Skip to main content

Advertisement

SpringerLink
Log in

Risky Trade: Individual and Neighborhood-Level Socio-Demographics Associated with Transactional Sex among Urban African American MSM

  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

There is a clear, persistent association between poverty and HIV risk and HIV infection. Low educational attainment, neighborhood disadvantage, and residential instability are ways in which poverty is instrumentally experienced in urban America. We investigated the role of lived poverty at both the individual and neighborhood levels in transactional sex behavior among African American men who have sex with men (MSM) residing in urban neighborhoods. Using population-averaged models estimated by generalized estimating equation (GEE) models, we identified individual-level and neighborhood-level factors that are associated with exchanging sex for drugs and/or money. We tested the association between neighborhood and individual-level socioeconomic status and HIV risk behavior by combining area-based measures of neighborhood quality from the US Census with individual survey data from 542 low-income African American MSM. The primary outcome measure was self-reported transactional sex defined as exchanging sex for drugs or money. Individual-level covariates included high school non-completion, income, and problem drug use. Neighborhood-level covariates were high school non-completion and poverty rates. The findings suggested that educational attainment is associated with both the individual level and neighborhood level. Participants were more likely to engage in transactional sex if they did not complete high school (OR = 1.78), and similarly if their neighbors did not complete high school (OR = 7.70). These findings suggest potential leverage points for both community-level interventions and advocacy for this population, particularly related to transactional sex and education, and will aid HIV prevention efforts that seek to address the contextual constraints on individual risk behavior.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Centers for Disease Control and Prevention. Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011--United States and 6 dependent areas. HIV surveilance report. 2013;23:1–84.

  2. Oster AM, Wejnert C, Mena LA, Elmore K, Fisher H, Heffelfinger JD. Network analysis among HIV-infected young Black men who have sex with men demonstrates high connectedness around few venues. Sex Transm Dis. 2013;40(3):206–12.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kidder DP, Wolitski RJ, Pals SL, Campsmith ML. Housing status and HIV risk behaviors among homeless and housed persons with HIV. J Acquir Immune Defic Syndr. 2008;49(4):451–5.

    Article  PubMed  Google Scholar 

  4. Outlaw AY, Phillips G 2nd, Hightow-Weidman LB, et al. Age of MSM sexual debut and risk factors: results from a multisite study of racial/ethnic minority YMSM living with HIV. AIDS Patient Care STDS. 2011;Suppl 1:S23–9.

    Article  Google Scholar 

  5. Ransome Y, Kawachi I, Braunstein S, Nash D. Structural inequalities drive late HIV diagnosis: the role of black racial concentration, income inequality, socioeconomic deprivation, and HIV testing. Health Place. 2016;42:148–58.

    Article  PubMed  Google Scholar 

  6. Brawner BM, Reason JL, Goodman BA, Schensul JJ, Guthrie B. Multilevel drivers of HIV/AIDS among black Philadelphians: exploration using community ethnography and geographic information systems. Nurs Res. 2015;64(2):100.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kozol J. Savage inequalities: children in America’s schools. New York: Crown Publishers Inc; 1991.

  8. Eaton LA, Driffin DD, Bauermeister J, Smith H, Conway-Washington C. Minimal awareness and stalled uptake of pre-exposure prophylaxis (PrEP) among at risk, HIV-negative, black men who have sex with men. AIDS Patient Care STDs. 2015;29(8):423–9.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Latkin CA, German D, Vlahov D, Galea S. Neighborhoods and HIV: a social ecological approach to prevention and care. Am Psychol. 2013;68(4):210–24.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Raymond HF, Chen YH, Syme SL, Catalano R, Hutson MA, McFarland W. The role of individual and neighborhood factors: HIV acquisition risk among high-risk populations in San Francisco. AIDS Behav. 2014;18(2):346–56.

    Article  CAS  PubMed  Google Scholar 

  11. Vaughan AS, Rosenberg E, Shouse RL, Sullivan PS. Connecting race and place: a county-level analysis of White, Black, and Hispanic HIV prevalence, poverty, and level of urbanization. Am J Public Health. 2014;104(7):e77–84.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Vaughan AS, Rosenberg ES, Sullivan PS. Spatial relationships between gay stigma, poverty, and HIV infection among black and white men who have sex with men in Atlanta. AIDS Res Hum Retrovir. 2014;30(8):740–1.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kerrigan D, Witt S, Glass B, Chung SE, Ellen J. Perceived neighborhood social cohesion and condom use among adolescents vulnerable to HIV/STI. AIDS Behav. 2006;10(6):723–9.

    Article  PubMed  Google Scholar 

  14. Halkitis PN, Kapadia F, Siconolfi DE, et al. Individual, psychosocial, and social correlates of unprotected anal intercourse in a new generation of young men who have sex with men in New York City. Am J Public Health. 2013;103(5):889–95.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bobashev GV, Zule WA, Osilla KC, Kline TL, Wechsberg WM. Transactional sex among men and women in the south at high risk for HIV and other STIs. J Urban Health. 2009;86(Suppl 1):32–47.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bacon O, Lum P, Hahn J, et al. Commercial sex work and risk of HIV infection among young drug-injecting men who have sex with men in San Francisco. Sex Transm Dis. 2006;33(4):228–34.

    Article  PubMed  Google Scholar 

  17. Latkin CA, Curry AD. Stressful neighborhoods and depression: a prospective study of the impact of neighborhood disorder. J Health Soc Behav. 2003;44(1):34–44.

    Article  PubMed  Google Scholar 

  18. Gorbach PM, Murphy R, Weiss RE, Hucks-Ortiz C, Shoptaw S. Bridging sexual boundaries: men who have sex with men and women in a street-based sample in Los Angeles. J Urban Health. 2009;86(Suppl 1):63–76.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Newman PA, Rhodes F, Weiss RE. Correlates of sex trading among drug-using men who have sex with men. Am J Public Health. 2004;94(11):1998–2003.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Jemmott JB III, Jemmott LS, O'Leary A, et al. On the efficacy and mediation of a one-on-one HIV risk-reduction intervention for African American men who have sex with men: a randomized controlled trial. AIDS Behav. 2014;

  21. O'Leary A, Jemmott JB 3rd, Stevens R, Rutledge SE, Icard LD. Optimism and education buffer the effects of syndemic conditions on HIV status among African American men who have sex with men. AIDS Behav. 2014;18(11):2080–8.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kamb ML, Fishbein M, Douglas JMJ, et al. Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial. J Am Med Assoc. 1998;280(13):1161–7.

    Article  CAS  Google Scholar 

  23. Lowmaster S, Morey L, Baker L, Hopwood C. Structure, reliability, and predictive validity of the Texas Christian University correctional residential self-rating form at intake in a residential substance abuse treatment facility. J Subst Abus Treat. 2010;39(2):180–7.

    Article  Google Scholar 

  24. Geronimus AT, Bound J. Use of census-based aggregate variables to proxy for socioeconomic group: evidence from national samples. Am J Epidemiol. 1998;148(5):475–86.

    Article  CAS  PubMed  Google Scholar 

  25. Krieger N. A century of census tracts: health & the body politic (1906–2006). J Urban Health. 2006;83(3):355–61.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Carter RE, Lipsitz SR, Tilley BC. Quasi-likelihood estimation for relative risk regression models. Biostatistics. 2005;6(1):39–44.

    Article  PubMed  Google Scholar 

  27. Last A, Wilson S. Relative risks and odds ratios: what’s the difference? J Fam Pract. 2004;53(2):108.

    PubMed  Google Scholar 

  28. Stevens R, Bernadini S, Jemmott JB. Social environment and sexual risk-taking among gay and transgender African American youth. Cult Health Sex. 2013;15(10):1148–61.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Colfax G, Coates TJ, Husnik MJ, Huang Y, Buchbinder S, Koblin B, et al. Longitudinal patterns of methamphetamine, popper (amyl nitrite), and cocaine use and high-risk sexual behavior among a cohort of San Francisco men who have sex with men. J Urban Health. 2005;82:i62–70.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Duncan DT, Kawachi I, Subramanian SV, Aldstadt J, Melly SJ, Williams DR. Examination of how neighborhood definition influences measurements of youths’ access to tobacco retailers: a methodological note on spatial misclassification. Am J Epidemiol. 2014;179(3):373–81.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Pennsylvania School of Nursing, Philadelphia, PA, USA

    Robin Stevens

  2. Temple University, Philadelphia, PA, USA

    Larry Icard & Scott Rutledge

  3. Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA

    John B. Jemmott & Janet Hsu

  4. Center for Disease Control and Prevention, Atlanta, GA, USA

    Ann O’Leary

  5. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Alisa Stephens-Shields

Authors
  1. Robin Stevens
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Larry Icard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John B. Jemmott
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ann O’Leary
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Scott Rutledge
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Janet Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alisa Stephens-Shields
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robin Stevens.

Ethics declarations

Institutional review boards (IRB) at the University of Pennsylvania and Temple University approved this study. The data for this article were from the baseline sample of the Being Responsible for Ourselves (BRO) HIV Risk-Reduction Intervention randomized controlled trial [20, 21].

Funding

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 study was supported in part by the National Institute of Mental Health (R01 MH079736).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stevens, R., Icard, L., Jemmott, J.B. et al. Risky Trade: Individual and Neighborhood-Level Socio-Demographics Associated with Transactional Sex among Urban African American MSM. J Urban Health 94, 676–682 (2017). https://doi.org/10.1007/s11524-017-0187-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-017-0187-5

Keywords

Search

Navigation