Elucidating the HIV Paradox: Sexual Partner Networks in Men Who Have Sex With Men
thesisposted on 10.12.2012, 00:00 by Kyle W. Jones
African American MSM (AAMSM) have higher rates of HIV, despite having less unprotected anal intercourse (UAI) than Caucasian. Clearly AAMSM have riskier sex partners than do other ethnic groups. Having older sexual partners is a risk factor for HIV and STI’s in young African American women. However, this has not been thoroughly examined among African American MSM. We hypothesized that AAMSM would have more age-discordant partners, and that age-discordance would underlie AAMSM’s greater likelihood of reporting an HIV sero-discordant partner, UAI with recent partners, and STI infection. We also tested three psychosocial variables that may lead AAMSM toward older partners: diminished social support, internalized homophobia, and drug use. These effects were assessed among 55 African American and 99 Caucasian MSM aged 18 - 29. African-American and Caucasian MSM did not differ in their likelihood of UAI, but AAMSM did report older sexual partners. Race was not associated with participant STI infection, HIV status, or UAI with recent partners. More African-American participants reported an HIV sero-discordant partner than did Caucasians. There were no racial differences in social support, internalized homophobia, and drug use. Diminished social support predicted age discordant partnering among both AAMSM and Caucasian MSM. AAMSM’s greater number of HIV sero-discordant partners was not mediated by their having older partners, but was associated with their experiencing diminished social support. These findings indicate that AAMSM are more likely than Caucasian MSM to expose themselves to HIV with each sexual episode, with concomitant risk for HIV infection. While AAMSM were more likely to report older sexual partners, social support, internalized homophobia and drug use do not underlie that effect. Contrary to our hypothesis, older partners did not put these AAMSM at risk for HIV sero-discordant partners. Rather, diminished social support played a key role in both Caucasian MSM and AAMSM’s exposure to risky sexual partners. Future studies should focus on developing interventions to address the mechanisms of HIV sero-discordant partnering among AAMSM. Interventions to facilitate social support may help younger MSM make safer partner choices.