Correlates of Risk Patterns and Race/Ethnicity Among HIV-Positive Men Who Have Sex With Men

Ann O'Leary; Holly H. Fisher; David W. Purcell; Pilgrim S. Spikes; Cynthia A. Gomez

Disclosures

AIDS and Behavior. 2007;11(5):706-715. 

In This Article

Abstract and Introduction

Abstract

Behaviors related to HIV infection vary by race, with African American and Latino men who have sex with men (MSM) more likely to report sex with women than are European-American MSM. The epidemic among African Americans, in particular, is growing rapidly among both men and women. Some have hypothesized that bisexually active men may be contributing to the epidemic among women. However, little is known about risk patterns among men of different races who are already infected. In this study of 456 HIV-seropositive MSM we found that, like HIV-negative MSM, African American MSM who are HIV-positive were less likely than European American men to identify as gay, more likely to report sex with women, and less comfortable discussing their MSM behavior with close friends and acquaintances. African American participants also exhibited higher levels of internalized homophobia, as well as lower self-efficacy for disclosing their HIV status to sex partners. Implications for interventions for this population are discussed.

Introduction

In the United States, the HIV epidemic continues to affect African American and Latino men who have sex with men (MSM) disproportionately to their representation in the population. African American MSM exhibit the highest prevalence (CDC, 2005b) and incidence (CDC, 2001) of HIV infection, with Latino MSM exhibiting the next highest rates. African American women are also very disproportionately affected, and bisexual behavior among African American men has been speculated to contribute to the epidemic among women (Millett, Malebranche, Mason, & Spikes, 2005; Montgomery, Mokotoff, Gentry, & Blair, 2003; Millett, Peterson, Wolitski, & Stall, 2006).

Previous research on MSM of negative or unknown HIV status has indicated higher rates of bisexual behavior among MSM of African American and Latino ethnicity (Binson, Michaels, Stall, Coates, Gagnon, & Catania, 1995; Doll & Beeker, 1996; Heckman, Kelly, Bogart, Kalichman, & Rompa, 1999; Kennedy & Doll, 2001; McKirnan, Stokes, Doll, & Burzette, 1995; Montgomery et al., 2003; Valleroy, MacKellar, Behel, Secura, & The Young Mens' Survey Study Group, 2004), and among African American men, more "down-low" (secretive) bisexual activity attributable in part to men's perceptions of homophobia in their communities (Lichtenstein, 2000; Mays, Cochran, & Zamudio, 2004; Williams, Wyatt, Resell, Peterson, & Asuan-O'Brien, 2004). In addition, higher levels of internalized homophobia and less frequent disclosure of homosexual orientation have been observed among African American MSM relative to other racial groups (Kennamer, Honnold, Bradford, & Hendricks, 2000; Stokes & Peterson, 1998), although in fact African American and European American heterosexuals report similar levels of homophobic attitudes (Herek & Capitanio, 1995). Other aspects of African American and Latino culture that may influence sexual behavior and orientation include the importance of family, social expectations regarding gender roles, influences of the church, and the availability and use of drugs and alcohol (Williams et al., 2004).

Behavioral differences preceding and leading to HIV infection may be continued post-infection. However, individuals who know their seropositive status are generally less likely to engage in transmission risk behavior (Marks, Crepaz, Senterfitt, & Janssen, 2005; Weinhardt, Carey, Johnson, & Bickham, 1999). To date, little is known about transmission risk behavior among known HIV-infected men from different racial/ethnic groups, and whether the patterns differ from those of seronegative or status-unknown men.

The present study sought to compare HIV-seropositive MSM from different racial/ethnic backgrounds recruited for the CDC-funded Seropositive Urban Men's Study (SUMS; O'Leary, Purcell, Remien, & Gomez, 2003; Parsons, Halkitis, Wolitski, & Gomez, 2003; Purcell, Parsons, Halkitis, Mizuno, & Woods, 2001; Wolitski, Bailey, O'Leary, Gomez, & Parsons, 2003; Wolitski, Parsons, Gomez, SUMS Study Team, & SUMIT Study Team, 2004). Aims in the present analysis were to compare the risk patterns of seropositive MSM from different race/ethnicity groups, particularly to explore rates and correlates of bisexual behavior and factors theoretically related to having sex with women. We hypothesized that factors that may be linked to secretive sexual behavior among MSM, or that might otherwise reflect less openness with their homosexuality would be elevated among African American and Latino men. These include levels of participation in gay community activities, internalized homophobia, willingness to disclose HIV status, and comfort level talking with others about sex with men. We also included measures of sexual motivation and control that we thought might relate to bisexual activity. The overall goal was to identify factors that might be pertinent to future interventions designed to reduce transmission risk behavior among HIV-seropositive MSM from different racial/ethnic groups.

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