title: 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 with recent convictions were more likely to have a sexually transmitted infection at 6 months (AOR = 3.97; 95% CI 1.58-9.94), while those who were unstably housed were more likely to have a sexually transmitted infection at 12 months (AOR = 1.71; 95%CI 1.02 = 2.86). 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.
authors.affiliation: School of Nursing, University of Rochester, Rochester, NY, USA. laron_nelson@urmc.rochester.edu.|Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada. laron_nelson@urmc.rochester.edu.
authors.forename: LaRon E
authors.initials: LE
authors.lastname: Nelson
authors.affiliation: College of Community and Public Affairs, State University of New York at Binghamton, Binghamton, NY, USA.|Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa.
authors.forename: Leo
authors.initials: L
authors.lastname: Wilton
authors.affiliation: Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Nanhua
authors.initials: N
authors.lastname: Zhang
authors.affiliation: Dalla Lana School of Public Health, Divisions of Epidemiology and Social & Behavioural Health Sciences, University of Toronto, Toronto, ON, Canada.|Gillings School of Public Health, Department of Health Behavior, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Arjumand
authors.initials: A
authors.lastname: Siddiqi
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Ting
authors.initials: T
authors.lastname: Sa
authors.affiliation: College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.|David Geffen School of Medicine, General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA, USA.
authors.forename: Nina
authors.initials: N
authors.lastname: Harawa
authors.affiliation: David Geffen School of Medicine, Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA.|School of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA.
authors.forename: Rotrease
authors.initials: R
authors.lastname: Regan
authors.affiliation: School of Public Health, Department of Epidemiology and Biostatistics, University of Maryland College Park, College Park, MD, USA.
authors.forename: Typhanye Penniman
authors.initials: TP
authors.lastname: Dyer
authors.affiliation: School of Public Health, George Washington University, Washington, DC, USA.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Watson
authors.affiliation: New York Blood Center, New York, NY, USA.
authors.forename: Beryl
authors.initials: B
authors.lastname: Koblin
authors.affiliation: Rollins School of Public Health, Hubert Department of Global Health and School of Medicine, Department of Medicine, Emory University, Atlanta, GA, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Del Rio
authors.affiliation: San Francisco Department of Public Health, HIV Research Section, San Francisco, CA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Buchbinder
authors.affiliation: School of Social Welfare, State University of New York Albany, Albany, NY, USA.
authors.forename: Darrell P
authors.initials: DP
authors.lastname: Wheeler
authors.affiliation: Fenway Health, The Fenway Institute, Boston, MA, USA.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
mesh_terms: D000328:Adult; D001741:Black or African American; D017280:Condoms / Q000706:statistics & numerical data; D057237:Criminals / Q000706:statistics & numerical data; D015658:HIV Infections / Q000208:ethnology*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006798:Housing / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012725:Sexual Behavior / Q000208:ethnology; D012749:Sexually Transmitted Diseases / Q000208:ethnology; D012959:Socioeconomic Factors; D014478:Unemployment / Q000706:statistics & numerical data*; D014505:Urban Population
keywords: African-American; Black MSM; Condom use; HIV; HIV prevention; Hardships; Incarceration; STI; Sexual risk; Social determinants; Unstable housing
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