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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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.
Conflict of interest
The authors have no conflicts of interest to disclose.
The Institutional Review Board at Public Health Solutions approved all study procedures.
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
- Men who have sex with men
- Drug use
- Sexual orientation