Methods: Participants were 168 YMSM ages 18-34 (M=25.01, SD=3.58) recruited from AIDS service organizations (ASOs) that provide HIV prevention services in two mid-sized midwestern cities. They were 57.7% Black and 42.3% White. Data were collected through computer-assisted personal interviews. Dependent variables identified as gold standards to assess HIV risk behaviors were number of unprotected anal intercourse (UAI) occasions and number of male sexual partners (MSEXP) in last 3 and 12 months. Independent variables included: violence exposure (number of adverse childhood experiences, intimate partner and community violence; Bynum et al., 2010; Dahlberg et al., 2005; Stephenson & Finneran, 2013); mental health problems (depression, anxiety, and PTSD; Blanchard et al., 1996; Kroenke, 2002; Spitzer et al., 2006;) and substance use (age at first drink; hazardous drinking, drug abuse severity, lifetime polydrug use; Babor et al., 2001; Yudko, Lozhkina, & Fouts, 2007). Demographic variables included self-reported race (Black/White), education, income, employment. Data analyses included descriptive statistics, spearman correlations, and negative binomial regressions.
Results: Bivariate analyses indicated that White YMSM reported significantly more UAI and MSEXP than their Black counterparts, and YMSM with more education reported more MSEXP than those with lower education. Results of negative binomial regressions showed that participants with depression in the clinical range reported significantly more UAI than those who were not depressed. Among substance use factors, earlier initiation of alcohol and greater lifetime polydrug use were significantly associated with more MSEXP when controlling for other variables in the model. ACES and exposure to IPV and community violence were not unique predictors of HIV sexual risk, nor were race or socioeconomic factors at the multivariate level.
Conclusions: Findings indicate that depression, early initiation of alcohol, and polydrug use are important targets for HIV prevention among service using YMSM in midsized cities. The nonsignificant findings of violence as a risk factor suggests that further research is warranted with more diverse and larger samples. Consistent with syndemic theory, this study also suggests that strategies to reduce HIV disparities among YMSM include interventions that target multiple interacting risk factors within this marginalized community.