Social Capital Moderates the Relationship Between Stigma and Sexual Risk Among Male Sex Workers in the US Northeast


Stigma contributes to elevated HIV incidence among male sex workers (MSW). Social capital (i.e., resources accessed through one’s social relationships) may act as a buffer between stigma and sexual risk behaviors and HIV acquisition. Using negative binomial regression, we examined the association between both sex work-related stigma and social capital with respect to number of condomless sex acts among 98 MSW living in the US Northeast. In models adjusted for sociodemographic characteristics, sex work-related stigma was associated with number of condomless sex acts with any non-paying partner (i.e., male and female) (aIRR = 1.25, p < 0.001) and male non-paying partners (aIRR = 1.27, p = 0.09) among individuals with low social capital, not among those with high social capital. Sex work-related stigma was not associated with number of condomless anal sex acts with male paying clients at any level of social capital. Future HIV prevention interventions should consider promoting social capital among MSW.


El estigma contribuye al gran número de casos de VIH entre hombres trabajadores sexuales (HTS). El capital social (es decir, los recursos disponibles a través de relaciones sociales) puede actuar como un moderador de la asociación entre el estigma y comportamientos de riesgo sexual y transmisión del VIH. Utilizamos regresión binomial negativa para examinar las asociaciónes entre el estigma asociado al trabajo sexual, y el capital social, con la cantidad de actos sexuales sin condón entre 98 HTS en el Nordeste de Estados Unidos. En nuestros modelos ajustados por variables socioeconómicas y demográficas, el estigma asociado al trabajo sexual era asociado al número de actos sexuales sin condón con parejas no comerciales femeninas o masculinas (tasa de incidencia ajustada, TIa = 1.25, p < 0.001) y con parejas no comerciales masculinas (TIa = 1.27, p = 0.09) solamente entre las personas con bajo capital social, pero no entre aquellos con alto capital social. El estigma asociado al trabajo sexual no era asociado con el número de actos sexuales sin condón con parejas pagantes a cualquier nivel de capital social. Futuras intervenciones de prevención del VIH deben promover el capital social entre los HTS.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

Fig. 1


  1. 1.

    Oldenburg CE, Perez-Brumer AG, Reisner SL, Mattie J, Bärnighausen T, Mayer KH, et al. Global burden of HIV among men who engage in transactional sex: a systematic review and meta-analysis. PLoS ONE. 2014;9(7):e103549.

  2. 2.

    Nerlander LM, Hess KL, Sionean C, Rose CE, Thorson A, Broz D, et al. Exchange sex and HIV infection among men who have sex with men: 20 US cities, 2011. AIDS Behav. 2017;21(8):2283–94.

  3. 3.

    Mimiaga MJ, Reisner SL, Tinsley JP, Mayer KH, Safren SA. Street workers and internet escorts: contextual and psychosocial factors surrounding HIV risk behavior among men who engage in sex work with other men. J Urban Health. 2009;86(1):54–66.

  4. 4.

    Landers S, Closson EF, Oldenburg CE, Holcomb R, Spurlock S, Mimiaga MJ. HIV prevention needs among street-based male sex workers in Providence, Rhode Island. Am J Public Health. 2014;104(11):e100–2.

  5. 5.

    Biello KB, Colby D, Closson E, Mimiaga MJ. The syndemic condition of psychosocial problems and HIV risk among male sex workers in Ho Chi Minh City, Vietnam. AIDS Behav. 2014;18(7):1264–71.

  6. 6.

    Cohan D, Lutnick A, Davidson P, Cloniger C, Herlyn A, Breyer J, et al. Sex worker health: San Francisco style. Sex Transm Infect. 2006;82(5):418–22.

  7. 7.

    George PE, Bayer AM, Garcia PJ, Perez-Lu JE, Burke JG, Coates TJ, et al. Is intimate partner and client violence associated with condomless anal intercourse and HIV among male sex workers in Lima, Peru? AIDS Behav. 2016;20(9):2078–89.

  8. 8.

    Oldenburg CE, Perez-Brumer AG, Reisner SL, Mayer KH, Mimiaga MJ, Hatzenbuehler ML, et al. Human rights protections and HIV prevalence among MSM who sell sex: cross-country comparisons from a systematic review and meta-analysis. Glob Public Health. 2018;13(4):414–25.

  9. 9.

    Oldenburg CE, Perez-Brumer AG, Hatzenbuehler ML, Krakower D, Novak DS, Mimiaga MJ, et al. State-level structural sexual stigma and HIV prevention in a national online sample of HIV-uninfected MSM in the United States. AIDS (London, England). 2015;29(7):837–45.

  10. 10.

    Hatzenbuehler ML, O’Cleirigh C, Safren SA, Mimiaga MJ, Mayer KH. Prospective associations between HIV-related stigma, transmission risk behaviors, and adverse mental health outcomes in men who have sex with men. Ann Behav Med. 2011;42(2):227–34.

  11. 11.

    Balaji AB, Bowles KE, Hess KL, Smith JC, Paz-Bailey G, Taussig J, et al. Association between enacted stigma and HIV-related risk behavior among MSM, National HIV Behavioral Surveillance System, 2011. AIDS Behav. 2017;21(1):227–37.

  12. 12.

    Baral SD, Friedman MR, Geibel S, Rebe K, Bozhinov B, Diouf D, et al. Male sex workers: practices, contexts, and vulnerabilities for HIV acquisition and transmission. Lancet (London, England). 2015;385(9964):260–73.

  13. 13.

    Hatzenbuehler ML, Nolen-Hoeksema S, Erickson SJ. Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: results from a prospective study of bereaved gay men. Health Psychol. 2008;27(4):455–62.

  14. 14.

    Ayala G, Bingham T, Kim J, Wheeler DP, Millett GA. Modeling the impact of social discrimination and financial hardship on the sexual risk of HIV among Latino and Black men who have sex with men. Am J Public Health. 2012;102(S2):S242–9.

  15. 15.

    Choi KH, Steward WT, Miege P, Gregorich SE. Unpacking the influence of sexual stigma on HIV risk: results from a prospective study of men who have sex with men in Beijing, China. J Acquir Immune Defic Syndr. 2017;74(2):e38–44.

  16. 16.

    Oldenburg CE, Biello KB, Colby D, Closson EF, Mai T, Nguyen T, et al. Stigma related to sex work among men who engage in transactional sex with men in Ho Chi Minh City, Vietnam. Int J Public Health. 2014;59(5):833–40.

  17. 17.

    Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.

  18. 18.

    Diaz RM, Ayala G, Bein E, Henne J, Marin BV. The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. Am J Public Health. 2001;91(6):927–32.

  19. 19.

    Reisner SL, Mimiaga MJ, Skeer M, Bright D, Cranston K, Isenberg D, et al. Clinically significant depressive symptoms as a risk factor for HIV infection among Black MSM in Massachusetts. AIDS Behav. 2009;13(4):798–810.

  20. 20.

    Safren SA, Reisner SL, Herrick A, Mimiaga MJ, Stall RD. Mental health and HIV risk in men who have sex with men. J Acquir Immune Defic Syndr. 2010;55(Suppl 2):S74.

  21. 21.

    Mimiaga MJ, Biello KB, Sivasubramanian M, Mayer KH, Anand VR, Safren SA. Psychosocial risk factors for HIV sexual risk among Indian men who have sex with men. AIDS Care. 2013;25(9):1109–13.

  22. 22.

    Moore S, Kawachi I. Twenty years of social capital and health research: a glossary. J Epidemiol Community Health. 2017;71(5):513–7.

  23. 23.

    Putnam RD, Leonardi R, Nanetti RY. Making democracy work: civic traditions in modern Italy. Princeton: Princeton University Press; 1994.

  24. 24.

    Putnam RD. Bowling alone: the collapse and revival of American community. New York: Simon and Schuster; 2001.

  25. 25.

    Ferlander S. The importance of different forms of social capital for health. Acta Sociol. 2007;50(2):115–28.

  26. 26.

    Moore S, Carpiano RM. Measures of personal social capital over time: a path analysis assessing longitudinal associations among cognitive, structural, and network elements of social capital in women and men separately. Soc Sci Med. 2019.

  27. 27.

    Harpham T. The measurement of community social capital through surveys. Social capital and health. New York: Springer; 2008. p. 51–62.

  28. 28.

    Bourdieu P. The forms of capital. Handbook of theory and research for the sociology of education. New York: Greenwood; 1986. p. 241–258.

  29. 29.

    Carpiano RM. Actual or potential neighborhood resources for health. Social capital and health. New York: Springer; 2008. p. 83–93.

  30. 30.

    Coleman JS. Social capital in the creation of human capital. Am J Sociol. 1988;94:S95–120.

  31. 31.

    Moore S, Shiell A, Hawe P, Haines VA. The privileging of communitarian ideas: citation practices and the translation of social capital into public health research. Am J Public Health. 2005;95(8):1330–7.

  32. 32.

    Ransome Y, Thurber KA, Swen M, Crawford ND, German D, Dean LT. Social capital and HIV/AIDS in the United States: knowledge, gaps, and future directions. Popul Health. 2018;5:73–85.

  33. 33.

    Crosby RA, Holtgrave DR, DiClemente RJ, Wingood GM, Gayle JA. Social capital as a predictor of adolescents’ sexual risk behavior: a state-level exploratory study. AIDS Behav. 2003;7(3):245–52.

  34. 34.

    Holtgrave DR, Crosby RA. Social capital, poverty, and income inequality as predictors of gonorrhoea, syphilis, chlamydia and AIDS case rates in the United States. Sex Transm Infect. 2003;79(1):62–4.

  35. 35.

    Ransome Y, Galea S, Pabayo R, Kawachi I, Braunstein S, Nash D. Social capital is associated with late HIV diagnosis: an ecological analysis. J Acquir Immune Defic Syndr. 2016;73(2):213–21.

  36. 36.

    Webel A, Phillips JC, Rose CD, Holzemer WL, Chen W-T, Tyer-Viola L, et al. A cross-sectional description of social capital in an international sample of persons living with HIV/AIDS (PLWH). BMC Public Health. 2012;12:188.

  37. 37.

    Kerrigan DL, Fonner VA, Stromdahl S, Kennedy CE. Community empowerment among female sex workers is an effective HIV prevention intervention: a systematic review of the peer-reviewed evidence from low- and middle-income countries. AIDS Behav. 2013;17(6):1926–40.

  38. 38.

    Carrasco MA, Barrington C, Perez M, Donastorg Y, Kerrigan D. Social cohesion, condom use, and sexually transmitted infections among female sex workers living with HIV in the Dominican Republic. Int J STD AIDS. 2019;30(1):64–71.

  39. 39.

    Lippman SA, Donini A, Díaz J, Chinaglia M, Reingold A, Kerrigan D. Social-environmental factors and protective sexual behavior among sex workers: the Encontros intervention in Brazil. Am J Public Health. 2010;100(S1):S216–23.

  40. 40.

    Grover E, Grosso A, Ketende S, Kennedy C, Fonner V, Adams D, et al. Social cohesion, social participation and HIV testing among men who have sex with men in Swaziland. AIDS Care. 2016;28(6):795–804.

  41. 41.

    Kobayashi T, Kawachi I, Iwase T, Suzuki E, Takao S. Individual-level social capital and self-rated health in Japan: an application of the resource generator. Soc Sci Med. 2013;85:32–7.

  42. 42.

    Verhaeghe P-P, Pattyn E, Bracke P, Verhaeghe M, Van De Putte B. The association between network social capital and self-rated health: pouring old wine in new bottles? Health Place. 2012;18(2):358–65.

  43. 43.

    Song L, Lin N. Social capital and health inequality: evidence from Taiwan. J Health Soc Behav. 2009;50(2):149–63.

  44. 44.

    Wu YH, Moore S, Dube L. Social capital and obesity among adults: longitudinal findings from the Montreal neighborhood networks and healthy aging panel. Prev Med. 2018;111:366–70.

  45. 45.

    Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985;98(2):310–57.

  46. 46.

    Kawachi I, Berkman LF. Social ties and mental health. J Urban Health. 2001;78(3):458–67.

  47. 47.

    Walsh SD, Kolobov T, Harel-Fisch Y. Social capital as a moderator of the relationship between perceived discrimination and alcohol and cannabis use among immigrant and non-immigrant adolescents in Israel. Front Psychol. 2018;9:1556.

  48. 48.

    Mandelbaum J, Moore S, Silveira PP, Meaney MJ, Levitan RD, Dubé L. Does social capital moderate the association between children’s emotional overeating and parental stress? A cross-sectional study of the stress-buffering hypothesis in a sample of mother-child dyads. Soc Sci Med. 2018.

  49. 49.

    Safren SA, Thomas BE, Mayer KH, Biello KB, Mani J, Rajagandhi V, et al. A pilot RCT of an intervention to reduce HIV sexual risk and increase self-acceptance among MSM in Chennai, India. AIDS Behav. 2014;18(10):1904–12.

  50. 50.

    Garofalo R, Kuhns LM, Reisner SL, Biello K, Mimiaga MJ. Efficacy of an empowerment-based, group-delivered HIV prevention intervention for young transgender women: the Project LifeSkills randomized clinical trial. JAMA Pediatr. 2018;172(10):916–23.

  51. 51.

    Gorbach PM, Mensch BS, Husnik M, Coly A, Mâsse B, Makanani B, et al. Effect of computer-assisted interviewing on self-reported sexual behavior data in a microbicide clinical trial. AIDS Behav. 2013;17(2):790–800.

  52. 52.

    Jarlais DCD, Paone D, Milliken J, Turner CF, Miller H, Gribble J, et al. Audio-computer interviewing to measure risk behaviour for HIV among injecting drug users: a quasi-randomised trial. The Lancet. 1999;353(9165):1657–61.

  53. 53.

    Lakon CM, Godette DC, Hipp JR. Network-based approaches for measuring social capital. Social capital and health. New York: Springer; 2008. p. 63–81.

  54. 54.

    Borgatti SP, Everett MG, Johnson JC. Analyzing social networks. Thousand Oaks: Sage; 2018.

  55. 55.

    Latkin C, Yang C, Tobin K, Roebuck G, Spikes P, Patterson J. Social network predictors of disclosure of MSM behavior and HIV-positive serostatus among African American MSM in Baltimore, Maryland. AIDS Behav. 2012;16(3):535–42.

  56. 56.

    Fonner VA, Kerrigan D, Mnisi Z, Ketende S, Kennedy CE, Baral S. Social cohesion, social participation, and HIV related risk among female sex workers in Swaziland. PLoS ONE. 2014;9(1):e87527.

  57. 57.

    Rueda S, Mitra S, Chen S, Gogolishvili D, Globerman J, Chambers L, et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open. 2016;6(7):e011453.

  58. 58.

    Carter RT. Racism and psychological and emotional injury: recognizing and assessing race-based traumatic stress. Couns Psychol. 2007;35(1):13–105.

  59. 59.

    Lippman SA, Chinaglia M, Donini AA, Diaz J, Reingold A, Kerrigan DL. Findings from Encontros: a multilevel STI/HIV intervention to increase condom use, reduce STI, and change the social environment among sex workers in Brazil. Sex Transm Dis. 2012;39(3):209–16.

  60. 60.

    Galárraga O, Sosa-Rubí SG, González A, Badial-Hernández F, Conde-Glez CJ, Juárez-Figueroa L, et al. The disproportionate burden of HIV and STIs among male sex workers in Mexico City and the rationale for economic incentives to reduce risks. J Int AIDS Soc. 2014;17(1):19218.

  61. 61.

    Valente PK, Mantell JE, Masvawure TB, Tocco JU, Restar AJ, Gichangi P, et al. I couldn’t afford to resist: condom negotiations between male sex workers and male clients in Mombasa, Kenya. AIDS Behav. 2019;1–13.

  62. 62.

    Rose R. How much does social capital add to individual health? Soc Sci Med. 2000;51(9):1421–35.

  63. 63.

    Elifson KW, Boles J, Sweat M. Risk factors associated with HIV infection among male prostitutes. Am J Public Health. 1993;83(1):79–83.

  64. 64.

    Mimiaga MJ, Reisner SL, Closson EF, Perry N, Perkovich B, Nguyen T, et al. Self-perceived HIV risk and the use of risk reduction strategies among men who engage in transactional sex with other men in Ho Chi Minh City, Vietnam. AIDS Care. 2013;25(8):1039–44.

  65. 65.

    Sullivan PS, Salazar L, Buchbinder S, Sanchez TH. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS (London, England). 2009;23(9):1153–62.

  66. 66.

    Goodreau SM, Carnegie NB, Vittinghoff E, Lama JR, Sanchez J, Grinsztejn B, et al. What drives the US and Peruvian HIV epidemics in men who have sex with men (MSM)? PLoS ONE. 2012;7(11):e50522.

  67. 67.

    Voeten HACM, Egesah OB, Varkevisser CM, Habbema JDF. Female sex workers and unsafe sex in urban and rural Nyanza, Kenya: regular partners may contribute more to HIV transmission than clients. Trop Med Int Health. 2007;12(2):174–82.

  68. 68.

    Grov C, Wolff M, Smith MD, Koken J, Parsons JT. Male clients of male escorts: satisfaction, sexual behavior, and demographic characteristics. J Sex Res. 2014;51(7):827–37.

  69. 69.

    Prestage G, Jin F, Bavinton B, Hurley M. Sex workers and their clients among Australian gay and bisexual men. AIDS Behav. 2014;18(7):1293–301.

  70. 70.

    Verhaegh-Haasnoot A, Dukers-Muijrers NHTM, Hoebe CJPA. High burden of STI and HIV in male sex workers working as internet escorts for men in an observational study: a hidden key population compared with female sex workers and other men who have sex with men. BMC Infect Dis. 2015;15(1):291.

  71. 71.

    Timpson SC, Ross MW, Williams ML, Atkinson J. Characteristics, drug use, and sex partners of a sample of male sex workers. Am J Drug Alcohol Abuse. 2007;33(1):63–9.

  72. 72.

    Clatts MC, Giang LM, Goldsamt LA, Yi H. Male sex work and HIV risk among young heroin users in Hanoi, Vietnam. Sex Health. 2007;4(4):261–7.

  73. 73.

    Weber AE, Craib KJ, Chan K, Martindale S, Miller ML, Schechter MT, et al. Sex trade involvement and rates of human immunodeficiency virus positivity among young gay and bisexual men. Int J Epidemiol. 2001;30(6):1449–54.

  74. 74.

    Rietmeijer CA, Wolitski RJ, Fishbein M, Corby NH, Cohn DL. Sex hustling, injection drug use, and non-gay identification by men who have sex with men: associations with high-risk sexual behaviors and condom use. Sex Transm Dis. 1998;25(7):353–60.

  75. 75.

    Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995;36:38–56.

  76. 76.

    Hightow-Weidman LB, Phillips G 2nd, Jones KC, Outlaw AY, Fields SD, Smith JC. Racial and sexual identity-related maltreatment among minority YMSM: prevalence, perceptions, and the association with emotional distress. AIDS Patient Care STDs. 2011;25(Suppl 1):S39–45.

  77. 77.

    Friedman MR, Kurtz SP, Buttram ME, Wei C, Silvestre AJ, Stall R. HIV risk among substance-using men who have sex with men and women (MSMW): findings from South Florida. AIDS Behav. 2014;18(1):111–9.

  78. 78.

    Preston DB, D’Augelli AR, Kassab CD, Starks MT. The relationship of stigma to the sexual risk behavior of rural men who have sex with men. AIDS Educ Prev. 2007;19(3):218–30.

  79. 79.

    Pronyk PM, Harpham T, Busza J, Phetla G, Morison LA, Hargreaves JR, et al. Can social capital be intentionally generated? A randomized trial from rural South Africa. Soc Sci Med. 2008;67(10):1559–70.

Download references


The authors would like to thank the participants and research staff for their contribution to this study and Alberto Edeza and Naiane Lomes for translating the abstract into Spanish. This work was supported by the National Institute on Drug Abuse of the National Institutes of Health (R21DA035113; PI: Biello/Mimiaga). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The work described in this manuscript was presented at the AIDSImpact conference in London, UK, July 29–31, 2019. This manuscript has not been published previously, nor is it being considered for publication elsewhere.

Author information

Correspondence to Katie B. Biello.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

The Institutional Review Boards at Fenway Health approved the study.

Informed Consent

All participants underwent informed consent process. Written informed consent was obtained from all participants.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Valente, P.K., Mimiaga, M.J., Mayer, K.H. et al. Social Capital Moderates the Relationship Between Stigma and Sexual Risk Among Male Sex Workers in the US Northeast. AIDS Behav 24, 29–38 (2020).

Download citation


  • Male sex workers
  • Men who have sex with men
  • Social capital
  • Stigma

Palabras clave

  • VIH
  • Hombres trabajadores sexuales
  • Hombres que tienen sexo con hombres
  • Capital social
  • Estigma