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

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 and that those with recent financial crisis were more likely to have had two or more male sexual partners in the past 6 months. Black MSM with recent convictions were more likely to have a sexually transmitted infection at 6 months, while those who were unstably housed were more likely to have a sexually transmitted infection at 12 months. 

There were no city of residence and hardship interaction effects on HIV risks. Hardships are important factors that influence HIV risk for Black MSM. Integrating strategies that address structural factors that influence HIV risk may enhance HIV prevention interventions implementation efforts.

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By:  Nelson LE1,2, Wilton L3,4, Moineddin R5, Zhang N6, Siddiqi A7,8, Sa T6, Harawa N9,10, Regan R11,12, Dyer TP13, Watson CC14, Koblin B15, Del Rio C16,Buchbinder S17, Wheeler DP18, Mayer KH19; HPTN 061 Study Team.

• 1School of Nursing, University of Rochester, Rochester, NY, USA. laron_nelson@urmc.rochester.edu.
• 2Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada. laron_nelson@urmc.rochester.edu.
• 3College of Community and Public Affairs, State University of New York at Binghamton, Binghamton, NY, USA.
• 4Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa.
• 5Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
• 6Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
• 7Dalla Lana School of Public Health, Divisions of Epidemiology and Social & Behavioural Health Sciences, University of Toronto, Toronto, ON, Canada.
• 8Gillings School of Public Health, Department of Health Behavior, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
• 9College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
• 10David Geffen School of Medicine, General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA, USA.
• 11David Geffen School of Medicine, Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA.
• 12School of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA.
• 13School of Public Health, Department of Epidemiology and Biostatistics, University of Maryland College Park, College Park, MD, USA.
• 14School of Public Health, George Washington University, Washington, DC, USA.
• 15New York Blood Center, New York, NY, USA.
• 16Rollins School of Public Health, Hubert Department of Global Health and School of Medicine, Department of Medicine, Emory University, Atlanta, GA, USA.
• 17San Francisco Department of Public Health, HIV Research Section, San Francisco, CA, USA.
• 18School of Social Welfare, State University of New York Albany, Albany, NY, USA.
• 19Fenway Health, The Fenway Institute, Boston, MA, USA. 
• J Urban Health. 2016 Feb 1.

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