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Try out PMC Labs and tell us what you think. Learn More. Kelly, J. St Lawrence, and Y. Amirkhanian deed the overall study, developed the assessment measures, and conceptualized and maintained scientific oversight of the intervention. Tarima conceptualized and performed the statistical analyses. Tarima in the statistical analyses.

We examined correlates of condomless anal intercourse with nonmain sexual partners among African American men who have sex with men MSM. Participants reported pastmonth sexual behavior, substance use, and background, psychosocial, and HIV-related characteristics.

Condomless anal intercourse outside main concordant partnerships, reported by High frequency of condomless anal intercourse acts with nonmain partners was associated with high gay community participation, weak risk-reduction intentions, safer sex not being perceived as a peer norm, low condom-use self-efficacy, and longer time since most recent HIV testing.

Condomless anal intercourse with nonmain partners among Black MSM was primarily associated with gay community participation, alcohol and marijuana use, and risk-reduction behavioral intentions. HIV infection in the United States falls along sharp lines of disparity related to sexual orientation and race. For this reason, integrated HIV prevention approaches are needed, including improved interventions to reduce risk behavior among racial-minority MSM.

research has examined but has generally failed to establish differences in individual-level risk practices between Black and White MSM. These include risk-related sexual behavior norms, attitudes, and intentions 21—25 ; substance use 12,26—30 ; poverty and disadvantage 19,20 ; and psychosocial domains including internalized homonegativity or homophobia, 31—34 self-perceived masculinity, 35,36 HIV conspiracy beliefs or mistrust, 37,38 religiosity, 39 and resilience.

We examined HIV risk—specific characteristics because they are proximal to adopting protective actions according to many behavioral science theories.

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All seeds were Black MSM. Field staff approached the potential seed and explained the study. If recruited, the seed was asked to identify—by first name only—his close MSM friends. Seeds were asked to invite into the study each named friend.

They, in turn, invited their own friends. In this way, sociocentric networks reached out 3 waves from each initial seed. Participant inclusion criteria were being aged at least 18 years, living in the study city, being named as a friend by an already-enrolled participant, and providing written informed consent. We recruited 35 networks consisting of participants, and 54 from Milwaukee, Cleveland, and Miami Beach, respectively. We excluded 19 men who reported their race as White, reported no history of same-sex behavior, or declined to answer sexual behavior questions.

The sample size for analysis was Participants individually completed audio computer-assisted self-interviews and received risk-reduction counseling.

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Participants responded to questions about their gender at birth, self-identified present gender male, female, or transgenderage, race, ethnicity, employment, income, education, and housing stability. Participants indicated their of male and female sexual partners in the year.

Participants then described their sexual behaviors over the past 3 months on a partner-by-partner basis for up to the most recent 5 male and 5 female sexual partners. Respondents indicated their relationship with each partner main and committed, regular but not main and committed, casual, or commercialhow often in the past 3 months they had anal intercourse AI with each male partner, and how many of those acts were condomless AI CLAI.

For each partner, respondents reported whether they disclosed their HIV serostatus before intercourse and whether the partner did so.

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Participants with more than 5 partners of either gender in the past 3 months summarized their sexual practices with all additional partners. We divided the sample into 2 groups on the basis of their sexual behavior.

Participants were asked on how many days they drank alcohol in the past month and their of drinks in a typical drinking day. The assessment included 5 HIV risk—specific scales. Five scales measured broader psychosocial domains hypothesized in the literature to influence HIV risk among minority MSM. We assessed internalized homonegativity by using a measure adapted from Herek et al. We measured religiosity and church involvement with 6 items adapted from Forehand et al. We first calculated means and standard errors for continuous variables and relative frequencies for categorical variables to characterize the overall sample.

We performed bivariate and multivariable statistical analyses by using random effects models to for the potential effect of social network.

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We first used single-predictor logistic regressions with a random network effect to investigate the statistical ificance of differences between men who did or did not engage in any high-risk acts on individual variables.

We then performed multiple logistic regressions with a random network effect to identify ificant main effects by using forward stepwise variable selection. We investigated all variables that had achieved P values less than. We also tested all 2-way interactions between ificant main effects for statistical ificance.

Finally, we examined variables associated with reporting 3 or more high-risk CLAI acts with nonmain partners in the past 3 months.

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We used logistic regression analyses to compare the groups on the basis of their frequency of high-risk CLAI acts. Because of occasional small counts, we aggregated some into larger groups to free sex black Miami Florida at least 10 participants per cell after cross-tabulation with the risk-level indicator. Alcohol and marijuana were the substances most commonly used by study participants.

Injection drug use in the past month was reported by only 2 participants. Because many individuals used illicit drugs but the using a particular substance was often modest, substances other than alcohol and marijuana were combined into a category of any illicit drug use. Participants reported a mean of 5. Table 1 shows comparing participants who did or did not engage in high-risk acts. The groups ificantly differed on all of substance use variables reported in Table 1with substance use always greater among men who engaged in high-risk CLAI.

There were consistent differences between groups on 4 of the 5 HIV risk—specific scales. Men reporting high-risk acts had weaker perceived peer norms for condom use, risk behavior reduction intentions, attitudes toward condoms, and self-efficacy for condom use. With respect to psychosocial domains, participants reporting high-risk CLAI scored higher in gay community participation and lower in resilience.

Those who did not report high-risk CLAI tended to report greater religious and church involvement. of the multiple mixed logistic regression analysis predicting whether participants reported high-risk acts in the past 3 months are shown in Table 2with reported odds ratios ORs adjusted for ificant covariates. Four variables remained ificant in the regression model: gay community participation, drinking alcohol in the past month, using marijuana in the past month, and risk-reduction behavioral intentions.

Analogous to Table 1Table 3 compares sociodemographic characteristics, sexual and HIV history characteristics, substance use variables, HIV risk—specific scales, and scales measuring psychosocial domains between participants engaging in 3 or more CLAI acts with nonmain partners in the past 3 months and participants who engaged in fewer than 3 CLAI acts. We examined the influence of a diverse array of characteristics that have been hypothesized to be associated with HIV risk by using analyses that took into their intercorrelated nature.

The picture that emerged underscores the combined associations of sexual risk practices with alcohol and illicit drug use; perceived safer-sex peer norms, condom attitudes, and risk-reduction intentions; recency of HIV testing; and indicators of socioeconomic distress. Many of these variables were associated not only with whether men engaged in CLAI outside a seroconcordant main partner relationship but also how often they did so. Psychosocial domains such as internalized homonegativity, self-ascribed masculinity, and HIV conspiracy beliefs were generally not associated with risk behavior.

Although resilience distinguished between men who did or did not report high-risk CLAI in unadjusted bivariate analyses, gay community participation was the only psychosocial domain that remained ificant in the adjusted analyses and it was related to greater risk. There can be little doubt that factors such as resilience, masculinity, and internalized homonegativity play important roles in the lives of many racial-minority MSM. However, and like other studies, 21,22,51 this research did not confirm the independent association of these domains with riskiness or safety in sexual behavior.

One in 4 participants reported that he was HIV-positive, an alarming level of disease prevalence comparable to that usually found in developing countries devastated by AIDS. Although most men in this sample reported having had an HIV test at some point in their lives, one third of men had not been tested in the past year. Although the field often emphasizes the identification of factors associated with high-risk sexual behavior, the majority of participants in this sample either did not report CLAI in the past 3 months or did so only with their single HIV-concordant main partner. From a strengths-based perspective, these findings suggest that HIV prevention interventions should not only help persons develop protective HIV-related norms, attitudes, and intentions but also attempt to address socioeconomic disparities—including those related to income and employment—that contribute to risk.

Integrated HIV and substance abuse prevention and treatment are also free sex black Miami Florida.

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In contrast to most research, the present study recruited social networks of African American MSM based on their friendship interconnections rather than presence in gay-identified venues. Racial minority MSM do not always attend gay-identified venues, and network recruitment affords a strategy for reaching men who might otherwise be hidden in the community.

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Network enrollment methods may be useful not only for reaching racial minority MSM in the community—many of whom in this study were HIV-positive—but also for delivering HIV prevention interventions for risk-behavior reduction, to promote regular HIV testing, or to encourage HIV medical care engagement. The study has several limitations. Because the study recruited social networks of Black MSM, rather than a true representative probability sample, analyses had to take into potential dependence of participant responses within social networks.

Although we determined associations between conceptually defined characteristics with risk behavior, this methodology does not demonstrate causality, especially because predictor and outcome variables were assessed at a single point.

Stigmatized activities may have been underreported, although audio computer-assisted self-interview assessment reduces self-presentation bias. It is possible that the risk levels of some participants were miscategorized. We did not assess whether HIV-positive partners were in medical care. HIV risk among African American MSM is influenced by the makeup of their sexual networks, 25,52 and this study did not assess sexual network characteristics. Finally, HIV concordance was defined on the basis of what participants reported about themselves and about what their partners said to them.

Some individuals may have misportrayed or not known their true HIV status. Antiretroviral therapy can greatly reduce viral load among persons living with HIV infection and, in turn, reduce their likelihood of transmitting the disease to sexual partners.

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However, their impact will be determined by ART coverage and adherence, and neither is likely to be quick or complete. There remains an urgent need for improved risk-behavior reduction interventions for Black MSM and for integrated behavioral, social, and biomedical prevention. The study was conducted following a protocol that was approved by the Medical College of Wisconsin institutional review board. Written informed consent was obtained from all participants.

National Center for Biotechnology InformationU. Am J Public Health. Published online January. Jeffrey A.