Violence, Mental Health Problems, and Substance Use: Relationships to in HIV Sexual Risk Behaviors in Black and White Young Men Who Have Sex with Men

Background: Sexual minorities experience higher rates of violence, substance use, and mental and physical health problems compared to their heterosexual counterparts. Specifically, young men who have sex with men (YMSM) are at disproportionately high risk for HIV, the 8^th leading cause of death for those ages 25-34 in the US. Recently, scholars have demonstrated that violence, substance use, and mental health problems interact to create an exponential negative effect on HIV risk and refer to this phenomenon as a syndemic (Singer et al., 2017). Yet, few studies have examined which of these factors are the strongest predictors of HIV risk behaviors in this high-risk population, specifically when accounting for race and socioeconomic status. Identifying the syndemic factors that are significantly associated with HIV risk behaviors in HIV-negative YMSM can lead to targeted HIV prevention interventions. Therefore, the following research question was investigated: What violence, mental health, and substance use factors are significantly associated with HIV risk behaviors in YMSM?

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.