Open AccessA Syndemic Model of Exchange Sex Among HIV-Positive Men Who Have Sex With Men
Author(s) -
Suzan M. Walters,
Amy Braksmajer,
Bethany M. Coston,
Irene S. Yoon,
Christian Grov,
Martin J. Downing,
Richard Teran,
Sabina Hirshfield
Publication year - 2020
Publication title -
archives of sexual behavior
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.288
H-Index - 111
eISSN - 1573-2800
pISSN - 0004-0002
DOI - 10.1007/s10508-020-01628-8
Subject(s) - syndemic , men who have sex with men , polysubstance dependence , psychosocial , transactional sex , psychology , psychological intervention , public health , demography , domestic violence , medicine , poison control , substance abuse , psychiatry , population , injury prevention , human immunodeficiency virus (hiv) , environmental health , syphilis , nursing , family medicine , sociology , research methodology
Exchange sex is a behavior associated with HIV transmission risk among men who have sex with men (MSM). Few studies have examined exchange sex among HIV-positive MSM. We utilize a syndemic framework to account for co-occurring psychosocial problems that suggest the presence of intertwining epidemics (i.e., syndemics), which have not been examined within the context of exchange sex among HIV-positive MSM. In 2015, MSM were recruited via online sexual networking Web site and app advertisements for Sex Positive! [+] , a video-based online intervention that aimed to improve health outcomes for men living with HIV. Participants completed surveys every three months for a year. Surveys covered demographics, drug use, exchange sex, intimate partner violence (IPV), and past 2-week depressive symptoms. We conducted three logistic regression models to assess syndemic factors associated with exchange sex in the past 3 months. Of the 722 HIV-positive MSM included in the sample, 59 (8%) reported exchange sex in the past 3 months at 12-month follow-up. HIV-positive MSM who had more syndemic factors had greater odds of exchange sex. Exchange sex was associated with being African-American/Black, age 18-29 years, past and present experiences with IPV, stimulant use, polysubstance use, and depressive symptoms. Exchange sex was associated with multiple psychosocial factors, indicating exchange sex may be part of a syndemic involving substance use, depression, HIV, and IPV. Interventions should address the social and behavioral circumstances that perpetuate environments that can foster multiple negative health outcomes.