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A Syndemic Model of Exchange Sex Among HIV-Positive Men Who Have Sex With Men

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Abstract

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.

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References

  • Allison, P. D. (2012). Logistic regression using SAS: Theory and application. Cary, NC: SAS Institute.

    Google Scholar 

  • Arnett, J. J. (2007). Emerging adulthood: What is it, and what is it good for? Child Development Perspectives,1(2), 68–73.

    Google Scholar 

  • Bacon, O., Lum, P., Hahn, J., Evans, J., Davidson, P., Moss, A., & Page-Shafer, K. (2006). Commercial sex work and risk of HIV infection among young drug-injecting men who have sex with men in San Francisco. Sexually Transmitted Diseases,33(4), 228–234. https://doi.org/10.1097/ol.olq.0000204914.91923.ad.

    Article  PubMed  Google Scholar 

  • Baral, S. D., Friedman, M. R., Geibel, S., Rebe, K., Bozhinov, B., Diouf, D., & Cáceres, C. F. (2015). Male sex workers: Practices, contexts, and vulnerabilities for HIV acquisition and transmission. The Lancet,385(9964), 260–273.

    Google Scholar 

  • Barré-Sinoussi, F., Abdool Karim, S. S., Albert, J., Bekker, L.-G., Beyrer, C., Cahn, P., & Godfrey-Faussett, P. (2018). Expert consensus statement on the science of HIV in the context of criminal law. Journal of the International AIDS Society,21(7), e25161. https://doi.org/10.1002/jia2.25161.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bauermeister, J., Eaton, L., & Stephenson, R. (2016). A multilevel analysis of neighborhood socioeconomic disadvantage and transactional sex with casual partners among young men who have sex with men living in metro Detroit. Behavioral Medicine,42(3), 197–204.

    PubMed  Google Scholar 

  • Biello, K. B., Colby, D., Closson, E., & Mimiaga, M. J. (2014). The syndemic condition of psychosocial problems and HIV risk among male sex workers in Ho Chi Minh City, Vietnam. AIDS and Behavior,18(7), 1264–1271. https://doi.org/10.1007/s10461-013-0632-8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Blashill, A. J., Bedoya, C. A., Mayer, K. H., O’Cleirigh, C., Pinkston, M. M., Remmert, J. E., & Safren, S. A. (2015). Psychosocial syndemics are additively associated with worse ART adherence in HIV-infected individuals. AIDS and Behavior,19(6), 981–986.

    PubMed  PubMed Central  Google Scholar 

  • Bond, K. T., Yoon, I. S., Houang, S. T., Downing, M. J., Grov, C., & Hirshfield, S. (2019). Transactional sex, substance use, and sexual risk: Comparing pay direction for an internet-based US sample of men who have sex with men. Sexuality Research and Social Policy,16, 255–267.

    PubMed  Google Scholar 

  • Borrell, L. N., Kiefe, C. I., Williams, D. R., Diez-Roux, A. V., & Gordon-Larsen, P. (2006). Self-reported health, perceived racial discrimination, and skin color in African Americans in the CARDIA study. Social Science and Medicine,63(6), 1415–1427.

    PubMed  Google Scholar 

  • Bostwick, W. B., & Dodge, B. (2019). Introduction to the special section on bisexual health: Can you see us now? Archives of Sexual Behavior,48(1), 79–87. https://doi.org/10.1007/s10508-018-1370-9.

    Article  PubMed  Google Scholar 

  • Breslow, A. S., & Brewster, M. E. (2019). HIV is not a crime: Exploring dual roles of criminalization and discrimination in HIV/AIDS minority stress. Stigma and Health. https://doi.org/10.7916/D8FF591M.

    Article  Google Scholar 

  • Bull, S. S., Piper, P., & Rietmeijer, C. (2002). Men who have sex with men and also inject drugs-profiles of risk related to the synergy of sex and drug injection behaviors. Journal of Homosexuality,42(3), 31–51.

    PubMed  Google Scholar 

  • Buller, A. M., Devries, K. M., Howard, L. M., & Bacchus, L. J. (2014). Associations between Intimate partner violence and health among men who have sex with men: A systematic review and meta-analysis. PLoS Medicine,11(3), e1001609. https://doi.org/10.1371/journal.pmed.1001609

    Article  PubMed  PubMed Central  Google Scholar 

  • Buttram, M. E., & Kurtz, S. P. (2015). A mixed methods study of health and social disparities among substance-using African American/Black men who have sex with men. Journal of Racial and Ethnic Health Disparities,2(1), 1–10.

    PubMed  Google Scholar 

  • Carpiano, R. M., Link, B. G., & Phelan, J. C. (2008). Social inequality and health future directions for the fundamental cause explanation. In A. Lareau & D. Conley (Eds.), Social class: How does it work (pp. 232–263). New York, NY: Russell Sage Foundation.

    Google Scholar 

  • Centers for Disease Control and Prevention. (2017). HIV surveillance report, 2017; vol. 29. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published November 2018. Accessed 15 Mar 2019.

  • Centers for Disease Control and Prevention. (2019). HIV in the United States and dependent areas. Retrieved from https://www.cdc.gov/hiv/statistics/overview/ataglance.html. Accessed 15 Mar 2019.

  • Chandler, C. J., Bukowski, L. A., Matthews, D. D., Hawk, M. E., Markovic, N., Egan, J. E., & Stall, R. D. (2019). Examining the impact of a psychosocial syndemic on past six-month HIV screening behavior of Black men who have sex with men in the United States: Results from the POWER Study. AIDS and Behavior. https://doi.org/10.1007/s10461-019-02458-z.

    Article  PubMed  PubMed Central  Google Scholar 

  • Clatts, M. C., Goldsamt, L. A., Yu, G., & Colby, D. (2016). Sexually transmissible infection and HIV prevention and treatment for young male sex workers in Vietnam: Findings from the SHEATH intervention. Sexual Health,13(6), 575–581.

    PubMed  Google Scholar 

  • Cockerham, W. C. (2014). Medical sociology. New York: Routledge (Wiley Online Library).

    Google Scholar 

  • Daskalopoulou, M., Rodger, A., Phillips, A. N., Sherr, L., Speakman, A., Collins, S., & Fisher, M. (2014). Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: Results from the cross-sectional ASTRA study. The Lancet HIV,1(1), e22–e31.

    PubMed  Google Scholar 

  • DiNenno, E. A., Prejean, J., Irwin, K., Delaney, K. P., Bowles, K., Martin, T., & Hutchinson, A. B. (2017). Recommendations for HIV screening of gay, bisexual, and other men who have sex with men—United States, 2017. MMWR. Morbidity and Mortality Weekly Report,66(31), 830.

    PubMed  PubMed Central  Google Scholar 

  • Du Bois, W. E. B., & Eaton, I. (1899). The Philadelphia Negro: A social study. Philedelphia: University of Pennsylvania Press.

    Google Scholar 

  • Duncan, D. T., Goedel, W. C., Stults, C. B., Brady, W. J., Brooks, F. A., Blakely, J. S., & Hagen, D. (2018). 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. American Journal of Men’s Health,12(2), 292–301.

    PubMed  Google Scholar 

  • Dyer, T. P., Shoptaw, S., Guadamuz, T. E., Plankey, M., Kao, U., Ostrow, D., & Stall, R. (2012). Application of syndemic theory to Black men who have sex with men in the multicenter AIDS Cohort Study. Journal of Urban Health,89(4), 697–708. https://doi.org/10.1007/s11524-012-9674-x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Eisinger, R. W., Dieffenbach, C. W., & Fauci, A. S. (2019). HIV viral load and transmissibility of HIV infection. Journal of the American Medical Association,321(5), 451–452. https://doi.org/10.1001/jama.2018.21167.

    Article  PubMed  Google Scholar 

  • Farmer, P. (2003). Pathologies of power: Health, human rights, and the new war on the poor. North American Dialogue,6(1), 1–4.

    Google Scholar 

  • Feinstein, B. A., Dodge, B., Korpak, A. K., Newcomb, M. E., & Mustanski, B. (2019). Improving the health of cisgender men who identify as bisexual: What do they want from interventions? Sexuality Research and Social Policy. https://doi.org/10.1007/s13178-019-0380-2.

    Article  PubMed  Google Scholar 

  • Feldman, M. B., Díaz, R. M., Ream, G. L., & El-Bassel, N. J. (2007). Intimate partner violence and HIV sexual risk behavior among Latino gay and bisexual men. Journal of LGBT Health Research,3(2), 9–19.

    PubMed  Google Scholar 

  • Fendrich, M., Avci, O., Johnson, T. P., & Mackesy-Amiti, M. E. (2013). Depression, substance use and HIV risk in a probability sample of men who have sex with men. Addictive Behaviors,38(3), 1715–1718. https://doi.org/10.1016/j.addbeh.2012.09.005.

    Article  PubMed  Google Scholar 

  • Fletcher, J. B., Swendeman, D., & Reback, C. J. (2018). Associations between major depressive episode, methamphetamine use disorder severity, and engagement in sexual risk-taking among methamphetamine-using men who have sex with men. AIDS and Behavior,22(5), 1461–1466.

    PubMed  PubMed Central  Google Scholar 

  • Floyd, F. J., & Bakeman, R. (2006). Coming-out across the life course: Implications of age and historical context. Archives of Sexual Behavior,35(3), 287–296.

    PubMed  Google Scholar 

  • Friedman, M. R., & Dodge, B. M. (2016). The role of syndemic in explaining health disparities among bisexual men: A blueprint for a theoretically informed perspective. Understanding the HIV/AIDS epidemic in the United States (pp. 71–98). Cham, Switzerland: Springer.

    Google Scholar 

  • Friedman, M. R., Stall, R., Plankey, M., Wei, C., Shoptaw, S., Herrick, A., & Silvestre, A. J. (2015). Effects of syndemics on HIV viral load and medication adherence in the multicenter AIDS Cohort Study. AIDS,29(9), 1087–1096.

    PubMed  Google Scholar 

  • Ghanem, A., Little, S. J., Drumright, L., Liu, L., Morris, S., & Garfein, R. S. (2011). High-risk behaviors associated with injection drug use among recently HIV-infected men who have sex with men in San Diego, CA. AIDS and Behavior,15(7), 1561–1569. https://doi.org/10.1007/s10461-011-9970-6.

    Article  PubMed  PubMed Central  Google Scholar 

  • Guadamuz, T. E., McCarthy, K., Wimonsate, W., Thienkrua, W., Varangrat, A., Chaikummao, S., & van Griensven, F. (2014). Psychosocial health conditions and HIV prevalence and incidence in a cohort of men who have sex with men in Bangkok, Thailand: Evidence of a syndemic effect. AIDS and Behavior,18(11), 2089–2096. https://doi.org/10.1007/s10461-014-0826-8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Halkitis, P. N., Kapadia, F., Bub, K. L., Barton, S., Moreira, A. D., & Stults, C. B. (2015). A longitudinal investigation of syndemic conditions among young gay, bisexual, and other MSM: The P18 Cohort Study. AIDS and Behavior,19(6), 970–980.

    PubMed  PubMed Central  Google Scholar 

  • Henny, K. D., Kidder, D. P., Stall, R., & Wolitski, R. J. (2007). Physical and sexual abuse among homeless and unstably housed adults living with HIV: Prevalence and associated risks. AIDS and Behavior,11(6), 842–853.

    PubMed  PubMed Central  Google Scholar 

  • Hirshfield, S., Chiasson, M. A., Joseph, H., Scheinmann, R., Johnson, W. D., Remien, R. H., & Margolis, A. D. (2012). An online randomized controlled trial evaluating HIV prevention digital media interventions for men who have sex with men. PLoS ONE,7(10), e46252. https://doi.org/10.1371/journal.pone.0046252.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hirshfield, S., Downing, M. J., Chiasson, M. A., Yoon, I. S., Houang, S. T., Teran, R. A., & Parsons, J. T. (2019). Evaluation of Sex Positive! A video eHealth intervention for men living with HIV. AIDS and Behavior, 23, 3103–3118. https://doi.org/10.1007/s10461-019-02498-5.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hirshfield, S., Downing, M. J., Jr., Parsons, J. T., Grov, C., Gordon, R. J., Houang, S. T., & Anderson, I. (2017). Developing a video-based eHealth intervention for HIV-positive gay, bisexual, and other men who have sex with men: Study protocol for a randomized controlled trial. JMIR Research Protocols,5(2), e125. https://doi.org/10.2196/resprot.5554.

    Article  Google Scholar 

  • Hirshfield, S., Schrimshaw, E. W., Stall, R. D., Margolis, A. D., Downing, M. J., Jr., & Chiasson, M. A. (2015). Drug use, sexual risk, and syndemic production among men who have sex with men who engage in group sexual encounters. American Journal of Public Health,105(9), 1849–1858.

    PubMed  PubMed Central  Google Scholar 

  • Hirshfield, S., Teran, R. A., Downing, M. J., Jr., Chiasson, M. A., Tieu, H.-V., Dize, L., & Gaydos, C. A. (2018). Quantification of HIV-1 RNA among men who have sex with men using an at-home self-collected dried blood spot specimen: Feasibility study. JMIR Public Health and Surveillance,4(4), e10847. https://doi.org/10.2196/10847.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hoppe, T. A. (2015). Disparate risks of conviction under Michigan’s felony HIV disclosure law: An observational analysis of convictions and HIV diagnoses, 1992–2010. Punishment and Society,17(1), 73–93. https://doi.org/10.1177/1462474514561711.

    Article  Google Scholar 

  • Hoppe, T. (2017). Punishing disease: HIV and the criminalization of sickness. Oakland, CA: University of California Press.

    Google Scholar 

  • Houston, E., & McKirnan, D. J. (2007). Intimate partner abuse among gay and bisexual men: Risk correlates and health outcomes. Journal of Urban Health,84(5), 681–690.

    PubMed  PubMed Central  Google Scholar 

  • Hudson, D. L., Puterman, E., Bibbins-Domingo, K., Matthews, K. A., & Adler, N. E. (2013). Race, life course socioeconomic position, racial discrimination, depressive symptoms and self-rated health. Social Science and Medicine,97, 7–14.

    PubMed  Google Scholar 

  • Hughes, C. E., & Stevens, A. (2010). What can we learn from the Portuguese decriminalization of illicit drugs? British Journal of Criminology,50(6), 999–1022. https://doi.org/10.1093/bjc/azq038.

    Article  Google Scholar 

  • Hurley, R. (2018). Illicit drug use should not be a crime, says Royal College of Physicians. British Medical Journal (Online),361, k1832. https://doi.org/10.1136/bmj.k1832.

    Article  Google Scholar 

  • Jackson, C. A., & Heineman, J. (2018). Repeal FOSTA and decriminalize sex work. Contexts,17(3), 74–75. https://doi.org/10.1177/1536504218792534.

    Article  Google Scholar 

  • Javanbakht, M., Ragsdale, A., Shoptaw, S., & Gorbach, P. M. (2019). Transactional sex among men who have sex with men: Differences by substance use and HIV status. Journal of Urban Health, 96, 429–441. https://doi.org/10.1007/s11524-018-0309-8.

    Article  PubMed  Google Scholar 

  • Jie, W., Ciyong, L., Xueqing, D., Hui, W., & Lingyao, H. (2012). A syndemic of psychosocial problems places the MSM (men who have sex with men) population at greater risk of HIV infection. PLoS ONE,7(3), e32312. https://doi.org/10.1371/journal.pone.0032312.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kessler, R. C., Mickelson, K. D., & Williams, D. R. (1999). The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. Journal of Health and Social Behavior,40(3), 208–230.

    PubMed  Google Scholar 

  • Krieger, N., & Sidney, S. (1996). Racial discrimination and blood pressure: the CARDIA Study of young black and white adults. American Journal of Public Health,86(10), 1370–1378.

    PubMed  PubMed Central  Google Scholar 

  • LeMessurier, J., Traversy, G., Varsaneux, O., Weekes, M., Avey, M. T., Niragira, O., & Rodin, R. (2018). Risk of sexual transmission of human immunodeficiency virus with antiretroviral therapy, suppressed viral load and condom use: A systematic review. Canadian Medical Association Journal,190(46), E1350–E1360. https://doi.org/10.1503/cmaj.180311.

    Article  PubMed  PubMed Central  Google Scholar 

  • Link, B. G., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior. https://doi.org/10.2307/2626958.

    Article  PubMed  Google Scholar 

  • Löwe, B., Kroenke, K., & Gräfe, K. (2005). Detecting and monitoring depression with a two-item questionnaire (PHQ-2). Journal of Psychosomatic Research,58(2), 163–171.

    PubMed  Google Scholar 

  • Mayer, K. H., Sohn, A., Kippax, S., & Bras, M. (2018). Addressing HIV criminalization: Science confronts ignorance and bias. Journal of the International AIDS Society,21(7), e25163. https://doi.org/10.1002/jia2.25163.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mays, V. M., & Cochran, S. D. (2001). Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health,91(11), 1869–1876.

    PubMed  PubMed Central  Google Scholar 

  • Mimiaga, M. J., O’Cleirigh, C., Biello, K. B., Robertson, A. M., Safren, S. A., Coates, T. J., & Stall, R. D. (2015). The effect of psychosocial syndemic production on 4-year HIV incidence and risk behavior in a large cohort of sexually active men who have sex with men. Journal of Acquired Immune Deficiency Syndromes,68(3), 329–336.

    PubMed  Google Scholar 

  • Mustanski, B., Garofalo, R., Herrick, A., & Donenberg, G. (2007). 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. Annals of Behavioral Medicine,34(1), 37–45. https://doi.org/10.1080/08836610701495268.

    Article  PubMed  Google Scholar 

  • Mustanski, B., Phillips, G., Ryan, D. T., Swann, G., Kuhns, L., & Garofalo, R. (2017). prospective effects of a syndemic on HIV and STI incidence and risk behaviors in a cohort of young men who have sex with men. AIDS and Behavior,21(3), 845–857. https://doi.org/10.1007/s10461-016-1607-3.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mykhalovskiy, E. (2015). The public health implications of HIV criminalization: Past, current, and future research directions. Critical Public Health,25(4), 373–385. https://doi.org/10.1080/09581596.2015.1052731.

    Article  Google Scholar 

  • Nerlander, L. M., Hess, K. L., Sionean, C., Rose, C., Thorson, A., Broz, D., & Paz-Bailey, G. (2017). Exchange sex and HIV infection among men who have sex with men: 20 US cities, 2011. AIDS and Behavior,8, 2283–2294. https://doi.org/10.1007/s10461-016-1450-6.

    Article  Google Scholar 

  • Oldenburg, C. E., Perez-Brumer, A. G., Reisner, S. L., & Mimiaga, M. J. (2015). Transactional sex and the HIV epidemic among men who have sex with men (MSM): Results from a systematic review and meta-analysis. AIDS and Behavior,12, 2177–2183. https://doi.org/10.1007/s10461-015-1010-5.

    Article  Google Scholar 

  • Pachankis, J. E. (2015). A transdiagnostic minority stress treatment approach for gay and bisexual men’s syndemic health conditions. Archives of Sexual Behavior,44(7), 1843–1860.

    PubMed  PubMed Central  Google Scholar 

  • Parsons, J. T., Bimbi, D. S., Koken, J. A., & Halkitis, P. N. (2005). Factors related to childhood sexual abuse among gay/bisexual male Internet escorts. Journal of Child Sexual Abuse,14(2), 1–23.

    PubMed  Google Scholar 

  • Parsons, J. T., Grov, C., & Golub, S. A. (2012). Sexual compulsivity, co-occurring psychosocial health problems, and HIV risk among gay and bisexual men: Further evidence of a syndemic. American Journal of Public Health,102(1), 156–162. https://doi.org/10.2105/Ajph.2011.300284.

    Article  PubMed  PubMed Central  Google Scholar 

  • Parsons, J. T., Millar, B. M., Moody, R. L., Starks, T. J., Rendina, H. J., & Grov, C. (2017). Syndemic conditions and HIV transmission risk behavior among HIV-negative gay and bisexual men in a US national sample. Health Psychology,36(7), 695–703.

    PubMed  PubMed Central  Google Scholar 

  • Parsons, J. T., Rendina, H. J., Moody, R. L., Ventuneac, A., & Grov, C. (2015). Syndemic production and sexual compulsivity/hypersexuality in highly sexually active gay and bisexual men: Further evidence for a three group conceptualization. Archives of Sexual Behavior,44(7), 1903–1913.

    PubMed  PubMed Central  Google Scholar 

  • Patterson, S. E., Milloy, M. J., Ogilvie, G., Greene, S., Nicholson, V., Vonn, M., & Kaida, A. (2015). The impact of criminalization of HIV non-disclosure on the healthcare engagement of women living with HIV in Canada: A comprehensive review of the evidence. Journal of the International AIDS Society,18(1), 20572. https://doi.org/10.7448/ias.18.1.20572.

    Article  PubMed  PubMed Central  Google Scholar 

  • Perlman, D. C., & Jordan, A. E. (2018). The syndemic of opioid misuse, overdose, HCV, and HIV: Structural-level causes and interventions. Current HIV/AIDS Reports, 15, 96–112.

    PubMed  PubMed Central  Google Scholar 

  • Phelan, J. C., Link, B. G., Diez-Roux, A., Kawachi, I., & Levin, B. (2004). “Fundamental causes” of social inequalities in mortality: A test of the theory. Journal of Health and Social Behavior,45(3), 265–285.

    PubMed  Google Scholar 

  • Phelan, J. C., Link, B. G., & Tehranifar, P. (2010). Social conditions as fundamental causes of health inequalities theory, evidence, and policy implications. Journal of Health and Social Behavior,51(1 suppl), S28–S40.

    PubMed  Google Scholar 

  • Pouget, E. R., & Bennett, A. S. (2016). A syndemic approach to understanding HIV/AIDS among people who inject drugs in the US. In E. R. Wright & N. Carnes (Eds.), Understanding the HIV/AIDS epidemic in the United States (pp. 195–216). Cham, Switzerland: Springer International Publishing.

    Google Scholar 

  • Pouget, E. R., West, B. S., Tempalski, B., Cooper, H. L., Hall, H. I., Hu, X., & Friedman, S. R. (2014). Persistent racial/ethnic disparities in AIDS diagnosis rates among people who inject drugs in US metropolitan areas, 1993–2007. Public Health Reports,129(3), 267–279.

    PubMed  PubMed Central  Google Scholar 

  • Prabhu, S., McFall, A. M., Mehta, S. H., Srikrishnan, A. K., Kumar, M. S., Anand, S., & Solomon, S. S. (2020). Psychosocial barriers to viral suppression in a community-based sample of human immunodeficiency virus–infected men who have sex with men and people who inject drugs in India. Clinical Infectious Diseases, 70, 304–313. https://doi.org/10.1093/cid/ciz175.

    Article  PubMed  Google Scholar 

  • Reisner, S. L., Mimiaga, M. J., Skeer, M., Bright, D., Cranston, K., Isenberg, D., & Mayer, K. H. (2009). Clinically significant depressive symptoms as a risk factor for HIV infection among black MSM in Massachusetts. AIDS and Behavior,13(4), 798–810. https://doi.org/10.1007/s10461-009-9571-9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rhodes, T. (2009). Risk environments and drug harms: A social science for harm reduction approach. Risk Environment and Drug Harms,20(3), 193–201. https://doi.org/10.1016/j.drugpo.2008.10.003.

    Article  Google Scholar 

  • Romero-Daza, N., Weeks, M., & Singer, M. (2003). “Nobody gives a damn if I live or die”: Violence, drugs, and street-level prostitution in inner-city Hartford, Connecticut. Medical Anthropology,22(3), 233–259.

    PubMed  Google Scholar 

  • Rosario, M., Schrimshaw, E. W., & Hunter, J. (2004). Ethnic/racial differences in the coming-out process of lesbian, gay, and bisexual youths: A comparison of sexual identity development over time. Cultural Diversity and Ethnic Minority Psychology,10(3), 215–228.

    PubMed  Google Scholar 

  • Rothman, R. E. (2003). Preventive care in the emergency department: Should emergency departments conduct routine HIV screening? A systematic review. Academic Emergency Medicine,10(3), 278–285. https://doi.org/10.1197/aemj.10.3.278.

    Article  PubMed  Google Scholar 

  • Sah, P., Fitzpatrick, M. C., Pandey, A., & Galvani, A. P. (2017). HIV criminalization exacerbates subpar diagnosis and treatment across the United States: Response to the ‘Association of HIV diagnosis rates and laws criminalizing HIV exposure in the United States’. AIDS,31(17), 2437–2439.

    PubMed  Google Scholar 

  • Singer, M. (1996). A dose of drugs, a touch of violence, a case of AIDS: Conceptualizing the SAVA syndemic. Free Inquiry in Creative Sociology,24(2), 99–110.

    Google Scholar 

  • Singer, M., Bulled, N., Ostrach, B., & Mendenhall, E. (2017). Syndemics and the biosocial conception of health. The Lancet,389(10072), 941–950.

    Google Scholar 

  • Singer, M. C., Erickson, P. I., Badiane, L., Diaz, R., Ortiz, D., Abraham, T., & Nicolaysen, A. M. (2006). Syndemics, sex and the city: Understanding sexually transmitted diseases in social and cultural context. Social Science and Medicine,63(8), 2010–2021.

    PubMed  Google Scholar 

  • Singh, S., Bradley, H., Hu, X., Skarbinski, J., Hall, H. I., & Lansky, A. (2014). Men living with diagnosed HIV who have sex with men: Progress along the continuum of HIV care–United States, 2010. Morbidity and Mortality Weekly Report,63(38), 829–833.

    PubMed  PubMed Central  Google Scholar 

  • Stall, R., Mills, T. C., Williamson, J., Hart, T., Greenwood, G., Paul, J., & Catania, J. A. (2003). Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. American Journal of Public Health,93(6), 939–942.

    PubMed  PubMed Central  Google Scholar 

  • Stein, R., Xu, S., Williams, W., Marano, M., Eke, A., Finlayson, T., & Wejnert, C. (2019). Factors associated with HIV antiretroviral therapy among men who have sex with men in 20 US cities, 2014. Journal of Urban Health, 96, 868–877. https://doi.org/10.1007/s11524-019-00386-w.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stephenson, R., & Finneran, C. (2017). Receipt and perpetration of intimate partner violence and condomless anal intercourse among gay and bisexual men in Atlanta. AIDS and Behavior,21(8), 2253–2260.

    PubMed  PubMed Central  Google Scholar 

  • Stevens, R., Icard, L., Jemmott, J. B., O’Leary, A., Rutledge, S., Hsu, J., & Stephens-Shields, A. (2017). Risky trade: Individual and neighborhood-level socio-demographics associated with transactional sex among urban African American MSM. Journal of Urban Health,94(5), 676–682.

    PubMed  PubMed Central  Google Scholar 

  • Stults, C. B., Javdani, S., Greenbaum, C. A., Kapadia, F., & Halkitis, P. N. (2015). Intimate partner violence and substance use risk among young men who have sex with men: The P18 Cohort Study. Drug and Alcohol Dependence,154, 54–62.

    PubMed  PubMed Central  Google Scholar 

  • Stults, C. B., Javdani, S., Greenbaum, C. A., Kapadia, F., & Halkitis, P. N. (2016). Intimate partner violence and sex among young men who have sex with men. Journal of Adolescent Health,58(2), 215–222.

    Google Scholar 

  • Sullivan, P. S., Khosropour, C. M., Luisi, N., Amsden, M., Coggia, T., Wingood, G. M., & DiClemente, R. J. (2011). Bias in online recruitment and retention of racial and ethnic minority men who have sex with men. Journal of Medical Internet Research,13(2), e38.

    PubMed  PubMed Central  Google Scholar 

  • Tran, N. K., Hatzenbuehler, M. L., & Goldstein, N. D. (2019). Potential relationship between HIV criminalization and structural stigma related to sexual orientation in the United States. Journal of Acquired Immune Deficiency Syndromes,80(5), e106–e108. https://doi.org/10.1097/qai.0000000000001961.

    Article  PubMed  Google Scholar 

  • Tsai, A. C., & Burns, B. F. (2015). Syndemics of psychosocial problems and HIV risk: A systematic review of empirical tests of the disease interaction concept. Social Science and Medicine,139, 26–35.

    PubMed  Google Scholar 

  • Tsai, A. C., & Venkataramani, A. S. (2016). Syndemics and health disparities: A methodological note. AIDS and Behavior,20(2), 423–430. https://doi.org/10.1007/s10461-015-1260-2.

    Article  PubMed  PubMed Central  Google Scholar 

  • Van den Berg, J. J., Fernández, M. I., Fava, J. L., Operario, D., Rudy, B. J., & Wilson, P. A. (2017). Using syndemics theory to investigate risk and protective factors associated with condomless sex among youth living with HIV in 17 US cities. AIDS and Behavior,21(3), 833–844.

    PubMed  PubMed Central  Google Scholar 

  • Walters, S. M., Rivera, A. V., Reilly, K. H., Anderson, B. J., Bolden, B., Wogayehu, A., … Braunstein, S. (2018). Exchange sex among persons who inject drugs in the New York metropolitan area: The importance of local context, gender and sexual identity. AIDS and Behavior, 22(9), 2773–2787.

  • Weber, A. E., Craib, K. J., Chan, K., Martindale, S., Miller, M. L., Schechter, M. T., & Hogg, R. S. (2001). Sex trade involvement and rates of human immunodeficiency virus positivity among young gay and bisexual men. International Journal of Epidemiology,30(6), 1449–1454.

    PubMed  Google Scholar 

  • Wheeler, J., Anfinson, K., Valvert, D., & Lungo, S. (2014). Is violence associated with increased risk behavior among MSM? Evidence from a population-based survey conducted across nine cities in Central America. Global Health Action,7, 1–12. https://doi.org/10.3402/gha.v7.24814.

    Article  Google Scholar 

  • Williams, D. R. (1999). Race, socioeconomic status, and health the added effects of racism and discrimination. Annals of the New York Academy of Sciences,896(1), 173–188. https://doi.org/10.1111/j.1749-6632.1999.tb08114.x.

    Article  PubMed  Google Scholar 

  • Williams, M. L., Bowen, A. M., Timpson, S. C., Ross, M. W., & Atkinson, J. S. (2006). HIV prevention and street–based male sex workers: An evaluation of brief interventions. AIDS Education and Prevention,18(3), 204–215.

    PubMed  Google Scholar 

  • Williams, D. R., & Collins, C. (2001). Racial residential segregation: A fundamental cause of racial disparities in health. Public Health Reports,116(5), 404–416.

    PubMed  PubMed Central  Google Scholar 

  • Williams, J. E., Dangerfield, D. T., Kral, A. H., Wenger, L. D., & Bluthenthal, R. N. (2019). Correlates of sexual coercion among people who inject drugs (PWID) in Los Angeles and San Francisco, CA. Journal of Urban Health, 96, 469–476.

    Google Scholar 

  • Williams, D. R., & Sternthal, M. (2010). Understanding racial-ethnic disparities in health sociological contributions. Journal of Health and Social Behavior,51(1 suppl), S15–S27.

    PubMed  PubMed Central  Google Scholar 

  • Williams, J. K., Wilton, L., Magnus, M., Lei, W., Jing, W., Penniman Dyer, T., & Cummings, V. (2015). Relation of childhood sexual abuse, intimate partner violence, and depression to risk factors for HIV among black men who have sex with men in 6 US cities. American Journal of Public Health,105(12), 2473–2481. https://doi.org/10.2105/AJPH.2015.302878.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wright, E. R., Carnes, N., & Colón-Diaz, M. (2016). Understanding the HIV/AIDS epidemic in the United States—The role of syndemics in shaping the public’s health. In E. R. Wright & N. Carnes (Eds.), Understanding the HIV/AIDS epidemic in the United States (pp. 1–17). Cham, Switzerland: Springer International Publishing.

    Google Scholar 

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Acknowledgments

This research was supported by a grant from the National Institute of Mental Health (R01-MH100973-03S1) to Sabina Hirshfield, principal investigator. Richard Teran was supported by a predoctoral fellowship in the Global HIV Implementation Science Research training program sponsored by the Mailman School of Public Health, Columbia University, with funding from the National Institute of Allergy and Infectious Diseases (T32 AI114398, PI: Howard). Suzan Walters was supported with funding from the National Institute on Drug Abuse (T32 DA007233-31, PI: Falkin and R25DA026401; PI Avelardo Valdez). The authors would like to thank Steven Houang, Irene Yoon, and Dayana Bermudez for their contributions to study enrollment, data collection, and retention activities. We would also like to thank all the participants of this study. Without them, this research could not have been conducted.

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Authors and Affiliations

  1. Rory Meyers College of Nursing, New York University, 380 2nd Ave., Suite 306, NY 10010, New York, NY, USA

    Suzan M. Walters

  2. Center for Drug Use and HIV/HCV Research, New York, NY, USA

    Suzan M. Walters

  3. Department of Sociology, SUNY Geneseo, Geneseo, NY, USA

    Amy Braksmajer

  4. Department of Gender, Sexuality, and Women’s Studies, Virginia Commonwealth University, Richmond, VA, USA

    Bethany Coston

  5. Research and Advisory, Gartner L2, New York, NY, USA

    Irene Yoon

  6. CUNY Graduate School of Public Health and Health Policy and the CUNY Institute for Implementation Science in Population Health, New York, NY, USA

    Christian Grov

  7. Department of Psychology, CUNY Lehman College, Bronx, NY, USA

    Martin J. Downing Jr.

  8. Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA

    Richard Teran

  9. Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Sabina Hirshfield

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  1. Suzan M. Walters
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  2. Amy Braksmajer
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  3. Bethany Coston
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  4. Irene Yoon
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  5. Christian Grov
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Correspondence to Suzan M. Walters.

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The Institutional Review Board at Public Health Solutions approved all study procedures.

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Participants provided consent by clicking a button at the end of an online consent form to indicate that they had read the consent page and agreed to participate. A Certificate of Confidentiality was obtained from the National Institute of Mental Health to protect the privacy of HIV-positive participants enrolled in this study.

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Walters, S.M., Braksmajer, A., Coston, B. et al. A Syndemic Model of Exchange Sex Among HIV-Positive Men Who Have Sex With Men. Arch Sex Behav 49, 1965–1978 (2020). https://doi.org/10.1007/s10508-020-01628-8

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  • DOI: https://doi.org/10.1007/s10508-020-01628-8

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