Association of Discrimination-Related Trauma with Sexual Risk Among HIV-positive African American Men Who Have Sex with Men

Published In: American Journal of Public Health, v. 103, no. 5, May 2013, p. 875-880

Posted on RAND.org on January 01, 2013

by Errol L Fields, Laura M. Bogart, Frank H. Galvan, Glenn Wagner, David J. Klein, Mark A. Schuster

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Research Question

  1. Does experiencing discrimination-related trauma affect risk taking among HIV-positive African American men who have sex with men?

OBJECTIVES: We investigated whether 1 form of traumatic stress, discrimination-related trauma (e.g., physical assault because of race), was associated with unprotected anal intercourse, especially when compared with non-discrimination-related trauma, among African American men who have sex with men. METHODS: A convenience sample of 131 HIV-positive African American men who have sex with men receiving antiretroviral treatment completed audio computer-assisted self-interviews that covered unprotected anal intercourse, interpersonal trauma, and whether trauma was because of discrimination on the basis of race/ethnicity, HIV serostatus, or sexual orientation. RESULTS: Sixty percent reported at least 1 interpersonal trauma; they attributed at least 1 trauma to being gay (47%), African American (17%), or HIV positive (9%). In a multivariate regression, experiencing discrimination-related trauma was significantly associated with unprotected anal intercourse (adjusted odds ratio [AOR] = 2.4; 95% confidence interval [CI] = 1.0, 5.7; P = .04), whereas experiencing non-discrimination-related trauma was not (AOR = 1.3; 95% CI = 0.6, 3.1; P = .53). CONCLUSIONS: HIV-positive African American men who have sex with men experience high levels of discrimination-related trauma, a stressor associated with greater risk taking. HIV prevention interventions should consider the potential damaging effects of discrimination in the context of trauma.

Key Finding

  • Men who experienced discrimination-related interpersonal trauma in their lifetime were more likely than were those who had not experienced such trauma to have engaged in unprotected anal intercourse with a male partner.

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