Abstract
We examined correlates of sexual risk among gay and bisexual men, who recently migrated from western and eastern African countries to the USA and lived in New York City and who are HIV negative or of unknown status. These men migrate from countries where same-sex sexuality is socially rejected and mostly illegal contributing to the motivation to migrate. Their background might predispose these men to engagement in sexual risk practices, while they are not specifically addressed in HIV prevention programming. Participants (N = 62) reported in face-to-face interviews on pre- and postmigration experiences, psychosocial determinants of sexual risk, and current sexual practices. Operationalization of sexual risk was based on the number of men with whom they had condomless receptive and/or insertive anal sex. Over a third of the men reported always having used condoms in the past year; among the other men, sexual risk varied. Multivariate analyses showed that sexual risk was lower among men with a stronger motivation to avoid HIV infection and higher among men who currently engaged in transactional sex. Further analyses indicated that housing instability was independently associated with reduced motivation to avoid HIV infection and with engagement in transactional sex in the USA. In recent western and eastern African gay and bisexual immigrants to the USA, structural factors, including housing instability, are strongly associated with sexual risk.
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Castañeda H, Holmes SM, Madrigal DS, Young M-EDE, Beyeler N, Quesada J. Immigration as a social determinant of health. Annu Rev Public Health. 2015; 36: 375–392.
Fakoya I, Álvarez-del Arco D, Woode-Owusu M, et al. A systematic review of post-migration acquisition of HIV among migrants from countries with generalised HIV epidemics living in Europe: implications for effectively managing HIV prevention programmes and policy. BMC Public Health. 2015; 15: 561.
Ruiz Y, Guilamo-Ramos V, McCarthy K, Muñoz-Laboy MA, de Lourdes Rosas López M. Exploring migratory dynamics on HIV transmission: the case of Mexicans in New York City and Puebla, Mexico. Am J Public Health. 2014; 104(6): 1036–1044.
Dougan S, Elford J, Rice B, et al. Epidemiology of HIV among Black and minority ethnic men who have sex with men in England and Wales. Sex Transm Infect. 2005; 81(4): 345–350.
Dougan S, Elford J, Sinka K, Fenton KA, Evans BG. Men who have sex with men who are born abroad and diagnosed with HIV in England and Wales: an epidemiological perspective. Int J STD AIDS. 2005; 16(9): 618–621.
Aggarwal I, Smith M, Tatt ID, et al. Evidence for onward transmission of HIV-1 non-B subtype strains in the United Kingdom. J Acquir Immune Defic Syndr. 2006; 41(2): 201–209.
Kobrak P, Ponce R, Zielony R. New arrivals to New York City: vulnerability to HIV among urban migrant young gay men. Arch Sex Behav. 2015; 44(7): 2041–2053.
Lewis N. Rupture, resilience, and risk: relationships between mental health and migration among gay-identified men in North America. Health Place. 2014; 27: 212–219.
Pachankis JE, Eldahan AI, Golub SA. New to New York: ecological and psychological predictors of health among recently arrived young adult gay and bisexual urban migrants. Ann Behav Med. 2016. Published Online: 19 April 2016. doi: 10.1007/s12160-016-9794-8.
Carroll A. State sponsored homophobia: a world survey of of sexual orientation laws: criminalisation, protection and recognition. file:///C:/Users/sandfor/Downloads/SSHR2016_WEB_110516.pdf. Published May 2016. Accessed 10 July 2016.
Smith T, Son J, Kim J. Public attitudes toward homosexuality and gay rights across time and countries. Los Angeles, LA: The Williams Institute; 2014.
Beyrer C. Pushback: the current wave of anti-homosexuality laws and impacts on health. PLoS Med. 2014; 11(6), e1001658.
Clark F. Discrimination against LGBT people triggers health concerns. Lancet. 2014; 383(9916): 500–502.
Stall R, Mills T, Williamson J, 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): 939–942.
Safren SA, Reisner SL, Herrick A, Mimiaga MJ, Stall RD. Mental health and HIV risk in men who have sex with men. J Acquir Immune Defic Syndr. 2011; 55(Suppl 2): S74–S77.
Zahn R, Grosso A, Scheibe A, et al. Human rights violations among men who have sex with men in Southern Africa: comparisons between legal contexts. PLoS ONE. 2016; 11(1), e0147156.
Baral S, Trapence G, Motimedi F, et al. HIV prevalence, risks for HIV infection, and human rights among men who have sex with men (MSM) in Malawi, Namibia, and Botswana. PLoS ONE. 2009; 4(3), e4997.
Alessi A, Kahn A, Chatterji A. “The darkest times of my life”: recollections of child abuse among forced migrants persecuted because of their sexual orientation and gender identity. Child Abuse Negl. 2016; 51: 93–105.
Michalopoulos LM, Aifah A, El-Bassel N. A systematic review of HIV risk behaviors and trauma among forced and unforced migrant populations from low and middle-income countries: state of the literature and future directions. AIDS Behav. 2016; 20(2): 243–261.
Casado B, Hong M, Harrington D. Measuring migratory grief and loss associated with the experience of immigration. Res Soc Work Pract. 2010; 20(6): 611–620.
Flynn MA, Eggerth DE, Jacobson CJ. Undocumented status as a social determinant of occupational safety and health: the workers’ perspective. Am J Ind Med. 2015; 58(11): 1127–1137.
Palazzolo SL, Yamanis TJ, De Jesus M, Maguire-Marshall M, Barker SL. Documentation status as a contextual determinant of HIV risk among young transgender Latinas. LGBT Health. 2016; 3(2): 132–138.
Heller P. Challenges facing LGBT asylum-seekers: the role of social work in correcting oppressive immigration processes. J Gay Lesb Soc Serv. 2009; 21(2–3): 294–308.
Greif MJ. Housing, medical, and food deprivation in poor urban contexts: implications for multiple sexual partnerships and transactional sex in Nairobi’s slums. Health Place. 2012; 18(2): 400–407.
Reed E, Gupta J, Biradavolu M, Devireddy V, Blankenship KM. The role of housing in determining HIV risk among female sex workers in Andhra Pradesh, India: considering women’s life contexts. Soc Sci Med. 2011; 72(5): 710–716.
Beyrer C, Trapence G, Motimedi F, et al. Bisexual concurrency, bisexual partnerships, and HIV among Southern African men who have sex with men. Sex Transm Infect. 2010; 86(4): 323–327.
Padilla M, Castellanos D, Guilamo-Ramos V, Reyes AM, Sánchez Marte LE, Soriano MA. Stigma, social inequality, and HIV risk disclosure among Dominican male sex workers. Soc Sci Med. 2008; 67(3): 380–388.
Hershberger SL, D’Augelli AR. The impact of victimization on the mental health and suicidality of lesbian, gay, and bisexual youths. Dev Psychol. 1995; 31(1): 65–74.
Burgard SA, Seefeldt KS, Zelner S. Housing instability and health: findings from the Michigan Recession and Recovery Study. Soc Sci Med. 2012; 75(12): 2215–2224.
Dandona L, Dandona R, Gutierrez JP, Kumar GA, McPherson S, Bertozzi SM. Sex behaviour of men who have sex with men and risk of HIV in Andhra Pradesh, India. AIDS. 2005; 19(6): 611–619.
Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory care quality improvement project (ACQUIP). Alcohol use disorders identification test. Arch Intern Med. 1998; 158(16): 1789–1795.
Lang AJ, Wilkins K, Roy-Byrne PP, et al. Abbreviated PTSD checklist (PCL) as a guide to clinical response. Gen Hosp Psychiatry. 2012; 34(4): 332–338.
Kroenke K, Spitzer RL, Williams JB. The patient health questionnaire-2: validity of a two-item depression screener. Med Care. 2003; 41(11): 1284–1292.
Monahan PO, Shacham E, Reece M, et al. Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in western Kenya. J Gen Intern Med. 2009; 24(2): 189–197.
Day NE, Schoenrade P. Staying in the closet versus coming out: relationships between communication about sexual orientation and work attitudes. Pers Psychol. 1997; 50(1): 147–163.
Mohr JJ, Fassinger RE. Sexual orientation identity and romantic relationship quality in same-sex couples. Personal Soc Psychol Bull. 2006; 32(8): 1085–1099.
Sandfort T, Bos H, Knox J, Reddy V. Gender nonconformity, discrimination, and mental health among Black South African men who have sex with men: a further exploration of unexpected findings. Arch Sex Behav. 2015; 45(3): 661–670.
Evans A, Hart G, Mole R, et al. Central and East European migrant men who have sex with men: an exploration of sexual risk in the UK. Sex Transm Infect. 2011; 87: 325–330.
Acknowledgements
This research was supported by an HIV Center Pilot grant and an NIMH center grant (P30-MH43520; PI: Robert H. Remien, Ph.D.). Dr. Anyamele is supported by an NIMH training grant (T32-MH19139 Behavioral Sciences Research in HIV Infection; PI: Theodorus G.M. Sandfort, Ph.D.).
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All study procedures were approved by the IRB of the New York State Psychiatric Institute. In addition, the identity of the participants was protected by a Confidentiality Certificate issued by the National Institute of Mental Health.
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Sandfort, T., Anyamele, C. & Dolezal, C. Correlates of Sexual Risk among Recent Gay and Bisexual Immigrants from Western and Eastern Africa to the USA. J Urban Health 94, 330–338 (2017). https://doi.org/10.1007/s11524-017-0135-4
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DOI: https://doi.org/10.1007/s11524-017-0135-4