Economic, Legal, and Social Hardships Associated with HIV Risk among Black Men who have Sex with Men in Six US Cities

Abstract

We assessed whether economic, legal, and social hardships were associated with human immunodeficiency virus (HIV) risk among a sample of Black men who have sex with men (MSM) and whether associations were moderated by city of residence. The study analyzed baseline and follow-up data from HIV Prevention Trials Network 061 (N = 1553). Binary logistic regression assessed associations between hardships and HIV risk indicators. Multivariate regressions were used to test if city of residence had a moderating effect for hardships and HIV risks. Adjusted analyses showed that Black MSM with recent job loss were more likely to engage in condomless insertive anal intercourse (adjusted odds ratios (AOR) = 1.37, 95 % CI 1.01-1.87) and that those with recent financial crisis were more likely to have had two or more male sexual partners in the past 6 months (AOR = 1.65; 95 % CI 1.18-2.29). Black MSM

Pre‐exposure prophylaxis initiation and adherence among Black men who have sex with men (MSM) in three US cities: results from the HPTN 073 study

“…Our findings suggest BMSM are willing to initiate PrEP and that this decision can be supported with interventions and improved access to consistent healthcare .…”

“…Our findings on initiation and adherence to PrEP are comparable to, or exceeded, those reported in large-scale PrEP randomized controlled trials [32,34] results provide additional data [33,41] that support the safety of daily oral PrEP among BMSM. Our findings suggest BMSM are willing to initiate PrEP and that this decision can be supported with interventions and improved access to consistent healthcare [5][6][7][8][9][10][11][12][13][14][15][16]42]. This is particularly salient in that this population faces multiple forms of structural inequalities and studies have shown that these barriers often influence PrEP uptake and utilization among Black MSM [41, [65][66][67].…”

“…A constellation of factors contribute to increased HIV infections among Black MSM, including higher levels of unrecognized HIV and sexually transmitted infections (STI), and delayed initiation of antiretroviral therapy [3,5,[8][9][10][11][12]. Structural factors, such as lower income, un-/under-employment, educational inequalities, inadequate access to healthcare and treatment, incarceration, stigma and discrimination also influence the incidence and prevalence of HIV among Black MSM [13][14][15][16][17][18][19]. Research also documents inadequate incorporation of Black researchers in conducting HIV prevention and clinical studies focused on Black communities.…”

Development of a Black Caucus within the HIV Prevention Trials Network (HPTN): Representing the Perspectives of Black Men Who Have Sex with Men (MSM)

“…Black men who have sex with men (MSM) have experienced substantial disproportionate HIV infection burden as compared to other populations in the United States (US) [1][2][3][4][5][6]. Prior epidemiologic research has demonstrated that several socio-structural factors have contributed to the disparate HIV infection rates among Black MSM including insufficient access to health care and treatment, higher rates of being un-or under-insured, socio-economic indicators (e.g., poverty, educational inequities, un-or under-employment), housing and food instability, and incarceration [7][8][9][10][11][12][13]. One recent large-scale study (n = 1553) among Black MSM found that economic (recent job loss and financial crisis), legal (recent conviction), and social hardships (unstable housing) were associated with HIV sexual risk behavior and/or a sexually transmitted infection (STI) diagnosis [12].…”

“…Research has indicated that Black MSM are less likely to engage in HIV clinical trials, as compared to their White counterparts, due to pervasive cultural mistrust of health care providers and the medical-industrial complex or medical research establishment [25,[33][34][35]. Provider bias, past negative experiences with the healthcare system, perceived racist ideologies, and HIV-related conspiracy theories serve as other factors that may impede Black MSM from participating in clinical research studies [12,18,25,28,[36][37][38]. Research has also documented the inadequate incorporation of Black researchers in conducting prevention and clinical studies focused on Black communities [39][40][41].…”