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Differential Patterns of Risk and Vulnerability Suggest the Need for Novel Prevention Strategies for Black Bisexual Men in the HPTN 061 Study

Dyer, Typhanye V., PhD, MPH*; Khan, Maria R., PhD, MPH; Regan, Rotrease, PhD, MPH, RN; Harawa, Nina T., PhD, MPH§; Nelson, LaRon E., PhD, RN, FNP, FNAP, FAAN║,¶; Wilton, Leo, PhD#,**; Wang, Lei, PhD††; Peng, Lili, MS††; Ou, San San, MS††; Shoptaw, Steve, PhD‡‡

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 15, 2018 - Volume 78 - Issue 5 - p 491–498
doi: 10.1097/QAI.0000000000001716

Background: Black men who have sex with men (BMSM) and some who also have sex with women (BMSMW) account for over 70% of new HIV infections in the United States representing an elevated HIV risk in this group, also informing risks of HIV transmission to other BMSM and female sexual partners.

Settings: We examined trajectories of self-reported substance use, HIV-related sexual risk behaviors, and psychosocial vulnerabilities among BMSMW versus BMSM over a 1-year study period.

Methods: We analyzed baseline, 6-, and 12-month follow-up data from the HIV Prevention Trials Network “BROTHERS” Study (HPTN 061; n = 1126). Categorizing participants by sexual partner type across 3 time points: (1) BMSMO: having male and no female partners across assessments and (2) BMSMW: having sex with male and one or more female partners at least at 1 time point. Using generalized estimating equations, we estimated associations between being BMSMW (versus BMSMO) and changes in psychosocial vulnerability, substance use, and HIV-related sexual risk behaviors.

Results: Generalized estimating equation models controlling for sociodemographics, time-varying effects, and intervention status showed that BMSMW versus BMSMO had 50% increased odds of crack use, 71% increased odds of alcohol use during condomless anal intercourse (CAI), 51% greater odds of using drugs at last CAI, and twice the odds of receiving goods at last CAI.

Conclusions: Findings show stable and comparatively elevated illicit drugs, alcohol, and exchange sex during last CAI among BMSMW. Future intervention research should focus on ways to address changes in substance-related HIV-transmission behaviors over time in this population of men.

*Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD;

Population Health, New York University School of Medicine, New York, NY;

Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA;

§Charles R. Drew University of Medicine and Science, Los Angeles, CA;

University of Rochester, School of Nursing, Rochester, NY;

Centre for Urban Health Solutions, St. Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, ON;

#Department of Human Development, State University of New York at Binghamton, Binghamton, NY;

**Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa;

††Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; and

‡‡Department of Family Medicine, University of California Los Angeles, Los Angeles, CA.

Correspondence to: Typhanye V. Dyer, PhD, MPH, Department of Epidemiology and Biostatistics, The University of Maryland, 2234FF School of Public Health College Park, MD 20742 (e-mail:

Supported by NIAID, NIDA, and NIMH under cooperative agreement #UM1 AI068619 as part of the HPTN Scholars Program. T.V.D. additionally received funding from The UCLA HIV/AIDS Translational Training Program (R25 MH-080644), Johns Hopkins Drug Dependence Epidemiology Training Program (2-T32 DA-007292-17), Project DISRUPT (R01 DA-028766), and UCLA CHIPTS (P30 MH 058107). The HPTN 061 Manuscript Review Committee made the final decision to submit the manuscript for publication.

The authors have no conflicts of interest to disclose.

Received October 20, 2017

Accepted April 06, 2018

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