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

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

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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