HIV persists as an important public health concern in the United States (US) and continues to disproportionately impact Black men who have sex with men (BMSM). Many BMSM experience high levels of victimization including intimate partner violence and, in turn, stress, depression, and substance use, all of which are well-documented HIV risk factors. Another adverse experience that is disproportionately concentrated in Black men is incarceration. While some BMSM may be exposed to any one of these HIV risk factors, these factors are highly correlated and may work together to create what is called a "syndemic" that drives HIV. Syndemics have been used successfully to explain HIV risk among Black men who have sex with men only (BMSMO). However, some BMSM also have sex with women (BMSMW) and hence can bridge HIV infection between MSM and women. BMSMW are thought to experience particular social vulnerabilities given they lie between two worlds -- that of MSM and heterosexual men. Syndemics may drive HIV in BMSMW, yet no prior study has described the prevalence of exposure to syndemics and the association between syndemics and HIV risk in BMSMW. This new R03 proposal seeks to utilize prospective data from The HIV Prevention Trials Network (HPTN) 061 study to characterize syndemics experienced by BMSMW and to measure the prospective association between baseline exposure to syndemics and 12 month risk of high-risk sex partnerships, sexually transmitted infections (STIs), and HIV infection.
Black men who have sex with men and also women (BMSMW) are a highly understudied group, yet they have disproportionate levels of HIV infection and occupy a position of considerable epidemiologic importance as a potential bridge group to women. The current study seeks to explore how high levels of victimization, psychopathology, substance use, and incarceration that many BMSMW face may work in tandem to drive HIV infection in this group. Findings have the potential to improve HIV prevention efforts by providing data needed to build multi-component interventions that address the unique clustering of co-morbidities that influence HIV transmission in this highly vulnerable population.