Abstract
Resilience is an understudied intrapersonal factor that may reduce HIV risk among men who have sex with men (MSM). Multivariable Poisson regression models were used to estimate the prevalence ratio (PR) of sexual risk behaviors, HIV prevalence, and history of sexually transmitted infections (STIs) with resilience scores in a population-based study among 364 black MSM in the Deep South. Participants with higher resilience scores had a lower prevalence of condomless anal sex with casual sexual partners in past 12 months (PR = 0.80, p value = 0.001) and during their last sexual encounter (PR = 0.81; p value = 0.009). Resilience was inversely associated with a lower prevalence of condomless anal sex with main sexual partners, participating in a sex party/orgy and having a STI in the past 12 months. Resilience may have a protective effect on HIV among black MSM, especially in the Deep South, and should be further explored in studies with prospective designs.
Resumen
La resistencia es un factor intrapersonal que ha sido poco estudiado que puede reducir el riesgo de VIH entre los hombres que tienen sex con hombres (HSH). Modelos de regresión multivariable de Posesión han sido utilizado para estimar el ratio de prevalencia (RP) de los comportamientos sexuales, la prevalencia de VIH, y la historia de infección de transmisión sexual (ITS) en comparación con los resultados de resistencia en un estudio basado en la población entre 364 HSH negros en los estados del sureste de los EEUU. Los participantes con mayor resistencia tuvieron una prevalencia menor de tener sexo anal sin un condón con una pareja sexual casual en los últimos 12 meses (PR = 0.80; p = 0.001) y en su último encuentro sexual (PR = 0.81; p = 0.009). La resistencia fue inversamente asociado con una prevalencia baja de sexo anal sin condón con una pareja sexual principal, participando en una orgía y si tiene un ITS en los últimos 12 meses. La resistencia puede que tenga un efecto protector de VIH con la población HSH negros, especialmente en los estados del sureste de los EEUU, y debe estar mejor investigado con investigaciones prospectivas.
Similar content being viewed by others
References
Centers for Disease Control and Prevention. HIV Surveillance Report, 2015; vol. 27. Available at: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2015-vol-27.pdf.
Lieb S, Prejean J, Thompson DR, Fallon SJ, Cooper H, Gates GJ, et al. HIV prevalence rates among men who have sex with men in the southern United States: population-based estimates by race/ethnicity. AIDS Behav. 2011;15(3):596–606.
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Half of black gay men and a quarter of Latino gay men projected to be diagnosed within their lifetime. 2016. Retrieved from http://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-risk.html.
Matthews DD, Smith JC, Brown AL, Malebranche DJ. Reconciling epidemiology and social justice in the public health discourse around the sexual networks of black men who have sex with men. Am J Public Health. 2016;106(5):808–14.
Hickson DA, Truong NL, Smith-Bankhead N, Sturdevant N, Duncan DT, Schnorr J, et al. Rationale, design and methods of the ecological study of sexual behaviors and HIV/STI among African American men who have sex with men in the Southeastern United States (the MARI study). PLoS ONE. 2015;10(12):e0143823.
Baral S, Logie CH, Grosso A, Wirtz AL, Beyrer C. Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics. BMC Public Health. 2013;13:482.
Mayer KH, Wheeler DP, Bekker LG, Grinsztejn B, Remien RH, Sandfort TG, et al. Overcoming biological, behavioral, and structural vulnerabilities: new directions in research to decrease HIV transmission in men who have sex with men. J Acquir Immune Defic Syndr. 2013;63(Suppl 2):S161–7.
Fullilove R. African Americans, health disparities and HIV/AIDS: Recommendations for confronting the epidemic in Black America. 2006. Available at: http://img.thebody.com/nmac/blacks_aids.pdf.
McCree DH, Jones KT, O’Leary A, editors. African Americans and HIV/AIDS: understanding and addressing the epidemic. New York: Springer; 2010.
Fergus S, Zimmerman MA. Adolescent resilience: a framework for understanding healthy development in the face of risk. Annu Rev Public Health. 2005;26:399–419.
Wilson PA, Meyer IH, Antebi-Gruszka N, Boone MR, Cook SH, Cherenack EM. Profiles of resilience and psychosocial outcomes among young black gay and bisexual men. Am J Community Psychol. 2016;57(1–2):144–57.
Masten AS. Ordinary magic: resilience processes in development. Am Psychol. 2001;56(3):227–38.
Buttram ME. The social environmental elements of resilience among vulnerable African American/black men who have sex with men. J Hum Behav Soc Environ. 2015;25(8):923–33.
Herrick AL, Stall R, Goldhammer H, Egan JE, Mayer KH. Resilience as a research framework and as a cornerstone of prevention research for gay and bisexual men: theory and evidence. AIDS Behav. 2014;18(1):1–9.
Mustanski BS, Newcomb ME, Du Bois SN, Garcia SC, Grov C. HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions. J Sex Res. 2011;48(2–3):218–53.
Herrick AL, Stall R, Chmiel JS, Guadamuz TE, Penniman T, Shoptaw S, et al. It gets better: resolution of internalized homophobia over time and associations with positive health outcomes among MSM. AIDS Behav. 2013;17(4):1423–30.
Gwadz MV, Clatts MC, Yi H, Leonard NR, Goldsamt L, Lankenau S. Resilience among young men who have sex with men in New York City. Sex Res Soc Policy. 2006;3(1):13–21.
Kurtz SP, Buttram ME, Surratt HL, Stall RD. Resilience, syndemic factors, and serosorting behaviors among HIV-positive and HIV-negative substance-using MSM. AIDS Educ Prev. 2012;24(3):193–205.
Mustanski B, Garofalo R, Herrick A, Donenberg G. Psychosocial health problems increase risk for HIV among urban young men who have sex with men: preliminary evidence of a syndemic in need of attention. Ann Behav Med. 2007;34(1):37–45.
Quinn K, Dickson-Gomez J, DiFranceisco W, Kelly JA, Lawrence JS. Correlates of internalized homonegativity among black men who have sex with men. AIDS Educ Prev. 2015;27(3):212–26.
Boone MR. Internalized homophobia, psychological distress, and resilience as correlates of substance use during sexual encounters in young adult black men who have sex with men. Columbia: Academic Commons. Available at: https://academiccommons.columbia.edu/catalog/ac:178201.
Peterson JL, Bakeman R, Sullivan P, Millett GA, Rosenberg E, Salazar L, et al. Social discrimination and resiliency are not associated with differences in prevalent HIV infection in black and white men who have sex with men. J Acquir Immune Defic Syndr. 2014;66(5):538–43.
Scott HM, Pollack L, Rebchook GM, Huebner DM, Peterson J, Kegeles SM. Peer social support is associated with recent HIV testing among young black men who have sex with men. AIDS Behav. 2014;18(5):913–20.
O’Leary A, Jemmott JB III, Stevens R, Rutledge SE, Icard LD. Optimism and education buffer the effects of syndemic conditions on HIV status among African American men who have sex with men. AIDS Behav. 2014;18(11):2080–8.
Reif S, Geonnotti KL, Whetten K. HIV infection and AIDS in the Deep South. Am J Public Health. 2006;96(6):970–3.
Reif S, Pence BW, Hall I, Hu X, Whetten K, Wilson E. HIV diagnoses, prevalence and outcomes in nine southern states. J Community Health. 2015;40(4):642–51.
Reif SS, Whetten K, Wilson ER, McAllaster C, Pence BW, Legrand S, et al. HIV/AIDS in the Southern USA: a disproportionate epidemic. AIDS Care. 2014;26(3):351–9.
Millett GA, Peterson JL, Wolitski RJ, Stall R. Greater risk for HIV infection of black men who have sex with men: a critical literature review. Am J Public Health. 2006;96(6):1007–19.
Maulsby C, Millett G, Lindsey K, Kelley R, Johnson K, Montoya D, et al. HIV among black men who have sex with men (MSM) in the United States: a review of the literature. AIDS Behav. 2014;18(1):10–25.
Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson resilience scale (CD-RISC). Depress Anxiety. 2003;18:76–82.
Campbell-Sills L, Cohan SL, Stein MB. Relationship of resilience to personality, coping, and psychiatric symptoms in young adults. Behav Res Ther. 2006;44(4):585–99.
Brown DL. African American resiliency: examining racial socialization and social support as protective factors. J Black Psychol. 2008;34:32–48.
Coates EE, Phares V, Dedrick RF. Psychometric properties of the Connor-Davidson Resilience Scale 10 among low-income, African American men. Psychol Assess. 2013;25(4):1349–54.
Campbell-Sills L, Stein MB. Psychometric analysis and refinement of the Connor-davidson Resilience Scale (CD-RISC): validation of a 10-item measure of resilience. J Trauma Stress. 2007;20(6):1019–28.
Resnick BA, Inguito PL. The Resilience Scale: psychometric properties and clinical applicability in older adults. Arch Psychiatr Nurs. 2011;25(1):11–20.
Spiegelman D, Hertzmark E. Easy SAS calculations for risk or prevalence ratios and differences. Am J Epidemiol. 2005;162(3):199–200.
Poteat T, German D, Flynn C. The conflation of gender and sex: gaps and opportunities in HIV data among transgender women and MSM. Glob Public Health. 2016;11(7–8):835–48.
Sanchez T, Finlayson T, Murrill C, Guilin V, Dean L. Risk behaviors and psychosocial stressors in the New York City house ball community: a comparison of men and transgender women who have sex with men. AIDS Behav. 2010;14(2):351–8.
Bauermeister JA, Ventuneac A, Pingel E, Parsons JT. Spectrums of love: examining the relationship between romantic motivations and sexual risk among young gay and bisexual men. AIDS Behav. 2012;16(6):1549–59.
MacDonald TK, Martineau AM. Self-esteem, mood, and intentions to use condoms: when does low self-esteem lead to risky health behaviors? J Exp Soc Psychol. 2002;38(3):299–306.
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. 2009;23(9):1153–62.
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.
Mimiaga MJ, Reisner SL, Bland SE, Driscoll MA, Cranston K, Isenberg D, et al. Sex parties among urban MSM: an emerging culture and HIV risk environment. AIDS Behav. 2011;15(2):305–18.
Solomon TM, Halkitis PN, Moeller RM, Siconolfi DE, Kiang MV, Barton SC. Sex parties among young gay, bisexual, and other men who have sex with men in New York City: attendance and behavior. J Urban Health. 2011;88(6):1063–75.
Binson D, Woods WJ, Pollack L, Paul J, Stall R, Catania JA. Differential HIV risk in bathhouses and public cruising areas. Am J of Public Health. 2001;91(9):1482–6.
Grov C, Parsons JT, Bimbi DS. Sexual risk behavior and venues for meeting sex partners: an intercept survey of gay and bisexual men in LA and NYC. AIDS Behav. 2007;11(6):915–26.
Pollock JA, Halkitis PN. Environmental factors in relation to unprotected sexual behavior among gay, bisexual, and other MSM. AIDS Educ Prev. 2009;21(4):340–55.
Jones KT, Gray P, Whiteside YO, Wang T, Bost D, Dunbar E, et al. Evaluation of an HIV prevention intervention adapted for black men who have sex with men. Am J Public Health. 2008;98(6):1043–50.
Wilton L, Herbst JH, Coury-Doniger P, Painter TM, English G, Alvarez ME, et al. Efficacy of an HIV/STI prevention intervention for black men who have sex with men: findings from the many men, many voices (3MV) project. AIDS Behav. 2009;13(3):532–44.
Saewyc EM. Research on adolescent sexual orientation: Development, health disparities, stigma, and resilience. J Res Adoles. 2011;21(1):256–72.
Longmore MA, Manning WD, Giordano PC, Rudolph JL. Self-esteem, depressive symptoms, and adolescents’ sexual onset. Soc Psychol Q. 2004;67(3):279–95.
Lohman BJ, Billings A. Protective and risk factors associated with adolescent boys’ early sexual debut and risky sexual behaviors. J Youth Adoles. 2008;37(6):723–35.
Herrick AL, Lim SH, Wei C, Smith H, Guadamuz T, Friedman MS, Stall R. Resilience as an untapped resource in behavioral intervention design for gay men. AIDS Behav. 2011;15(Suppl 1):S25–9.
Jones KT, Johnson WD, Wheeler DP, Gray P, Foust E, Gaiter J. Nonsupportive peer norms and incarceration as HIV risk correlates for young black men who have sex with men. AIDS Behav. 2008;12(1):41–50.
Brewer RA, Magnus M, Kuo I, Wang L, Liu TY, Mayer KH. The high prevalence of incarceration history among black men who have sex with men in the United States: associations and implications. Am J Public Health. 2014;104(3):448–54.
Taussig J, Shouse RL, LaMarre M, et al. HIV transmission among male inmates in a state prison system—Georgia, 1992–2005. J Am Med Assoc. 2006;296(2):162–4.
Millett GA, Peterson JL. The known hidden epidemic: HIV/AIDS among black men who have sex with men in the United States. Am J Prev Med. 2007;32(4 suppl):31–3.
Millett GA, Peterson JL, Flores SA, Hart TA, Jeffries WL, Wilson PA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. Lancet. 2012;380(9839):341–8.
Oster AM, Wiegand RE, Sionean C, Miles IJ, Thomas PE, Melendez-Morales L, et al. Understanding disparities in HIV infection between black and white MSM in the United States. AIDS. 2011;25(8):1103–12.
Sullivan PS, Rosenberg ES, Sanchez TH, Kelley CF, Luisi N, Cooper HL, et al. Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: a prospective observational cohort study. Ann Epidemiol. 2015;25(6):445–54.
Acknowledgements
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. The authors gratefully thank The MARI Study participants for their time and participation in the study as none of this would be possible without them. The authors also thank Dr. Matthew Mimiaga who reviewed an earlier draft of this manuscript and provided critical feedback.
Funding
This study was funded by the Centers for Disease Control and Prevention as part of the Minority HIV/AIDS Research Initiative (Cooperative Agreement: U01PS003315). This work was also supported, in part, by a Grant from the National Institutes of Health (PI: Nunn, Flanigan; MH083620).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that he/she has no conflict of interest. Damian Denson and Madeline Sutton are employees of the Centers for Disease Control and Prevention. The views expressed are their own and do not represent the views of the Centers for Disease Control and Prevention or the United States Government.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
McNair, O.S., Gipson, J.A., Denson, D. et al. The Associations of Resilience and HIV Risk Behaviors Among Black Gay, Bisexual, Other Men Who Have Sex with Men (MSM) in the Deep South: The MARI Study. AIDS Behav 22, 1679–1687 (2018). https://doi.org/10.1007/s10461-017-1881-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-017-1881-8