|
Citation
|
Mimiaga MJ, Hughto JMW, Klasko-Foster L, Jin H, Mayer KH, Safren SA, Biello KB. J. Acquir. Immune Defic. Syndr. (LWW) 2020; ePub(ePub): ePub. |
|
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 via elevated sexual risk. To our knowledge, there are no published studies examining this relationship longitudinally among MSW. This study examined how a syndemic of six 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 two Northeastern U.S. cities.
METHODS: Between 2015 and 2017, 100 MSW from Boston, MA and Providence, RI completed behavioral/psychosocial surveys at baseline, 6-, and 12-months. 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 six 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 one, 24% had two, 27% had three, and 15% had four 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 four or more psychosocial problems (aOR=5.18, 95% CI: 1.61-16.62).
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.
Language: en |