Profiles of HIV Risk, Sexual Power, and Decision-Making among Sexual Minority Men of Color Who Engage in Transactional Sex: A Latent Profile Analysis

S Raquel Ramos, David T Lardier Jr, Donte T Boyd, José I Gutierrez Jr, Eliana Carasso, David Houng, Trace Kershaw, S Raquel Ramos, David T Lardier Jr, Donte T Boyd, José I Gutierrez Jr, Eliana Carasso, David Houng, Trace Kershaw

Abstract

Though the transmission of HIV is preventable, there were still 37,968 new documented cases in the United States in 2018. HIV incidence is disproportionate in sexual minority men of color. The purpose of this study was to examine sexual relationship power risk profiles to identify distinct subgroups within the profiles who carry the highest HIV risk. Latent class profile analysis was used to identify subgroups of sexual minority men of color at the highest risk for contracting HIV based on their sexual power profiles. Among 322 sexual minority men, we identified four latent profiles. Profile 1: Low transactional sex and high power (n = 133; 14.3%); Profile 2: Transactional sex, high decision-making in sexual relationships, and low control in sexual relationship (n = 99; 30.7%); Profile 3: Low transactional sex, low decision-making, and moderate control (n = 43; 13.4%); Profile 4: High transactional sex and low power (n = 47; 14.6%). LPA was useful to identify distinct subgroups based on measures of sexual risk and relationship sexual power. Findings carry significant implications for developing tailored strategies to increase HIV knowledge and related HIV prevention and risk reduction services for sexual minority men of color who engage in transactional sex.

Trial registration: ClinicalTrials.gov NCT04061915.

Keywords: HIV; MSM; latent profile analysis; pre-exposure prophylaxis; sexual behavior; sexual relationship power; transactional sex; young adult.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Sexual power profiles using standardized means.

References

    1. CDC HIV Surveillance Report, 2018 (Updated); CDC: Atlanta, GA, USA, 2020; Volume 31. [(accessed on 4 April 2021)]; Available online:
    1. NIH About SGMRO. [(accessed on 21 February 2021)]; Available online: .
    1. Pulerwitz J., Gortmaker S.L., DeJong W. Measuring Sexual Relationship Power in HIV/STD Research. Sex Roles. 2000;42:637–660. doi: 10.1023/A:1007051506972.
    1. Luft H., Ke W., Trifol L., Halpern M., Larson E. Sexual Relationship Power and Safe Sex Communication among Partnered Women in the Dominican Republic. J. Transcult. Nurs. 2020;31:28–37. doi: 10.1177/1043659619840413.
    1. Mustanski B., Newcomb M.E., Clerkin E.M. Relationship characteristics and sexual risk-taking in young men who have sex with men. Health Psychol. 2011;30:597–605. doi: 10.1037/a0023858.
    1. Walters S.M., Braksmajer A., Coston B., Yoon I., Grov C., Downing M.J., Teran R., Hirshfield S. A Syndemic Model of Exchange Sex among HIV-Positive Men Who Have Sex with Men. Arch. Sex. Behav. 2020;49:1965–1978. doi: 10.1007/s10508-020-01628-8.
    1. Javanbakht M., Ragsdale A., Shoptaw S., Gorbach P.M. Transactional Sex among Men Who Have Sex with Men: Differences by Substance Use and HIV Status. J. Hered. 2019;96:429–441. doi: 10.1007/s11524-018-0309-8.
    1. Luke N., Goldberg R.E., Mberu B.U., Zulu E.M. Social Exchange and Sexual Behavior in Young Women’s Premarital Relationships in Kenya. J. Marriage Fam. 2011;73:1048–1064. doi: 10.1111/j.1741-3737.2011.00863.x.
    1. Morris M.D., Montgomery M.E., Briceno A., Evans J.L., Andrew E.V., Page K., Hahn J.A. A Study of Sexual Relationship Power among Young Women Who Inject Drugs and Their Sexual Partners. Subst. Use Misuse. 2018;53:1281–1287. doi: 10.1080/10826084.2017.1404105.
    1. Pulerwitz J., Amaro H., Jong W.D., Gortmaker S.L., Rudd R. Relationship power, condom use and HIV risk among women in the USA. AIDS Care. 2002;14:789–800. doi: 10.1080/0954012021000031868.
    1. Dworkin S.L., Zakaras J.M., Campbell C., Wilson P., Grisham K., Chakravarty D., Neilands T.B., Hoff C. Relationship Power Among Same-Sex Male Couples in New York and San Francisco: Laying the Groundwork for Sexual Risk Reduction Interventions Focused on Interpersonal Power. J. Sex Res. 2017;54:923–935. doi: 10.1080/00224499.2017.1279258.
    1. Crosby R.A., DiClemente R.J., Salazar L.F., Wingood G.M., McDermott-Sales J., Young A.M., Rose E. Predictors of Consistent Condom Use among Young African American Women. AIDS Behav. 2013;17:865–871. doi: 10.1007/s10461-011-9998-7.
    1. Carey M.P., Schroder K.E. Development and Psychometric Evaluation of the Brief HIV Knowledge Questionnaire. AIDS Educ. Prev. 2002;14:172–182. doi: 10.1521/aeap.14.2.172.23902.
    1. Mahat G., Scoloveno M.A., Ayres C. Comparison of Adolescents’ HIV/AIDS Knowledge and Self-Efficacy across Two Cultures. J. Cult. Divers. 2014;21:152–158.
    1. Villegas N., Cianelli R., Gonzalez-Guarda R., Kaelber L., Ferrer L., Peragallo N. Predictors of Self-Efficacy for HIV Prevention among Hispanic Women in South Florida. J. Assoc. Nurses AIDS Care. 2013;24:27–37. doi: 10.1016/j.jana.2012.03.004.
    1. Tulloch H.E., Balfour L., Kowal J., Tasca G.A., Angel J.B., Garber G., MacPherson P., Cooper C., Cameron D.W. HIV Knowledge among Canadian-Born and Sub-Saharan African-Born Patients Living with HIV. J. Immigr. Minor. Health. 2012;14:132–139. doi: 10.1007/s10903-011-9480-7.
    1. Swenson R.R., Rizzo C.J., Brown L.K., Vanable P.A., Carey M.P., Valois R.F., DiClemente R.J., Romer D. HIV Knowledge and Its Contribution to Sexual Health Behaviors of Low-Income African American Adolescents. J. Natl. Med. Assoc. 2010;102:1173–1182. doi: 10.1016/S0027-9684(15)30772-0.
    1. Bond K.T., Yoon I.S., Houang S.T., Downing M.J., Grov C., Hirshfield S. Transactional Sex, Substance Use, and Sexual Risk: Comparing Pay Direction for an Internet-Based, U.S. Sample of Men Who Have Sex with Men. Sex. Res. Soc. Policy. 2019;16:255–267. doi: 10.1007/s13178-018-0366-5.
    1. Barman-Adhikari A., Hsu H.T., Begun S., Portillo A.P., Rice E. Condomless Sex among Homeless Youth: The Role of Multidimensional Social Norms and Gender. AIDS Behav. 2017;21:688–702. doi: 10.1007/s10461-016-1624-2.
    1. Turpin R.E., Dyer T.V., Dangerfield II D.T., Liu H., Mayer K.H. Syndemic latent transition analysis in the HPTN 061 cohort: Prospective interactions between trauma, mental health, social support, and substance use. Drug Alcohol Depend. 2020;214:108106. doi: 10.1016/j.drugalcdep.2020.108106.
    1. Dangerfield D.T., Smith L.R., Anderson J.N., Bruce O.J., Farley J., Bluthenthal R. Sexual Positioning Practices and Sexual Risk among Black Gay and Bisexual Men: A Life Course Perspective. AIDS Behav. 2018;22:1919–1931. doi: 10.1007/s10461-017-1948-6.
    1. Smith L.A., Kolokotroni K.Z., Turner-Moore T. Making and Communicating Decisions about Sexual Consent during Drug-Involved Sex: A Thematic Synthesis. J. Sex Res. 2020;58:1–19. doi: 10.1080/00224499.2019.1706072.
    1. Rash C.J., Burki M., Montezuma-Rusca J.M., Petry N.M. A retrospective and prospective analysis of trading sex for drugs or money in women substance abuse treatment patients. Drug Alcohol Depend. 2016;162:182–189. doi: 10.1016/j.drugalcdep.2016.03.006.
    1. Threats M., Boyd D.T., Diaz J.E., Adebayo O.W. Deterrents and motivators of HIV testing among young Black men who have sex with men in North Carolina. AIDS Care. 2020:1–9. doi: 10.1080/09540121.2020.1852161.
    1. Thapa S., Hannes K., Cargo M., Buve A., Peters S., Dauphin S., Mathei C. Stigma reduction in relation to HIV test uptake in low- and middle-income countries: A realist review. BMC Public Health. 2018;18 doi: 10.1186/s12889-018-6156-4.
    1. Turpin R.E., Slopenm N., Chen S., Boekeloo B., Dallal C., Dyer T. Latent class analysis of a syndemic of risk factors on HIV testing among black men. AIDS Care. 2019;31:216–223. doi: 10.1080/09540121.2018.1524117.
    1. Harvey S.M., Bird S.T., Galavotti C., Duncan E.A., Greenberg D. Relationship power, sexual decision making and condom use among women at risk for HIV/STDS. Women Health. 2002;36:69–84. doi: 10.1300/J013v36n04_06.
    1. Pulerwitz J., Mathur S., Woznica D. How empowered are girls/young women in their sexual relationships? Relationship power, HIV risk, and partner violence in Kenya. PLoS ONE. 2018;13:e0199733. doi: 10.1371/journal.pone.0199733.
    1. Vermunt J.K., Magidson J. Technical Guide for Latent GOLD 5.0: Basic, Advanced, and Syntax. Statistical Innovations Inc.; Belmont, MA, USA: 2013.
    1. DiIorio C. Handbook of Sexuality-Related Measures. Routledge; Abingdon, UK: 2011. Safe Sex Behavior Questionnaire; pp. 594–596.
    1. Aneshensel C.S. Theory-Based Data Analysis for the Social Sciences. Sage Publications; Thousand Oaks, CA, USA: 2012.
    1. Howard M.C., Hoffman M.E. Variable-Centered, Person-Centered, and Person-Specific Approaches. Organ. Res. Methods. 2017;21:846–876. doi: 10.1177/1094428117744021.
    1. Bursac Z., Gauss C.H., Williams D.K., Hosmer D.W. Purposeful selection of variables in logistic regression. Source Code Biol. Med. 2008;3:17. doi: 10.1186/1751-0473-3-17.
    1. Langeheine R., Pannekoek J., Van de Pol F. Bootstrapping Goodness-of-Fit Measures in Categorical Data Analysis. Sociol. Methods Res. 1996;24:492–516. doi: 10.1177/0049124196024004004.
    1. Nerlander L.M., Hess K.L., Sionean C., Rose C.E., Thorson A., Broz D., Paz-Bailey G. Exchange Sex and HIV Infection among Men Who Have Sex with Men: 20 US Cities, 2011. AIDS Behav. 2017;21:2283–2294. doi: 10.1007/s10461-016-1450-6.
    1. CDC HIV and Substance Use 2020. [(accessed on 4 April 2021)]; Available online: .
    1. Kalichman S.C., Ntseane D., Nthomang K., Segwabe M., Phorano O., Simbayi L.C. Recent multiple sexual partners and HIV transmission risks among people living with HIV/AIDS in Botswana. Sex. Transm. Infect. 2007;83:371–375. doi: 10.1136/sti.2006.023630.
    1. Johns M.M., Pingel E., Eisenberg A., Santana M.L., Bauermeister J. Butch Tops and Femme Bottoms? Sexual Positioning, Sexual Decision Making, and Gender Roles among Young Gay Men. Am. J. Men’s Health. 2012;6:505–518. doi: 10.1177/1557988312455214.
    1. Dangerfield D.T., Smith L.R., Williams J., Unger J., Bluthenthal R. Sexual Positioning Among Men Who Have Sex with Men: A Narrative Review. Arch. Sex. Behav. 2017;46:869–884. doi: 10.1007/s10508-016-0738-y.
    1. White J.M., Reisner S.L., Dunham E., Mimiaga M.J. Race-Based Sexual Preferences in a Sample of Online Profiles of Urban Men Seeking Sex with Men. J. Hered. 2014;91:768–775. doi: 10.1007/s11524-013-9853-4.
    1. Mimiaga M.J., Reisner S.L., Fontaine Y.M., Bland S.E., Driscoll M.A., Isenberg D., Cranston K., Skeer M.R., Mayer K.H. Walking the line: Stimulant use during sex and HIV risk behavior among Black urban MSM. Drug Alcohol Depend. 2010;110:30–37. doi: 10.1016/j.drugalcdep.2010.01.017.
    1. Heiligenberg M., Wermeling P.R., van Rooijen M.S., Urbanus A.T., Speksnijder A.G., Heijman T., Prins M., Coutinho R.A., van der Loeff M.F. Recreational Drug Use During Sex and Sexually Transmitted Infections Among Clients of a City Sexually Transmitted Infections Clinic in Amsterdam, The Netherlands. Sex. Transm. Dis. 2012;39:518–527. doi: 10.1097/OLQ.0b013e3182515601.
    1. Brook D.W., Brook J.S., Pahl T., Montoya I. The longitudinal relationship between drug use and risky sexual behaviors among colombian adolescents. Arch. Pediatr. Adolesc. Med. 2002;156:1101–1107. doi: 10.1001/archpedi.156.11.1101.
    1. Semega J., Kollar M., Shrider E., Creamer J. Income and Poverty in the United States: 2019. The United States Census Bureau; Suitland, MD, USA: 2020. Current Population Reports (P60-270)
    1. Agüero J.M., Bharadwaj P. Do the More Educated Know More about Health? Evidence from Schooling and HIV Knowledge in Zimbabwe. Econ. Dev. Cult. Chang. 2014;62:489–517. doi: 10.1086/675398.
    1. CDC Why Schools? The Centers for Disease Control and Prevention 2020. [(accessed on 4 April 2021)]; Available online: .
    1. Ma Z.Q., Fisher M.A., Kuller L.H. School-based HIV/AIDS education is associated with reduced risky sexual behaviors and better grades with gender and race/ethnicity differences. Health Educ. Res. 2014;29:330–339. doi: 10.1093/her/cyt110.
    1. APA High School Graduation Facts: Ending the Dropout Crisis. [(accessed on 4 April 2021)];2016 Available online: .
    1. Oberski D. Modern statistical Methods for HCI. Springer; Berlin/Heidelberg, Germany: 2016. Mixture models: Latent Profile and Latent Class Analysis; pp. 275–287.
    1. Lanza S.T., Rhoades B.L. Latent Class Analysis: An Alternative Perspective on Subgroup Analysis in Prevention and Treatment. Prev. Sci. 2013;14:157–168. doi: 10.1007/s11121-011-0201-1.
    1. Magidson J., Vermunt J.K., Madura J.P. Latent Class Analysis. SAGE Publications Limited; Thousand Oaks, CA, USA: 2020.
    1. Chakraborty A., King M., Leavey G., McKenzie K. Perceived racism, medication adherence, and hospital admission in African-Caribbean patients with psychosis in the United Kingdom. Soc. Psychiatry Psychiatr. Epidemiol. 2011;46:915–923. doi: 10.1007/s00127-010-0261-8.
    1. Kinsler J.J., Wong M.D., Sayles J.N., Davis C., Cunningham W.E. The Effect of Perceived Stigma from a Health Care Provider on Access to Care among a Low-Income HIV-Positive Population. AIDS Patient Care STDs. 2007;21:584–592. doi: 10.1089/apc.2006.0202.
    1. Abadia-Barrero C.E., Castro A. Experiences of stigma and access to HAART in children and adolescents living with HIV/AIDS in Brazil. Soc. Sci. Med. 2006;62:1219–1228. doi: 10.1016/j.socscimed.2005.07.006.
    1. CDC HIV in the Southern United States. [(accessed on 4 April 2021)];2019 Available online: .
    1. Arnold E.A., Rebchook G.M., Kegeles S.M. ‘Triply cursed’: Racism, homophobia and HIV-related stigma are barriers to regular HIV testing, treatment adherence and disclosure among young Black gay men. Cult. Health Sex. 2014;16:710–722. doi: 10.1080/13691058.2014.905706.
    1. Cahill S., Taylor S.W., Elsesser S.A., Mena L., Hickson D., Mayer K.H. Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care. 2017;29:1351–1358. doi: 10.1080/09540121.2017.1300633.
    1. CDC HIV Risk Among Persons Who Exchange Sex for Money or Nonmonetary Items 2016. [(accessed on 4 April 2021)];2017 Available online: .
    1. Hightow-Weidman L.B., Magnus M., Beauchamp G., Hurt C.B., Shoptaw S., Emel L., Piwowar-Manning E., Mayer K.H., Nelson L.E., Wilton L., et al. Incidence and Correlates of Sexually Transmitted Infections among Black Men Who Have Sex with Men Participating in the HIV Prevention Trials Network 073 Preexposure Prophylaxis Study. Clin. Infect. Dis. 2019;69:1597–1604. doi: 10.1093/cid/ciy1141.
    1. Land E. New Research: Awareness, Perceived Effectiveness of U=U and Intermittent Prep Low Among MSM in New York City
    1. Siegel K., Meunier E. Awareness and Perceived Effectiveness of HIV Treatment as Prevention Among Men Who Have Sex with Men in New York City. AIDS Behav. 2019;23:1974–1983. doi: 10.1007/s10461-019-02405-y.
    1. Lachowsky N.J., Tattersall T.L., Sereda P., Wang C., Edwards J., Hull M. Community awareness of use of and attitudes towards HIV pre-exposure prophylaxis (PrEP) among men who have sex with men in Vancouver, Canada: Preparing health promotion for a publicly funded PrEP program. Sex. Health. 2019;16:180–186. doi: 10.1071/SH18115.
    1. CDC Changes in HIV Preexposure Prophylaxis Awareness and Use among Men Who Have Sex with Men—20 Urban Areas, 2014 and 2017. [(accessed on 4 April 2021)];2019 Available online: .
    1. Tan D.H., Schnubb A., Lawless J., Szadkowski L., Grennan T., Wilton J., Fowler S., Hart T.A., Maxwell J., Raboud J.M. Acceptability and tolerability of and adherence to HIV preexposure prophylaxis among Toronto gay and bisexual men: A pilot study. CMAJ Open. 2018;6:E611. doi: 10.9778/cmajo.20180068.
    1. Greenwald Z.R., Maheu-Giroux M., Szabo J., Robin J.A., Boissonnault M., Nguyen V.K., Thomas R. Cohort profile: L’Actuel Pre-Exposure Prophylaxis (PrEP) Cohort study in Montreal, Canada. BMJ Open. 2019;9:e028768. doi: 10.1136/bmjopen-2018-028768.
    1. Franks J., Hirsch-Moverman Y., Loquere A.S., Amico K.R., Grant R.M., Dye B.J., Rivera Y., Gamboa R., Mannheimer S.B. Sex, PrEP, and Stigma: Experiences with HIV Pre-exposure Prophylaxis among New York City MSM Participating in the HPTN 067/ADAPT Study. AIDS Behav. 2018;22:1139–1149. doi: 10.1007/s10461-017-1964-6.
    1. Dubov A., Galbo P., Jr., Altice F.L., Fraenkel L. Stigma and Shame Experiences by MSM Who Take PrEP for HIV Prevention: A Qualitative Study. Am. J. Men’s Health. 2018;12:1843–1854. doi: 10.1177/1557988318797437.
    1. Hu Y., Lu H., Raymond H.F., Sun Y., Sun J., Jia Y., He X., Fan S., Xiao Y., McFarland W., et al. Measures of condom and safer sex social norms and stigma towards HIV/AIDS among Beijing MSM. AIDS Behav. 2013;18:1068–1074. doi: 10.1007/s10461-013-0609-7.
    1. Rourke S.B., Bacon J., McGee F., Gilbert M. Good news on HIV: Tackling the social and structural drivers of HIV in Canada. Can. Commun. Dis. Rep. 2015;41:322. doi: 10.14745/ccdr.v41i12a03.

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