In the United States, black men who have sex with men (MSM) are disproportionately at risk of contracting HIV. Now, a new poster presented at the 2019 Association of Nurses in AIDS Care (ANAC) conference in Portland, Oregon, offers additional clues about the way intimate relationships might help public health experts understand -- and one day address -- HIV risk among black MSM.
Lead author Natalie Leblanc, Ph.D., M.P.H., RN, at the University of Rochester, presented her analysis on black MSM in the United States in a poster titled, "The Influence of Main Partners on Ecological and Syndemic Factors and Drug Use During Sex Vulnerability Among U.S. Black MSM: A Secondary Analysis."
Experts estimate that somewhere between 40% and 65% of HIV transmissions in U.S. MSM occur between serodiscordant couples. While many MSM talk about their HIV status openly within partnerships, Leblanc says black men are less likely to do so.
"When it comes to black couples, conversations about serostatus are not happening as much as other groups," she said.
Therefore, Leblanc and her colleagues sought to characterize the influence of main, or central, partnerships within the context of black MSM's lives, including the factors that predict HIV risk, alongside syndemic influences that can fuel risk behaviors.
Her research relied on data from a large longitudinal study conducted by the HIV Prevention Trials Network called HPTN 061, which included a sample of 1,553 black MSM from six U.S. cities.
For this analysis, the outcome Leblanc was interested in studying was their likelihood to report drug use during sex. Using drugs during sex decreases inhibitions and may increase the risk of HIV transmission. Leblanc hypothesized that having a main partner might provide support that could be protective broadly when it comes to sexual health.
However, she did not find a big enough sample size to study men who reported monogamous relationships. Ultimately, she compared a group of 681 men who reported that they had one main partner (even if they had casual partnerships outside their main partner), against a group of 791 men who did not have a central partner, but rather multiple casual partners.
About 60% of the men with a main partner reported using drugs during sex, compared to about 57% of the men who only had casual partners.
"There was not a big difference with this particular outcome of drug use during sex," she said. "What we saw in terms of the mean number of partners, they were almost the same."
Leblanc says this is important information that can help guide future research on HIV risk between couples.
"That lends insight into maybe a more social-network approach," she said. "Do we have to have more conversation around focusing on the role of the casual partner?"
Elsewhere in the research, Leblanc looked at predictive factors -- such as childhood violence, economic vulnerability, and anti-black stigma -- to see if those factors influenced a person's likelihood to engage in drug use during sex.
"This particular analysis focused on drug use during sex," she said. "We see that childhood violence, in the context of partnership, [is] still having an impact on drug use during sex."
This direct effect was only significant for men with a main partner. Meanwhile, she found that economic vulnerability and anti-black stigma had an indirect effect on drug use during sex.
"There is a subculture of men who have sex using drugs. In an earlier analysis, we saw that childhood violence was a factor, but we also saw economic status was related. There's addressing the drug use, but what's the motivation for that?"
Leblanc says she's just scratching the surface of couple studies and what they can tell us about HIV risk.
"Couple-based transmission is a contributor in terms of what we see in [racial] disparity," she said, noting that studying couples -- and ultimately tailoring interventions around them -- could go a long way toward reaching HIV elimination targets in the United States.