Associations Between Neighborhood Problems and Sexual Behaviors Among Black Men Who Have Sex with Men in the Deep South: The MARI Study

HIV pre-exposure prophylaxis (PrEP) effectively prevents HIV acquisition among men who have sex with men (MSM), but PrEP uptake has been associated with sexually transmitted infections (STIs). The effect of PrEP on STIs in MSM in the Deep South of the United States is unknown. We performed a retrospective analysis of adult MSM at an American Deep South PrEP clinic to calculate the prevalence and incidence rate of bacterial STIs (chlamydia, gonorrhea, and syphilis) and identify associated risk factors by linking incident STI to patient-reported outcomes; 139 MSM accessed the clinic between 2014 and 2018 with baseline bacterial STI prevalence of 11%. Twenty-six of 81 eligible MSM on PrEP had incident STIs with an incidence rate of 33.1 cases per 100 person-years. Significantly higher proportions of high PrEP adherence, multiple sexual partners, and inconsistent condom use were seen in those with incident STI, and we identified MSM with both high PrEP adherence and multiple sexual partners as being at especially high risk for bacterial STIs (hazard ratio: 7.57, 95% confidence interval: 1.75–32.74). Bacterial STIs are common after initiating PrEP in this clinic, and MSM reporting high PrEP adherence and multiple sexual partners have a significant risk for incident STI. High-risk sexual behaviors persisted after starting PrEP, highlighting the importance of ongoing, intensive sexual health screening and interventions.

Download Full-text

The relationship between life stressors and drug and sexual behaviors among a population-based sample of young Black men who have sex with men in Chicago

AIDS Care ◽

10.1080/09540121.2016.1224303 ◽

2016 ◽

Vol 29 (5) ◽

pp. 545-551 ◽

Cited By ~ 19

Author(s):

Dexter R. Voisin ◽

Anna L. Hotton ◽

John A. Schneider ◽

Keyword(s):

Black Men ◽

Sexual Behaviors ◽

Population Based ◽

Life Stressors ◽

Sex With Men ◽

The Relationship

Download Full-text

Collecting Mobility Data with GPS Methods to Understand the HIV Environmental Riskscape Among Young Black Men Who Have Sex with Men: A Multi-city Feasibility Study in the Deep South

AIDS and Behavior ◽

10.1007/s10461-018-2163-9 ◽

2018 ◽

Vol 22 (9) ◽

pp. 3057-3070 ◽

Cited By ~ 6

Author(s):

Dustin T. Duncan ◽

Basile Chaix ◽

Seann D. Regan ◽

Su Hyun Park ◽

Cordarian Draper ◽

...

Keyword(s):

Black Men ◽

Feasibility Study ◽

Deep South ◽

Mobility Data ◽

Sex With Men

Download Full-text

P559 Incarceration, stress and sexual risk-taking: an intersectional analysis of black men who have sex with men in the deep south

10.1136/sextrans-2019-sti.633 ◽

2019 ◽

Author(s):

Denton Callander ◽

Dustin Duncan ◽

Su Hyun Park ◽

Lisa Bowleg ◽

Lauren Brinkley-Rubinstein ◽

...

Keyword(s):

Sexual Risk ◽

Black Men ◽

Risk Taking ◽

Sexual Risk Taking ◽

Deep South ◽

Intersectional Analysis ◽

Sex With Men

Download Full-text

Ricky and Lucy: gender stereotyping among young Black men who have sex with men in the US Deep South and the implications for HIV risk in a severely affected population

Culture Health & Sexuality ◽

10.1080/13691058.2017.1347280 ◽

2017 ◽

Vol 20 (3) ◽

pp. 351-365 ◽

Cited By ~ 1

Author(s):

Bronwen Lichtenstein ◽

Emma Sophia Kay ◽

Ian Klinger ◽

Matt G. Mutchler

Keyword(s):

Black Men ◽

Hiv Risk ◽

Gender Stereotyping ◽

Deep South ◽

The Us ◽

Sex With Men

Download Full-text

Living While Black, Gay, and Poor: The Association of Race, Neighborhood Structural Disadvantage, and PrEP Utilization Among a Sample of Black Men Who Have Sex With Men in the Deep South

AIDS Education and Prevention ◽

10.1521/aeap.2021.33.5.395 ◽

2021 ◽

Vol 33 (5) ◽

pp. 395-410

Author(s):

Paul A. Burns ◽

Casey D. Xavier Hall ◽

Tonia Poteat ◽

Leandro A. Mena ◽

Frank Y. Wong

Keyword(s):

Black Men ◽

Structural Equation ◽

Neighborhood Context ◽

Multilevel Structural Equation Modeling ◽

Equation Modeling ◽

Black Msm ◽

Deep South ◽

Structural Level ◽

Structural Disadvantage ◽

Sex With Men

Utilizing the Andersen Healthcare Utilization Model, we examined the role of neighborhood context on pre-exposure prophylaxis (PrEP) utilization among a sample of Black men who have sex with men (MSM) residing in a medium-sized city in the Deep South. Data were derived from a sample of 142 Black MSM aged 18–64 years who were eligible for PrEP from a community-based study known as “ACCELERATE!” We used multilevel structural equation modeling to assess PrEP use. Social support, sexual risk, and health care access were predictive of PrEP use. Notably, residing in a neighborhood with concentrated poverty was associated with decreased PrEP use. Our findings reveal neighborhood structural disadvantage is associated with decreased PrEP use among Black MSM, after adjusting of individual-level sociodemographic characteristics. There is an urgent need to develop HIV prevention interventions and programs that explicitly address structural-level factors to eliminate racial/ethnic differences in HIV.

Download Full-text

Incidence and Correlates of Sexually Transmitted Infections Among Black Men Who Have Sex With Men Participating in the HIV Prevention Trials Network 073 Preexposure Prophylaxis Study

Clinical Infectious Diseases ◽

10.1093/cid/ciy1141 ◽

2019 ◽

Vol 69 (9) ◽

pp. 1597-1604 ◽

Cited By ~ 8

Author(s):

Lisa B Hightow-Weidman ◽

Manya Magnus ◽

Geetha Beauchamp ◽

Christopher B Hurt ◽

Steve Shoptaw ◽

...

Keyword(s):

Hiv Prevention ◽

Sexually Transmitted Infections ◽

Black Men ◽

Sexual Behaviors ◽

Nucleic Acid Amplification ◽

Sexually Transmitted ◽

Preexposure Prophylaxis ◽

Centered Care ◽

Prevention Trials ◽

Sex With Men

Abstract Background The HIV Prevention Trials Network (HPTN) Study 073 (HPTN 073) assessed the feasibility, acceptability, and safety of preexposure prophylaxis (PrEP) for black men who have sex with men (BMSM). The purpose of this analysis was to characterize the relationship between PrEP uptake and use and incident sexually transmitted infections (STIs) among participants enrolled in HPTN 073. Methods A total of 226 human immunodeficiency virus (HIV)–uninfected BMSM were enrolled in 3 US cities; all participants received client-centered care coordination (C4) and were offered daily oral PrEP. Participants were followed for 12 months with STI testing (rectal and urine nucleic acid amplification test for gonorrhea and chlamydia, rapid plasma reagin for syphilis) conducted at baseline, week 26, and week 52. Logistic regression was used to examine associations between STI incidence and PrEP uptake. Generalized estimating equations were used to evaluate associations between age, PrEP acceptance, sexual behaviors, and incident STIs. Results Baseline STI prevalence was 14.2%. Men aged <25 years were more likely to have a baseline STI (25.3% vs 6.7%; odds ratio [OR], 4.39; 95% confidence interval [CI:, 1.91, 10.11). Sixty participants (26.5%) acquired ≥1 STI during follow-up; the incidence rate was 34.2 cases per 100 person-years (95% CI, 27.4, 42.9). In adjusted analyses, baseline STI diagnosis (OR, 4.23; 95% CI, 1.82, 9.87; P < .001) and additional C4 time (OR, 1.03; 95% CI, 1.00, 1.06; P = .027) were associated with having an incident STI. STI incidence was not associated with PrEP acceptance or adherence. Conclusions While we found higher rates of STIs in younger BMSM, overall rates of STI were lower than in prior PrEP trials, with no increase over time. BMSM with STIs at PrEP initiation may require additional interventions that target STI acquisition risk. Clinical Trials Registration NCT01808352.

Download Full-text