title: Socioeconomic Disconnection as a Risk Factor for Increased HIV Infection in Young Men Who Have Sex with Men.
abstract: HIV disproportionately affects young men who have sex with men (YMSM), particularly black YMSM. Increasingly, researchers are turning to social, economic, and structural factors to explain these disproportionate rates. In this study, we explore the relationship between socioeconomic disconnection and HIV status and factors related to HIV infection, including drug use, condomless anal sex, and binge drinking. We operationalize socioeconomic disconnection in this young population as lack of engagement in educational and employment opportunities.
  
  
  
  Baseline data were analyzed from a longitudinal cohort study of YMSM aged 16-20 years recruited from the Chicago area (N = 450). Bivariate analyses of the association of socioeconomic disconnection and HIV-positive status, drug and alcohol use, and condomless anal sex were assessed using chi-square tests. The relationship of socioeconomic disconnection and HIV-positive status was then examined in multivariate logistic regression models, controlling for age and race/ethnicity and significant behavioral factors.
  
  
  
  Among study participants, 112 (25%) were not in school, 310 (69%) were not currently working, and 81 (18%) were neither in school nor working. Black MSM were more likely to be socioeconomically disconnected (neither in school nor working; n = 56, 23.3%). The results revealed that disconnected YMSM were more likely to binge drink (AOR = 2.34; 95% CI = 1.16, 4.74) and be HIV positive (AOR = 2.24; 95% CI = 1.04, 4.83). Subpopulation analysis for black participants revealed similar associations (AOR of binge drinking = 2.92; 95% CI = 1.07, 8.01; AOR of HIV positive = 2.38; 95% CI = 1.03, 5.51). Controlling for substance use, the association between disconnection and HIV-positive status remained significant (AOR = 2.37; 95% CI = 1.08, 5.20).
  
  
  
  Socioeconomic disconnection is significantly and positively associated with HIV status among YMSM, suggesting that the two factors are related. Socioeconomic factors present an important area for future research focusing on HIV infection in this high-risk group.
authors.affiliation: 1 Division of Adolescent Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University , Chicago, Illinois.
authors.forename: Travis A
authors.initials: TA
authors.lastname: Gayles
authors.affiliation: 1 Division of Adolescent Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University , Chicago, Illinois.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Kuhns
authors.affiliation: 1 Division of Adolescent Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University , Chicago, Illinois.
authors.forename: Soyang
authors.initials: S
authors.lastname: Kwon
authors.affiliation: 2 IMPACT Program, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University , Chicago, Illinois.
authors.forename: Brian
authors.initials: B
authors.lastname: Mustanski
authors.affiliation: 1 Division of Adolescent Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University , Chicago, Illinois.
authors.forename: Robert
authors.initials: R
authors.lastname: Garofalo
mesh_terms: D000293:Adolescent; D063425:Binge Drinking / Q000453:epidemiology; D002641:Chicago / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology*; D018451:Homosexuality, Male; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology; D016017:Odds Ratio; D012307:Risk Factors; D012959:Socioeconomic Factors; D035862:Vulnerable Populations; D055815:Young Adult
keywords: HIV; MSM; educational achievement; unemployment.