AIDS and Behavior

, Volume 21, Issue 12, pp 3478–3485 | Cite as

Financial Hardship, Condomless Anal Intercourse and HIV Risk Among Men Who Have Sex with Men

  • Dustin T. Duncan
  • Su Hyun Park
  • John A. Schneider
  • Yazan A. Al-Ajlouni
  • William C. Goedel
  • Brian Elbel
  • Jace G. Morganstein
  • Yusuf Ransome
  • Kenneth H. Mayer
Original Paper

Abstract

The objective of this study was to examine the association between financial hardship, condomless anal intercourse and HIV risk among a sample of men who have sex with men (MSM). Users of a popular geosocial networking application in Paris were shown an advertisement with text encouraging them to complete a anonymous web-based survey (n = 580). In adjusted multivariate models, high financial hardship (compared to low financial hardship) was associated with engagement in condomless anal intercourse (aRR 1.28; 95% CI 1.08–1.52), engagement in condomless receptive anal intercourse (aRR 1.34; 95% CI 1.07–1.67), engagement in condomless insertive anal intercourse (aRR 1.30; 95% CI 1.01–1.67), engagement in transactional sex (aRR 2.36; 95% CI 1.47–3.79) and infection with non-HIV STIs (aRR 1.50; 95% CI 1.07–2.10). This study suggests that interventions to reduce financial hardships (e.g., income-based strategies to ensure meeting of basic necessities) could decrease sexual risk behaviors in MSM.

Keywords

Social epidemiology Financial hardship Condomless anal intercourse Sexually transmitted infections Sexual health Gay men’s health Men who have sex with men (MSM) Health disparities Paris France 

Notes

Acknowledgements

Dr. Dustin Duncan was supported by grants from the National Institutes of Health and the Center for Disease Control and Prevention, including R01MH112406, U01PS005122, R21MH110190, and R03DA039748. This work was supported by Dr. Dustin Duncan’s New York University School of Medicine Start-Up Research Fund. We thank the translators and participants of this study who contributed to the project. We thank Noah Kreski for assisting in the development, translation and management of the survey used in the current study. In addition, we thank H. Rhodes Hambrick for conducting some background research used in this study.

Compliance with Ethical Standards

Conflicts of interest

Authors Dustin T. Duncan, Su Hyun Park, John A. Schneider, Yazan A. Al-Ajlouni, William C. Goedel, Brian Elbel, Jace G. Morganstein, Yusuf Ransome, and Kenneth H. Mayer declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of our institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in this study.

References

  1. 1.
    Centers for Disease Control. Prevention of acquired immune deficiency syndrome (AIDS): report of inter-agency recommendations. MMWR. 1983;32(8):101.Google Scholar
  2. 2.
    De Cock KM, Jaffe HW, Curran JW. The evolving epidemiology of HIV/AIDS. Aids. 2012;26(10):1205–13.CrossRefPubMedGoogle Scholar
  3. 3.
    Pharris A, et al. Ten years after Dublin: principal trends in HIV surveillance in the EU/EEA, 2004 to 2013. Euro Surveill. 2014;19(47):20968.CrossRefPubMedGoogle Scholar
  4. 4.
    Cazein F, et al. Dépistage du VIH et découvertes de séropositivité, France, 2003–2010. Bull Epidemiol Hebd. 2011;43(44):446–54.Google Scholar
  5. 5.
    Le Vu S, et al. Population-based HIV-1 incidence in France, 2003–2008: a modelling analysis. Lancet Infect Dis. 2010;10(10):682–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Mayer KH, et al. Comprehensive clinical care for men who have sex with men: an integrated approach. Lancet. 2012;380(9839):378–87.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Peterson JL, Jones KT. HIV prevention for black men who have sex with men in the United States. Am J Public Health. 2009;99(6):976–80.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Chi DL, Tucker-Seeley R. Gender-stratified models to examine the relationship between financial hardship and self-reported oral health for older US men and women. Am J Public Health. 2013;103(8):1507–15.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Tucker-Seeley RD, et al. Financial hardship and self-rated health among low-income housing residents. Health Educ Behav. 2013;40(4):442–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Tucker-Seeley RD, et al. Financial hardship and mortality among older adults using the 1996–2004 Health and Retirement Study. Ann Epidemiol. 2009;19(12):850–7.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Lynch JW, Kaplan GA, Shema SJ. Cumulative impact of sustained economic hardship on physical, cognitive, psychological, and social functioning. N Engl J Med. 1997;337(26):1889–95.CrossRefPubMedGoogle Scholar
  12. 12.
    Ferrie J, et al. Self-reported economic difficulties and coronary events in men: evidence from the Whitehall II study. Int J Epidemiol. 2005;34(3):640–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Choi K-H, Hudes ES, Steward WT. Social discrimination, concurrent sexual partnerships, and HIV risk among men who have sex with men in Shanghai, China. AIDS Behav. 2008;12(1):71–7.CrossRefGoogle Scholar
  14. 14.
    Ayala G, et al. Modeling the impact of social discrimination and financial hardship on the sexual risk of HIV among Latino and Black men who have sex with men. Am J Public Health. 2012;102(S2):S242–9.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Hatzenbuehler ML. Social factors as determinants of mental health disparities in LGB populations: implications for public policy. Soc Issues Policy Rev. 2010;4(1):31–62.CrossRefGoogle Scholar
  16. 16.
    Laurent T, Mihoubi F. Sexual orientation and wage discrimination in France: the hidden side of the rainbow. J Labor Res. 2012;33(4):487–527.CrossRefGoogle Scholar
  17. 17.
    Gallo LC, de los Monteros KE, Shivpuri S. Socioeconomic status and health: what is the role of reserve capacity? Curr Dir Psychol Sci. 2009;18(5):269–74.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Economics F France Economic Outlook, in Economic Forecasts from the World’s Leading Economists. 2016.Google Scholar
  19. 19.
    Darvas Z, Wolff GB. Europe’s social problem and its implications for economic growth. 2014.Google Scholar
  20. 20.
    Duncan DT, et al. Poor sleep health and its association with mental health, substance use, and condomless anal intercourse among gay, bisexual, and other men who have sex with men. Sleep Health. 2016;2(4):316–21.CrossRefPubMedGoogle Scholar
  21. 21.
    Duncan DT, et al. A study of intimate partner violence, substance abuse, and sexual risk behaviors among gay, bisexual, and other men who have sex with men in a sample of geosocial-networking smartphone application users. Am J Men Health. 2016. doi: 10.1177/1557988316631964.Google Scholar
  22. 22.
    Goedel WC, Duncan DT. Geosocial-networking app usage patterns of gay, bisexual, and other men who have sex with men: Survey among users of Grindr, a mobile dating app. JMIR public health and surveillance. 2015;1(1):e4.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Goedel WC, Duncan DT. Contextual factors in geosocial-networking smartphone application use and engagement in condomless anal intercourse among gay, bisexual, and other men who have sex with men who use Grindr. Sexual Health. 2016;13(6):549–54.Google Scholar
  24. 24.
    Goedel WC, et al. Serodiscussion, Perceived Seroconcordance, and Sexual Risk Behaviors Among Dyads of Men Who Have Sex with Men Who Use Geosocial-Networking Smartphone Applications in Lond. J Int Asso Provid AIDS Care (JIAPAC). 2017;16(3):233–8.CrossRefGoogle Scholar
  25. 25.
    Harkness JA, Van de Vijver FJ, Mohler PP. Cross-cultural survey methods. New Jersey: Wiley; 2003.Google Scholar
  26. 26.
    Tucker-Seeley RD, et al. Financial hardship, unmet medical need, and health self-efficacy among African American men. Health Educ Behav. 2014;42:285–92.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Barrera M, Caples H, Tein J-Y. The psychological sense of economic hardship: measurement models, validity, and cross-ethnic equivalence for urban families. Am J Commun Psychol. 2001;29(3):493–517.CrossRefGoogle Scholar
  28. 28.
    De Castro A, Gee GC, Takeuchi DT. Examining alternative measures of social disadvantage among Asian Americans: the relevance of economic opportunity, subjective social status, and financial strain for health. J Immigr Minor Health. 2010;12(5):659–71.CrossRefPubMedGoogle Scholar
  29. 29.
    Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Lick DJ, Durso LE, Johnson KL. Minority stress and physical health among sexual minorities. Perspect Psychol Sci. 2013;8(5):521–48.CrossRefPubMedGoogle Scholar
  31. 31.
    Wong CF, et al. Minority stress experiences and psychological well-being: the impact of support from and connection to social networks within the Los Angeles House and Ball communities. Prev Sci. 2014;15(1):44–55.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Gamarel KE, et al. Gender minority stress, mental health, and relationship quality: A dyadic investigation of transgender women and their cisgender male partners. J Fam Psychol. 2014;28(4):437–47.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Mimiaga MJ, et al. High prevalence of multiple syndemic conditions associated with sexual risk behavior and HIV infection among a large sample of Spanish-and Portuguese-speaking men who have sex with men in Latin America. Arch Sex Behav. 2015;44(7):1869–78.CrossRefPubMedGoogle Scholar
  34. 34.
    Mustanski B, et al. Psychosocial health problems increase risk for HIV among urban young men who have sex with men: preliminary evidence of a syndemic in need of attention. Ann Behav Med. 2007;34(1):37.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Stall R, et al. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. Am J Public Health. 2003;93(6):939–42.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Stall R, Friedman M, Catania JA. Interacting epidemics and gay men’s health: A theory of syndemic production among urban gay men, in Unequal Opportunity: Health Disparities Affecting Gay and Bisexual Men in the United States. New York: Oxford University Press; 2008. p. 251–74.Google Scholar
  37. 37.
    Halkitis PN, et al. Measurement model exploring a syndemic in emerging adult gay and bisexual men. AIDS Behav. 2013;17(2):662–73.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Abel GA, et al. Financial hardship and patient-reported outcomes after hematopoietic cell transplantation. Biol Blood Mar Transplant. 2016;22:1504–10.CrossRefGoogle Scholar
  39. 39.
    Roux A-VD. Neighborhoods and health: where are we and were do we go from here? Rev Epidemiol Sante Publique. 2007;55(1):13–21.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Dustin T. Duncan
    • 1
    • 8
  • Su Hyun Park
    • 1
  • John A. Schneider
    • 2
    • 3
  • Yazan A. Al-Ajlouni
    • 1
  • William C. Goedel
    • 1
  • Brian Elbel
    • 1
    • 4
  • Jace G. Morganstein
    • 1
  • Yusuf Ransome
    • 5
  • Kenneth H. Mayer
    • 6
    • 7
  1. 1.Department of Population HealthNew York University School of MedicineNew YorkUSA
  2. 2.Department of MedicineUniversity of Chicago School of MedicineChicagoUSA
  3. 3.Department of Public Health SciencesUniversity of Chicago School of MedicineChicagoUSA
  4. 4.New York University Wagner School of Public ServiceNew YorkUSA
  5. 5.Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonUSA
  6. 6.Fenway Health, The Fenway InstituteBostonUSA
  7. 7.Department of Medicine, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA
  8. 8.Spatial Epidemiology Lab, Department of Population HealthNew York University School of MedicineNew YorkUSA

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