TY - JOUR
T1 - Transactional Sex, HIV, and Bacterial STIs Among U.S. Men Who have Sex with Men
AU - Atkins, Kaitlyn
AU - Wiginton, John M.
AU - Carpino, Thomas
AU - Sanchez, Travis H.
AU - Murray, Sarah M.
AU - Baral, Stefan D.
N1 - Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2024/11
Y1 - 2024/11
N2 - Introduction: Men who have sex with men (MSM) and are engaged in transactional sex (MSM-TS) experience complex social and structural vulnerabilities that increase their HIV risk. This study aimed to estimate the prevalence of TS and associations between TS and sexually transmitted infection (STI) outcomes among cisgender MSM in the U.S. Methods: Using 2017–2021 data from an online survey of U.S. MSM, characteristics of MSM-TS were summarized, and adjusted prevalence ratios (aPRs) calculated for the associations between past-year TS and bacterial STI diagnosis, HIV status, and either antiretroviral or pre-exposure prophylaxis use. Analyses were conducted in 2023. Results: TS prevalence was 3.7% (n=1,848/49,539). Compared to other MSM, MSM-TS more commonly reported homelessness, being uninsured, condomless anal sex with partners of any HIV status and condomless anal sex with serodifferent partners, and illicit drug use. TS was associated with increased HIV (aPR 1.44, 95% CI 1.25–1.66) and bacterial STI prevalence (aPR 2.40, 95% CI=2.09–2.52) and lower antiretroviral therapy use (among MSM living with HIV; PR 0.92, 95% CI=0.87–0.97). Conclusions: Structural and behavioral risks converged among U.S. MSM engaging in TS leading to greater HIV and bacterial STI prevalence in this group. HIV interventions for U.S. MSM-TS should address individual as well as structural risks, including poverty and housing instability.
AB - Introduction: Men who have sex with men (MSM) and are engaged in transactional sex (MSM-TS) experience complex social and structural vulnerabilities that increase their HIV risk. This study aimed to estimate the prevalence of TS and associations between TS and sexually transmitted infection (STI) outcomes among cisgender MSM in the U.S. Methods: Using 2017–2021 data from an online survey of U.S. MSM, characteristics of MSM-TS were summarized, and adjusted prevalence ratios (aPRs) calculated for the associations between past-year TS and bacterial STI diagnosis, HIV status, and either antiretroviral or pre-exposure prophylaxis use. Analyses were conducted in 2023. Results: TS prevalence was 3.7% (n=1,848/49,539). Compared to other MSM, MSM-TS more commonly reported homelessness, being uninsured, condomless anal sex with partners of any HIV status and condomless anal sex with serodifferent partners, and illicit drug use. TS was associated with increased HIV (aPR 1.44, 95% CI 1.25–1.66) and bacterial STI prevalence (aPR 2.40, 95% CI=2.09–2.52) and lower antiretroviral therapy use (among MSM living with HIV; PR 0.92, 95% CI=0.87–0.97). Conclusions: Structural and behavioral risks converged among U.S. MSM engaging in TS leading to greater HIV and bacterial STI prevalence in this group. HIV interventions for U.S. MSM-TS should address individual as well as structural risks, including poverty and housing instability.
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U2 - 10.1016/j.amepre.2024.07.002
DO - 10.1016/j.amepre.2024.07.002
M3 - Article
C2 - 39002886
AN - SCOPUS:85201513508
SN - 0749-3797
VL - 67
SP - 722
EP - 729
JO - American journal of preventive medicine
JF - American journal of preventive medicine
IS - 5
ER -