A Comparison of the Social and Sexual Networks of Crack-Using and Non-Crack Using African American Men who Have Sex with Men

Abstract

The role of crack cocaine in accelerating the HIV epidemic among heterosexual populations has been well documented. Little is known about crack use as an HIV risk factor among African American men who have sex with men (AA MSM), a group disproportionately infected with HIV. We sought to compare the social and sexual network characteristics of crack-using and non-crack using AA MSM in Baltimore, MD, USA and to examine associations of crack use with sexual risk. Participants were recruited using streetbased and internet-based outreach, printed advertisements, and word of mouth. Inclusion criteria were being aged 18 years or older, African American or of black race/ethnicity, and having self-reported sex with another male in the prior 90 days. Crack use was operationalized as self-report of crack in the prior 90 days. Logistic regression was used to identify variables that were independently associated with crack use. Of 230 enrolled AA MSM, 37% (n=84) reported crack use. The sexual networks of crack-using AA MSM were composed of a greater number of HIV-positive sex partners, exchange partners, and partners who were both sex and drug partners and fewer networks with whom they always use condoms as compared to non-crack using AA MSM. Crack use was independently associated with increased odds of bisexual identity and networks with a greater number of exchange partners, overlap of drug and sex partners, and lesser condom use. Results of this study highlight sexual network characteristics of cracksmoking AA MSM that may promote transmission of HIV. HIV interventions are needed that are tailored to address the social context of crack-smoking AA MSM risk behaviors.

Revisão sistemática da literatura sobre crack: análise do seu uso prejudicial nas dimensões individual e contextual

“…O relato de sexo inseguro foi descrito em 12 estudos. Tobin et al (2011), em sua pesquisa comparando as características da rede social e sexual de UC e de não usuários nos EUA, observaram que a rede sexual dos não usuários tinha um número muito maior de parceiros que usavam preservativos do que a rede de UC sendo, portanto, o uso de crack associado ao aumento de risco sexual por práticas sexuais sem preservativos. Constataram, ainda, que a rede sexual dos UC é diversificada e que consiste de pessoas de ambos os sexos, levando a uma forte associação dos UC com a identidade bissexual e que 91% dos UC tiveram resultado positivo para HIV (TOBIN ET AL., 2011).…”

“…Tobin et al (2011), em sua pesquisa comparando as características da rede social e sexual de UC e de não usuários nos EUA, observaram que a rede sexual dos não usuários tinha um número muito maior de parceiros que usavam preservativos do que a rede de UC sendo, portanto, o uso de crack associado ao aumento de risco sexual por práticas sexuais sem preservativos. Constataram, ainda, que a rede sexual dos UC é diversificada e que consiste de pessoas de ambos os sexos, levando a uma forte associação dos UC com a identidade bissexual e que 91% dos UC tiveram resultado positivo para HIV (TOBIN ET AL., 2011). O crack também foi associado ao comportamento de risco sexual, em estudo recente realizado no sul do Brasil, no qual foi demostrado que os UC têm maior probabilidade de não usar preservativos, apresentando, por isso, alto índice de comportamento sexual de risco com transmissão de HIV (NARVAEZ ET AL., 2014).…”

O Programa Nacional de Controle do Tabagismo (PNCT) na perspectiva social: a análise de redes, capital e apoio social

“…Do mesmo modo, as investigações brasileiras, que apesar de não serem numerosas vêm se mostrando constantes [37][38][39][40][41][42] . Além dessas, há investigações que tratam de moradores de pequenas localidades específicas [43][44][45][46][47][48][49][50] , enquanto outros trabalham as relações interpessoais de grupos profissionais como enfermeiras ou funcionários públicos [51][52][53][54][55][56] . As investigações feitas em serviços tiveram o intuito de avaliá-los [57][58][59][60][61][62] , assim como a utilização deles por parte de seus usuários 63 .…”

Syndemic Health Disparities and Resilience Processes Related to HIV Transmission Risk among African American/Black Men in South Florida

“…Syndemic Health Disparities among African American/Black MSM A brief review of the literature on African American/Black MSM demonstrates the presence of health and social disparities related to substance use (Harawa et al 2008;Mimiaga et al 2010;Hatfield et al, 2009;Tobin et al 2011), HIV transmission or infection risk (Millett et al 2006;Millett et al 2007;Oster et al 2011), arrest history (Lim et al 2011), inadequate coping skills and social support (Kraft et al 2000;Shoptaw et al 2009), and social or cultural barriers Saleh et al 2011;Garofalo et al 2010;Harawa et al 2008;Haile et al 2011), among others. Whereas, one apparent article in the literature has addressed these concerns from a syndemic perspective (Dyer et al 2012) it was unable to address any larger socio-cultural or structural factors that contribute the specific health disparities among this population.…”

“…The theory proposed by Stall et al (2008) was important in advancing discussions and research on health disparities among MSM, however, much of the work dedicated to examining the SAVA syndemic among MSM that followed has focused on structural homophobia and institutionalized stigma, with a concentration on predominately White MSM and ignored sub-groups of MSM differentiated by race/ethnicity or subsumed them within larger studies in which they were not the target population (Dyer et al 2012). A focus on African American/Black MSM in the United States, with regard to syndemic investigation, was recently initiated, though this work is still scant (Dyer et al 2012 (Mimiaga et al 2010;Tobin et al 2011;Harawa et al 2008). Although substance use is not significantly greater overall among African American/Black MSM than among other MSM (Millet et al 2006;Shoptaw et al 2009), in the last few years, several studies have found that African American/Black men report more powder and crack cocaine use than White or Latino MSM (Hatfield et al 2009;Tobin et al 2011).…”