Black men who have sex with men and women (BMSMW) are at high risk for HIV and other sexually transmitted infections (STIs). Despite knowing that HIV/STI risk varies by sexual positioning practices, limited data have characterized the risk profiles of BSMW. This study utilized latent class analysis (LCA) to explore BMSMW’s sexual risk profiles regarding condomless sexual positioning practices. Participants were BMSMW in intervention studies in Los Angeles, Chicago, and Philadelphia. LCA was used to characterize their sexual risk profiles. Age, study location, HIV status, social support, and internalized homophobia were used as covariates in a multinomial regression model predicting the likelihood of class membership. Among the 546 participants, three latent classes of risk were identified: Seropositive Serosorters, Seronegative/unknown Serosorters, and Main Partners Only. All groups had the greatest probabilities of condomless sex with main partners. Seropositive Serosorters had the highest probabilities of condomless sex with HIV-positive partners. Seronegative/unknown Serosorters had the highest probabilities of condomless sex with HIV-negative or unknown status partners. HIV-positive BMSMW had 87% lower odds of being classified as Seronegative/unknown Serosorters than Seropositive Serosorters than HIV-negative/unknown status BMSMW (AOR = 0.13, 95% CI 0.06, 0.28). HIV-positive BMSMW had 71% lower odds of being classified as Main Partners Only than Seropositive Serosorters than HIV-negative/unknown status BMSMW (AOR = 0.29, 95% CI 0.16, 0.51). Findings highlight opportunities for clinicians to promote condom use and risk reduction among BMSMW with differing sexual risk profiles. Increased understanding of sexual positioning practices among BMSMW might help address HIV/STIs among this group.
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Asparouhov, T., & Muthén, B. (2014). Auxiliary variables in mixture modeling: Three-step approaches using Mplus. Structural Equation Modeling: A Multidisciplinary Journal, 21(3), 329–341. https://doi.org/10.1080/10705511.2014.915181.
Baggaley, R. F., White, R. G., & Boily, M.-C. (2010). HIV transmission risk through anal intercourse: Systematic review, meta-analysis and implications for HIV prevention. International Journal of Epidemiology. https://doi.org/10.1093/ije/dyq057.
Bogart, L. M., Landrine, H., Galvan, F. H., Wagner, G. J., & Klein, D. J. (2013). Perceived discrimination and physical health among HIV-positive black and Latino men who have sex with men. AIDS and Behavior, 17(4), 1431–1441. https://doi.org/10.1007/s10461-012-0397-5.
Boom, W. V. D., Stolte, I. G., Witlox, R., Sandfort, T., Prins, M., & Davidovich, U. (2013). Undetectable viral load and the decision to engage in unprotected anal intercourse among HIV-positive MSM. AIDS and Behavior, 17(6), 2136–2142. https://doi.org/10.1007/s10461-013-0453-9.
Centers for Disease Control and Prevention. (2014). Serosorting among gay, bisexual, and other men who have sex with men. Retrieved from http://www.cdc.gov/msmhealth/HIV.htm#Serosorting.
Centers for Disease Control and Prevention. (2015). HIV testing, HIV/AIDS, CDC. Retrieved February 2, 2016, from http://www.cdc.gov/hiv/testing/index.html.
Centers for Disease Control and Prevention. (2016). Women, gender, HIV by group, HIV/AIDS, CDC. Retrieved June 2, 2016, from http://www.cdc.gov/hiv/group/gender/women/index.html.
Craib, K. J., Meddings, D. R., Strathdee, S. A., Hogg, R. S., Montaner, J. S., O’Shaughnessy, M. V., & Schechter, M. T. (1995). Rectal gonorrhoea as an independent risk factor for HIV infection in a cohort of homosexual men. Genitourinary Medicine, 71(3), 150–154. https://doi.org/10.1136/sti.71.3.150.
Crosby, R. A., Mena, L., & Geter, A. (2017). Are HIV-positive young black MSM having safer sex than those who are HIV-negative? International Journal of STD and AIDS, 28, 441–446. https://doi.org/10.1177/0956462416651386.
Dangerfield, D. T., II, Craddock, J. B., Bruce, O. J., & Gilreath, T. D. (2017a). HIV testing and health care utilization behaviors among men in the United States: A latent class analysis. Journal of the Association of Nurses in AIDS Care, 28, 306–315. https://doi.org/10.1016/j.jana.2017.02.001.
Dangerfield, D., II, Smith, L. R., Williams, J., Unger, J., & Bluthenthal, R. (2017b). Sexual positioning among men who have sex with men: A narrative review. Archives of Sexual Behavior, 46, 869–884. https://doi.org/10.1007/s10508-016-0738-y.
Dodge, B., Jeffries, W., IV, & Sandfort, T. G. M. (2008). Beyond the down low: Sexual risk, protection, and disclosure among at-risk black men who have sex with both men and women (MSMW). Archives of Sexual Behavior, 37(5), 683–696. https://doi.org/10.1007/s10508-008-9356-7.
Fleming, D. T., & Wasserheit, J. N. (1999). From epidemiological synergy to public health policy and practice: The contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sexually Transmitted Infections, 75(1), 3–17.
Fox, J., White, P. J., Macdonald, N., Weber, J., McClure, M., Fidler, S., & Ward, H. (2009). Reductions in HIV transmission risk behaviour following diagnosis of primary HIV infection: A cohort of high-risk men who have sex with men. HIV Medicine, 10(7), 432–438. https://doi.org/10.1111/j.1468-1293.2009.00708.x.
Friedman, M. R., Wei, C., Klem, M. L., Silvestre, A. J., Markovic, N., & Stall, R. (2014). HIV infection and sexual risk among men who have sex with men and women (MSMW): A systematic review and meta-analysis. PLoS One. https://doi.org/10.1371/journal.pone.0087139.
Gilreath, T. D., Astor, R. A., Estrada, J. N., Johnson, R. M., Benbenishty, R., & Unger, J. B. (2014). Substance use among adolescents in California: A latent class analysis. Substance Use and Misuse, 49(1–2), 116–123. https://doi.org/10.3109/10826084.2013.824468.
Girometti, N., Gutierrez, A., Nwokolo, N., McOwan, A., & Whitlock, G. (2017). High HIV incidence in men who have sex with men following an early syphilis diagnosis: Is there room for pre-exposure prophylaxis as a prevention strategy? Sexually Transmitted Infections, 93, 320–322. https://doi.org/10.1136/sextrans-2016-052865.
Grov, C., Rendina, H. J., Moody, R. L., Ventuneac, A., & Parsons, J. T. (2015). HIV serosorting, status disclosure, and strategic positioning among highly sexually active gay and bisexual men. AIDS Patient Care and STDs, 29(10), 559–568. https://doi.org/10.1089/apc.2015.0126.
Gwadz, M., Cleland, C. M., Kutnick, A., Leonard, N. R., Ritchie, A. S., Lynch, L., … Martinez, B. (2016). Factors associated with recent HIV testing among heterosexuals at high risk for HIV infection in New York City. Frontiers in Public Health. https://doi.org/10.3389/fpubh.2016.00076.
Hampton, M. C., Halkitis, P. N., Storholm, E. D., Kupprat, S. A., Siconolfi, D. E., Jones, D., … McCree, D. H. (2012). Sexual risk taking in relation to sexual identification, age, and education in a diverse sample of African American men who have sex with men (MSM) in New York City. AIDS and Behavior, 17(3), 931–938. https://doi.org/10.1007/s10461-012-0139-8.
Harawa, N. T., Williams, J. K., Ramamurthi, H. C., & Bingham, T. A. (2006). Perceptions towards condom use, sexual activity, and HIV disclosure among HIV-positive African American men who have sex with men: Implications for heterosexual transmission. Journal of Urban Health, 83(4), 682–694. https://doi.org/10.1007/s11524-006-9067-0.
Harawa, N. T., Williams, J. K., Ramamurthi, H. C., Manago, C., Avina, S., & Jones, M. (2008). Sexual behavior, sexual identity, and substance abuse among low-income bisexual and non-gay-identifying African American men who have sex with men. Archives of Sexual Behavior, 37(5), 748–762. https://doi.org/10.1007/s10508-008-9361-x.
Harawa, N., Wilton, L., Wang, L., Mao, C., Kuo, I., Penniman, T., … HPTN 061. (2014). Types of female partners reported by black men who have sex with men and women (MSMW) and associations with intercourse frequency, unprotected sex and HIV and STI prevalence. AIDS and Behavior, 18(8), 1548–1559. https://doi.org/10.1007/s10461-014-0704-4.
Hart, T. A., Wolitski, R. J., Purcell, D. W., Gómez, C., Halkitis, P., & Seropositive Urban Men’s Study Team. (2003). Sexual behavior among HIV-positive men who have sex with men: What’s in a label? Journal of Sex Research, 40(2), 179–188. https://doi.org/10.1080/00224490309552179.
Hubach, R. D., Dodge, B., Goncalves, G., Malebranche, D., Reece, M., Pol, B. V. D., … Fortenberry, J. D. (2013). Gender matters: Condom use and nonuse among behaviorally bisexual men. Archives of Sexual Behavior, 43(4), 707–717. https://doi.org/10.1007/s10508-013-0147-4.
Jeffries, W. L., IV. (2014). Beyond the bisexual bridge: Sexual health among U.S. men who have sex with men and women. American Journal of Preventive Medicine, 47(3), 320–329. https://doi.org/10.1016/j.amepre.2014.05.002.
Jin, F., Crawford, J., Prestage, G. P., Zablotska, I., Imrie, J., Kippax, S. C., … Grulich, A. E. (2009). Unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men. AIDS, 23(2), 243–252. https://doi.org/10.1097/QAD.0b013e32831fb51a.
Johns, M. M., Pingel, E., Eisenberg, A., Santana, M. L., & Bauermeister, J. (2012). Butch tops and femme bottoms? Sexual positioning, sexual decision making, and gender roles among young gay men. American Journal of Men’s Health, 6(6), 505–518. https://doi.org/10.1177/1557988312455214.
Kidd, S., Stenger, M., Kirkcaldy, R. D., Llata, E., & Weinstock, H. (2015). Increases in syphilis and gonorrhea among men who have sex with men in the United States. Presented at the 2015 CSTE Annual Conference. Retrieved from https://cste.confex.com/cste/2015/webprogram/Paper5018.html.
Koblin, B. A., Mayer, K. H., Eshleman, S. H., Wang, L., Mannheimer, S., del Rio, C., … Wheeler, D. (2013). Correlates of HIV acquisition in a cohort of Black men who have sex with men in the United States: HIV Prevention Trials Network (HPTN) 061. PLoS ONE, 8(7), e70413. https://doi.org/10.1371/journal.pone.0070413.
Lanza, S. T., Patrick, M. E., & Maggs, J. L. (2010). Latent transition analysis: Benefits of a latent variable approach to modeling transitions in substance use. Journal of Drug Issues, 40(1), 93–120.
Lanza, S. T., & Rhoades, B. L. (2011). Latent class analysis: An alternative perspective on subgroup analysis in prevention and treatment. Prevention Science, 14(2), 157–168. https://doi.org/10.1007/s11121-011-0201-1.
Lauby, J. L., Millett, G. A., LaPollo, A. B., Bond, L., Murrill, C. S., & Marks, G. (2008). Sexual risk behaviors of HIV-positive, HIV-negative, and serostatus-unknown Black men who have sex with men and women. Archives of Sexual Behavior, 37(5), 708–719. https://doi.org/10.1007/s10508-008-9365-6.
Lo, Y., Mendell, N. R., & Rubin, D. B. (2001). Testing the number of components in a normal mixture. Biometrika, 88(3), 767–778.
Lyons, A., Pitts, M., Smith, G., Grierson, J., Smith, A., McNally, S., & Couch, M. (2011). Versatility and HIV vulnerability: Investigating the proportion of Australian gay men having both insertive and receptive anal intercourse. Journal of Sexual Medicine, 8(8), 2164–2171. https://doi.org/10.1111/j.1743-6109.2010.02197.x.
Malebranche, D. J., Arriola, K. J., Jenkins, T. R., Dauria, E., & Patel, S. N. (2010). Exploring the “bisexual bridge”: A qualitative study of risk behavior and disclosure of same-sex behavior among black bisexual men. American Journal of Public Health, 100(1), 159–164. https://doi.org/10.2105/AJPH.2008.158725.
Malebranche, D. J., Fields, E. L., Bryant, L. O., & Harper, S. R. (2007). Masculine socialization and sexual risk behaviors among Black men who have sex with men: A qualitative exploration. Men and Masculinities, 12, 90–112. https://doi.org/10.1177/1097184X07309504.
Mansergh, G., & Marks, G. (1998). Age and risk of HIV infection in men who have sex with men. AIDS, 12(10), 1119–1128.
Maulsby, C., Millett, G., Lindsey, K., Kelley, R., Johnson, K., Montoya, D., & Holtgrave, D. (2013a). HIV among Black men who have sex with men (MSM) in the United States: A review of the literature. AIDS and Behavior, 18(1), 10–25. https://doi.org/10.1007/s10461-013-0476-2.
Maulsby, C., Sifakis, F., German, D., Flynn, C. P., & Holtgrave, D. (2011). Partner characteristics and undiagnosed HIV seropositivity among men who have sex with men only (MSMO) and men who have sex with men and women (MSMW) in Baltimore. AIDS and Behavior, 16(3), 543–553. https://doi.org/10.1007/s10461-011-0046-4.
Maulsby, C., Sifakis, F., German, D., Flynn, C. P., & Holtgrave, D. (2013b). HIV risk among men who have sex with men only (MSMO) and men who have sex with men and women (MSMW) in Baltimore. Journal of Homosexuality, 60(1), 51–68. https://doi.org/10.1080/00918369.2013.735938.
Mustanski, B., Newcomb, M. E., & Clerkin, E. M. (2011). Relationship characteristics and sexual risk-taking in young men who have sex with men. Health Psychology, 30(5), 597–605. https://doi.org/10.1037/a0023858.
Nelson, K. M., Gamarel, K. E., Pantalone, D. W., Carey, M. P., & Simoni, J. M. (2016). Sexual debut and HIV-related sexual risk-taking by birth cohort among men who have sex with men in the United States. AIDS and Behavior. https://doi.org/10.1007/s10461-016-1330-0.
Newcomb, M. E., Ryan, D. T., Garofalo, R., & Mustanski, B. (2014). The effects of sexual partnership and relationship characteristics on three sexual risk variables in young men who have sex with men. Archives of Sexual Behavior, 43(1), 61–72. https://doi.org/10.1007/s10508-013-0207-9.
Nylund, K. L., Asparouhov, T., & Muthén, B. O. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study. Structural Equation Modeling: A Multidisciplinary Journal, 14(4), 535–569. https://doi.org/10.1080/10705510701575396.
Osmond, D. H., Pollack, L. M., Paul, J. P., & Catania, J. A. (2007). Changes in prevalence of HIV infection and sexual risk behavior in men who have sex with men in San Francisco: 1997 2002. American Journal of Public Health, 97(9), 1677–1683. https://doi.org/10.2105/AJPH.2005.062851.
Oster, A. M., Wiegand, R. E., Sionean, C., Miles, I. J., Thomas, P. E., Melendez-Morales, L., … Millett, G. A. (2011). Understanding disparities in HIV infection between Black and white MSM in the United States. AIDS, 25(8), 1103–1112. https://doi.org/10.1097/QAD.0b013e3283471efa.
Patel, P., Borkowf, C. B., Brooks, J. T., Lasry, A., Lansky, A., & Mermin, J. (2014). Estimating per-act HIV transmission risk: A systematic review. AIDS, 28(10), 1509–1519. https://doi.org/10.1097/QAD.0000000000000298.
Pines, H. A., Gorbach, P. M., Weiss, R. E., Shoptaw, S., Landovitz, R. J., Javanbakht, M., … Plankey, M. (2014). Sexual risk trajectories among MSM in the United States: Implications for pre-exposure prophylaxis delivery. Journal of Acquired Immune Deficiency Syndromes, 65(5), 579–586. https://doi.org/10.1097/QAI.0000000000000101.
Prestage, G., Mao, L., Kippax, S., Jin, F., Hurley, M., Grulich, A., … Zablotska, I. (2009). Use of viral load to negotiate condom use among gay men in Sydney, Australia. AIDS and Behavior, 13(4), 645–651. https://doi.org/10.1007/s10461-009-9527-0.
Satcher, A. J., Durant, T., Hu, X., & Dean, H. D. (2007). AIDS cases among women who reported sex with a bisexual man, 2000–2004—United States. Women and Health, 46(2–3), 23–40. https://doi.org/10.1300/J013v46n02_03.
Scott, H. M., Vittinghoff, E., Irvin, R., Sachdev, D., Liu, A., Gurwith, M., & Buchbinder, S. P. (2014). Age, race/ethnicity, and behavioral risk factors associated with per-contact risk of HIV infection among men who have sex with men in the United States. Journal of Acquired Immune Deficiency Syndromes, 65(1), 115–121. https://doi.org/10.1097/QAI.0b013e3182a98bae.
Snowden, J. M., Raymond, H. F., & McFarland, W. (2009). Prevalence of seroadaptive behaviours of men who have sex with men, San Francisco, 2004. Sexually Transmitted Infections, 85(6), 469–476. https://doi.org/10.1136/sti.2009.036269.
Solomon, M. M., Mayer, K. H., Glidden, D. V., Liu, A. Y., McMahan, V. M., Guanira, J. V., … Veloso, V. (2014). Syphilis predicts HIV incidence among men and transgender women who have sex with men in a pre-exposure prophylaxis trial. Clinical Infectious Diseases, 59(7), 1020–1026. https://doi.org/10.1093/cid/ciu450.
Sullivan, P. S., Salazar, L., Buchbinder, S., & Sanchez, T. H. (2009). Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS, 23(9), 1153–1162. https://doi.org/10.1097/QAD.0b013e32832baa34.
van Druten, H., van Griensven, F., & Hendriks, J. (1992). Homosexual role separation: Implications for analyzing and modeling the spread of HIV. Journal of Sex Research, 29(4), 477–499. https://doi.org/10.1080/00224499209551663.
Vermunt, J. K. (2010). Latent class modeling with covariates: Two improved + three-step approaches. Political Analysis, 18, 450–469. https://doi.org/10.1093/pan/mpq025.
Vittinghoff, E., Douglas, J., Judson, F., McKirnan, D., MacQueen, K., & Buchbinder, S. P. (1999). Per-contact risk of human immunodeficiency virus transmission between male sexual partners. American Journal of Epidemiology, 150(3), 306–311.
Wasserheit, J. (1992). Epidemiological synergy: Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sexually Transmitted Diseases, 19(2), 61–77.
Wiley, J. A., & Herschkorn, S. J. (1989). Homosexual role separation and AIDS epidemics: Insights from elementary models. Journal of Sex Research, 26(4), 434–449. https://doi.org/10.1080/00224498909551526.
Wilton, L., Koblin, B., Nandi, V., Xu, G., Latkin, C., Seal, D., … Spikes, P. (2015). Correlates of seroadaptation strategies among Black men who have sex with men (MSM) in 4 US cities. AIDS and Behavior, 19(12), 2333–2346. https://doi.org/10.1007/s10461-015-1190-z.
Young, S. D., Shoptaw, S., Weiss, R. E., Munjas, B., & Gorbach, P. M. (2009). Predictors of unrecognized HIV infection among poor and ethnic men who have sex with men in Los Angeles. AIDS and Behavior, 15(3), 643–649. https://doi.org/10.1007/s10461-009-9653-8.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
This work is the result of a collaborative effort funded by the Centers for Disease Control and Prevention cooperative agreement #1UR6PS0001099. This work was also supported by the National Science Foundation Graduate Research Fellowship Program (Award Year 2013) and National Institutes on Drug Abuse Grant # K01 DA039767.
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Dangerfield, D.T., Harawa, N.T., Smith, L.R. et al. Latent Classes of Sexual Risk Among Black Men Who Have Sex with Men and Women. Arch Sex Behav 47, 2071–2080 (2018). https://doi.org/10.1007/s10508-017-1142-y
- Black MSMW
- Black MSM
- Sexual positioning
- HIV risk
- STI risk
- Sexual orientation