment (AOR=3.11; 95% CI=1.45-6.66; p=0.004), and supportive condom use norms (AOR=0.69; 95% CI=0.49-0.97; p=0.03). CONCLUSION Frequent stimulant use is an important factor in HIV and STD sexual risk among Black MSM, particularly for older men and those with co-occurring psychosocial morbidities. HIV and STD prevention interventions in this population may benefit from addressing the precipitants of stimulant use and sexual risk taking.

HIV risk and social networks among male-to-female transgender sex workers in Boston, Massachusetts.

&NA; Male‐to‐female transgender individuals who engage in sex work constitute a group at high risk for HIV infection in the United States. This mixed‐methods formative study examined sexual risk among preoperative transgender male‐to‐female sex workers (N = 11) in Boston. More than one third of the participants were HIV‐infected and reported a history of sexually transmitted diseases. Participants had a mean of 36 (SD = 72) transactional male sex partners in the past 12 months, and a majority reported at least one episode of unprotected anal sex. Qualitative themes included (a) sexual risk, (b) motivations for engaging in sex work, (c) consequences of sex work, (d) social networks (i.e., “trans mothers,” who played a pivotal role in initiation into sex work), and (e) potential intervention strategies. Results suggest that interventions with transgender male‐to‐female sex workers must be at multiple levels and address the psychosocial and environmental contexts in which sexual risk behavior occurs.

Problematic alcohol use and HIV risk among Black men who have sex with men in Massachusetts.

Abstract This analysis was designed to explore the frequency of problem drinking and its role in potentiating HIV risk among a community-recruited sample of Black men who have sex with men (MSM) in Massachusetts. Black MSM (n=197) recruited via modified respondent-driven sampling between January and July 2008 completed an interviewer-administered survey, including HIV sexual behavior, the Center for Epidemiologic Studies Depression Scale (CES-D), and the CAGE alcohol screener. Bivariate and multivariable logistic regression procedures examined the association of behavioral HIV-risk factors and other psychosocial variables with problematic alcohol use (CAGE score 3 or 4). Overall, 29% of the sample was found to abuse alcohol. In a multivariable model adjusting for demographic and behavioral variables, factors associated with increased odds of problem drinking were: (1) depressive symptoms (CES-D 16+ ); (2) one or more episodes of serodiscordant unprotected anal sex during last sexual encounter with a casual male partner; and (3) one or more episodes of unprotected anal or vaginal sex with a female partner in the past 12 months. Black MSM who engaged in HIV risk behaviors may be more likely to have concurrent problematic alcohol use. HIV prevention interventions with Black MSM may benefit from incorporating screening and/or treatment for alcohol problems, as well as screening for co-morbid depressive symptoms.

Sex Parties among Urban MSM: An Emerging Culture and HIV Risk Environment

Private sex parties are an emerging risk environment for HIV among men who have sex with men (MSM). In 2009, 103 participants who reported attending at least one sex party in Massachusetts in the prior 12 months completed an in-depth, interviewer-administered quantitative assessment. Multivariable logistic regression analyses were conducted to examine associations with having engaged in one or more serodiscordant unprotected anal sex (SDUAS) acts at the most recent sex party attended. Nearly one-third (32%) of the sample reported engaging in SDUAS at the most recent sex party attended. Adjusting for age, race/ethnicity, and educational attainment, variables associated with an increased odds of engaging in SDUAS at the most recent sex party were: total number of unprotected anal receptive sex acts at sex parties in the past 12 months, self-perception of being at-risk for transmitting or acquiring HIV, and sexual sensation seeking. Examined in the same model, if condoms were provided/available at the most recent sex party attended, participants were at a decreased odds of engaging in SDUAS at that sex party. The majority (80%) expressed an interest in HIV prevention activities for MSM who attend sex parties. HIV prevention interventions are needed to reach MSM who attend sex parties and should take into account individual and contextual factors that may contribute to sexual risk. Environmental factors in the sex party setting, in particular the presence and availability of condoms, may potentially mitigate individual-level factors such as unprotected anal sex.

“It's a Quick Way to Get What You Want”: A Formative Exploration of HIV Risk Among Urban Massachusetts Men Who Have Sex with Men Who Attend Sex Parties

Community-based studies with men who have sex with men (MSM) suggest that between 8% and 25% of MSM have met recent male sexual partners at private sex parties. Little is known about HIV sexual risk behaviors of MSM who attend sex parties and whether risk reduction interventions can be delivered in this setting. In 2008, 40 MSM who reported attending and/or hosting sex parties in Massachusetts in the past 12 months completed a qualitative interview and quantitative assessment. Participants reported attending a mean number of 10 sex parties in Massachusetts in the past 12 months. A significant percentage (43%) reported also hosting sex parties. Participants had made sexual partner connections across multiple venues, including public cruising areas, bars/clubs, and the Internet. At the most recent sex party attended, the majority had used alcohol (58%) and/or drugs (50%), and one quarter (25%) put themselves at risk of acquiring or transmitting HIV or other sexually transmitted infections (STIs) by having unprotected anal sex with a mean number of three serodiscordant male sex partners. Although many participants perceived that communicating about sexual health in the sex party context would “ruin the mood,” the majority (80%) considered some form of HIV prevention at sex parties to be appropriate and necessary, as well as acceptable. Nonintrusive prevention and education activities were especially endorsed (i.e., condoms, lubricants, and coupons for free HIV/STI testing). The majority of participants (75%) expressed some interest in “safer sex” parties. MSM attending sex parties appear to be a subpopulation at high risk for HIV and STI acquisition and transmission. Risk reduction interventions responsive to the needs of MSM who attend sex parties are warranted.

Sentencing risk: history of incarceration and HIV/STD transmission risk behaviours among Black men who have sex with men in Massachusetts

This study investigated the role of incarceration in HIV/STD risk among 197 Black men who have sex with men in Massachusetts, USA. More than half (51%) reported a history of incarceration (28% < 90 days in jail/prison; 23% ≥ 90 days in jail/prison). Multivariable logistic regression models adjusted for age and sexual orientation examined associations between demographic, behavioural, social-psychological and cultural factors and incarceration history. Factors associated with < 90 days of incarceration were: unprotected sex with a man, STD history, injection drug use and substance abuse treatment. Factors associated with ≥ 90 days of incarceration were: unprotected sex with a woman, crack use during sex, STD history, injection drug use, substance abuse treatment, depressive symptoms, post-traumatic stress symptoms, HIV fatalism and social capital. Black men who have sex with men with incarceration histories may be at increased risk for HIV/STDs compared to those without such histories. HIV prevention efforts that focus on individual risk and cultural-contextual issues among Black men who have sex with men are warranted.

Pathways to Embodiment of HIV Risk: Black Men Who Have Sex with Transgender Partners, Boston, Massachusetts

A dearth of research to date has explored HIV risk among Black men who report sex with transgender partners. In 2008, 197 Black men residing in Massachusetts were recruited via modified respondent-driven sampling and completed an interviewer-administered survey. Overall, 8% reported sex with a transgender partner in the past 12 months. Over half (56%) reported unprotected sex during their last encounter with transgender partners. Factors significantly associated with having a transgender sex partner: history of substance abuse, incarceration, PTSD symptoms, lower levels of perceived social support, not having been exposed to HIV prevention services in the past 12 months, and endorsement of mobile van services as a comfortable location to access health care. These formative data suggest that Black men who partner with transgender individuals may be at elevated risk for an array of poorer health-related outcomes, including HIV sexual risk, substance abuse, incarceration, psychosocial vulnerability, and lack of access to health care. Theory-driven interventions that consider the broader context affecting the embodiment of HIV risk are warranted for men who have sex with transgender partners.