Situational, partner, and contextual factors associated with level of risk at most recent intercourse among Black men who have sex with men.

African American men who have sex with men (MSM) in the United States bear a disproportionate burden of HIV infection and disease incidence. 178 Black MSM provided detailed situational information concerning their most recent act of anal intercourse (AI) with a male partner including condom use, partner characteristics, serostatus disclosure, and substance use. Participants completed scales assessing AIDS-related as well as broader contextual domains. Most recent AI acts occurred with same-race partners outside of main relationships. Over one-third of AI acts were unprotected, and almost half of the unprotected acts were not between known HIV-concordant partners. Nearly half of men reported substance use before sex. In a multiple regression analysis, unprotected AI with a partner not known to be concordant was predicted by low risk reduction intentions and indicators of a casual relationship. The findings highlight issues and partner contexts associated with risk for contracting HIV infection among Black MSM.

Levels and predictors of HIV risk behavior among Black men who have sex with men.

Black men who have sex with men (MSM) contract HIV at disproportionately high rates, and National HIV/AIDS Strategy goals to reduce HIV incidence cannot be successful without improved HIV prevention among racial minority MSM. A total of 210 Black MSM from three cities (Cleveland, Miami, and Milwaukee) completed measures assessing their sexual behavior and demographic characteristics, as well as AIDS-specific psychosocial scales, broader contextual domains, and substance use. Nearly 50% of men reported recent unprotected anal intercourse (UAI), often with non-main partners, with partners not known to be HIV seroconcordant, or with multiple partners. Thirty-seven percent of men reported being HIV positive. In multiple regression analyses, higher levels of unprotected behavior were predicted by weaker perceived peer norms for condom use, weaker risk reduction behavioral intentions, being HIV negative, and recent use of marijuana, cocaine/crack, and poppers. Greater number of UAI partners was associated with weaker perceived peer condom use norms, lower risk reduction intentions, illicit use of prescribed opiates, and fewer AIDS conspiracy beliefs. These findings suggest important factors that should be targeted in HIV prevention programs for Black MSM.