Matthew J Mimiaga1,2,3, Jaclyn M W Hughto3,4,5,6, Lynne Klasko-Foster4,7, Harry Jin8, Kenneth H Mayer3,9, Steven A Safren3,10, Katie B Biello3,4,5,6. 1. Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA. 2. Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, CA. 3. The Fenway Institute, Fenway Health, Boston, MA. 4. Center for Health Promotion and Health Equity, Brown University, Providence, RI. 5. Departments of Behavioral and Social Sciences. 6. Epidemiology, Brown University School of Public Health, Providence, RI. 7. Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI. 8. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 9. Department of Infectious Diseases, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA; and. 10. Department of Psychology, University of Miami, Coral Gables, FL.
Abstract
BACKGROUND: Male sex workers (MSW) are disproportionately affected by HIV/AIDS, with an estimated HIV prevalence in the United States of 19.3%. Existing research suggests that MSW are also at risk of adverse psychosocial problems. Cross-sectional studies of MSW have suggested that co-occurring epidemics or a "syndemic" of psychosocial problems may increase vulnerability to HIV acquisition/transmission by elevated sexual risk. To the best of our knowledge, there are no published studies examining this relationship longitudinally among MSW. This study examined how a syndemic of 6 psychosocial problems result in additive risk for condomless anal sex (CAS) with male clients among a multicity, longitudinal cohort of MSW. SETTING: Community-based organization and health center in 2 Northeastern US cities. METHODS: Between 2015 and 2017, 100 MSW from Boston, MA and Providence, RI completed behavioral/psychosocial surveys at baseline, 6 months, and 12months. Generalized estimating equation modeling was used to examine the prospective relationship of additive psychosocial problems and subsequent CAS with male clients, adjusting for age, site, race/ethnicity, MSW-type, and HIV serostatus. RESULTS: Mean age = 34.7 (SD = 11.8); 62% racial/ethnic minority; and 20% HIV+. The prevalence of 6 psychosocial syndemic problems was substantial at baseline and remained high at each time point (all within the past 6 months): 74% problematic depressive symptoms, 27% polydrug use (3+ drugs, not including stimulants), 57% stimulant (methamphetamine/cocaine/crack) use, 44% hazardous drinking, 15% experienced client-specific physical/sexual violence, and 57% childhood sexual abuse. Looking at the number of psychosocial problems experienced, 7% had zero, 27% had 1, 24% had 2, 27% had 3, and 15% had 4 or more. We identified a statistically significant positive "dose-response" relationship between the number of psychosocial problems and CAS with male clients over time, with the greatest odds of engaging in CAS with a male client over follow-up among those with 4 or more psychosocial problems (adjusted odds ratio = 5.18, 95% CI: 1.61 to 16.62). CONCLUSIONS: Internet escorts and street-based MSW are likely to experience psychosocial problems and engaging in HIV sexual risk with male clients. The accumulation of psychosocial problems additively predicted CAS with male clients in a prospective cohort of MSW. The specification of psychosocial problems presents distinct treatment targets for HIV prevention among MSW in the United States.
BACKGROUND: Male sex workers (MSW) are disproportionately affected by HIV/AIDS, with an estimated HIV prevalence in the United States of 19.3%. Existing research suggests that MSW are also at risk of adverse psychosocial problems. Cross-sectional studies of MSW have suggested that co-occurring epidemics or a "syndemic" of psychosocial problems may increase vulnerability to HIV acquisition/transmission by elevated sexual risk. To the best of our knowledge, there are no published studies examining this relationship longitudinally among MSW. This study examined how a syndemic of 6 psychosocial problems result in additive risk for condomless anal sex (CAS) with male clients among a multicity, longitudinal cohort of MSW. SETTING: Community-based organization and health center in 2 Northeastern US cities. METHODS: Between 2015 and 2017, 100 MSW from Boston, MA and Providence, RI completed behavioral/psychosocial surveys at baseline, 6 months, and 12months. Generalized estimating equation modeling was used to examine the prospective relationship of additive psychosocial problems and subsequent CAS with male clients, adjusting for age, site, race/ethnicity, MSW-type, and HIV serostatus. RESULTS: Mean age = 34.7 (SD = 11.8); 62% racial/ethnic minority; and 20% HIV+. The prevalence of 6 psychosocial syndemic problems was substantial at baseline and remained high at each time point (all within the past 6 months): 74% problematic depressive symptoms, 27% polydrug use (3+ drugs, not including stimulants), 57% stimulant (methamphetamine/cocaine/crack) use, 44% hazardous drinking, 15% experienced client-specific physical/sexual violence, and 57% childhood sexual abuse. Looking at the number of psychosocial problems experienced, 7% had zero, 27% had 1, 24% had 2, 27% had 3, and 15% had 4 or more. We identified a statistically significant positive "dose-response" relationship between the number of psychosocial problems and CAS with male clients over time, with the greatest odds of engaging in CAS with a male client over follow-up among those with 4 or more psychosocial problems (adjusted odds ratio = 5.18, 95% CI: 1.61 to 16.62). CONCLUSIONS: Internet escorts and street-based MSW are likely to experience psychosocial problems and engaging in HIV sexual risk with male clients. The accumulation of psychosocial problems additively predicted CAS with male clients in a prospective cohort of MSW. The specification of psychosocial problems presents distinct treatment targets for HIV prevention among MSW in the United States.
Authors: M Reuel Friedman; Ron Stall; Anthony J Silvestre; Chongyi Wei; Steve Shoptaw; Amy Herrick; Pamela J Surkan; Linda Teplin; Michael W Plankey Journal: AIDS Date: 2015-06-01 Impact factor: 4.177
Authors: Matthew J Mimiaga; Jaclyn M W Hughto; Katie B Biello; Christopher M Santostefano; Lisa M Kuhns; Sari L Reisner; Robert Garofalo Journal: J Acquir Immune Defic Syndr Date: 2019-06-01 Impact factor: 3.731
Authors: Kristen Underhill; Kate M Guthrie; Christopher Colleran; Sarah K Calabrese; Don Operario; Kenneth H Mayer Journal: Arch Sex Behav Date: 2018-01-11
Authors: Matthew J Mimiaga; Sari L Reisner; Elizabeth F Closson; Nicholas Perry; Brandon Perkovich; Thi Nguyen; Nguyen N N Trang; Hang X Lan; Dinh Duc Thien; Kenneth H Mayer; Donn Colby Journal: AIDS Care Date: 2012-12-20