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.
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
This is a preview of subscription content, log in to check access.
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.
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 was obtained from all individual participants included in this study.
Centers for Disease Control. Prevention of acquired immune deficiency syndrome (AIDS): report of inter-agency recommendations. MMWR. 1983;32(8):101.Google Scholar
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
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
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
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
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
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
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
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
Economics F France Economic Outlook, in Economic Forecasts from the World’s Leading Economists. 2016.Google Scholar
Darvas Z, Wolff GB. Europe’s social problem and its implications for economic growth. 2014.Google Scholar
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
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
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
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
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
Harkness JA, Van de Vijver FJ, Mohler PP. Cross-cultural survey methods. New Jersey: Wiley; 2003.Google Scholar
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
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
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
Lick DJ, Durso LE, Johnson KL. Minority stress and physical health among sexual minorities. Perspect Psychol Sci. 2013;8(5):521–48.CrossRefPubMedGoogle Scholar
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
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
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
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
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
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