Partner Violence A Significant Part of a Syndemic

Partner Violence: A Significant Part of a Syndemic Among Black Men Who Have Sex With Men 24 July 2018 22 nd International AIDS Conference Elwin Wu, Nabila El-Bassel, Louisa Gilbert http: //sig. columbia. edu

Disclosure • Funding – National Institute on Drug Abuse (NIDA), Grant # R 01 DA 030296 (“Couple-Based HIV/STI Prevention for Drug-Involved, African American MSM”) • No conflicts of interest with respect to commercial, financial, or other relationships 1

State of Affairs for HIV Among MSM in the U. S. • Some Male-to-male MSM are sexual losing contact groundrepresents more thanthe others largest transmission category Figures from February 24, 2016 - Conference on Retroviruses and Opportunistic Infections 2

HIV: Part of a Syndemic 3

PV & the Syndemic Among MSM 4

Primary Research Questions • What is the prevalence of PV among a large sample of black MSM? • Is PV associated with other syndemic outcomes—HIV risk indicators, substance use—among this sample of black MSM? 5

Connect ’N Unite (CNU): HIV Prevention for At-Risk Black MSM Couples • Main Inclusion Criteria—Men who: – Report having a male “main partner” operationalized as: a male with whom he has had an ongoing sexual relationship over the prior 90 days, and § a male with whom the participant has an emotional relationship/bond more than any person; § – Self-identify as Black/African American*; – Report illicit substance at least 1 time in past 90 days*; – Report at least 1 unprotected act of anal intercourse in the prior 90 days with a male who is not the main partner*; and – Identify each other as their main partner *or has male main partner who meets this criterion 6

Sample • Black men who have sex with men (MSM) – Cis-man – ≥ 18 years old – Identifies as Black/African American – Had sex with a man in the past 3 months • 1, 271 individuals recruited and completed screening • Subsample of respondents who met the above criteria – N=1, 043 7

CNU Screening: Measures • Sociodemographics – Gender, Race/ethnicity, Age • Experienced partner violence (PV) – Revised conflict tactics scale (CTS 2) § Excluded minor psychological abuse – “Gay-related”: threatened and/or actually outed as gay – “HIV-related”: threatened and/or actually outed as HIV+ • HIV risk indicators (past 90 days) – HIV status (self-reported) – # of male sexual partners – # of acts of condomless anal intercourse (CAI) with men • Substance use (past 90 days) – NIDA Risk Behavior Assessment 8

Analyses • Prevalence of PV among this sample of Black MSM – Form: psychological, physical, sexual, injurious, gayrelated, HIV-related – “Directionality”: experiencing, perpetrating – Timeframe: ever, current (past 30 days) • Hypothesis Testing: PV will be associated with greater likelihood of adversity to wellbeing/health – Multivariate regression § Linear, binary logistic, multinomial depending on nature of the outcome variable § Covariance adjustment: age, HIV status (except for HIV status as dependent variable) 9

Results and Conclusions • Prevalence estimates: PV is a significant public health concern for Black MSM • Hypothesis testing: Support for PV as a central factor in the syndemic among Black MSM • Behavioral aspects of combination prevention need to address PV among Black MSM in the U. S. • Addressing PV among Black MSM may confer benefits with respect to prevention of HIV transmission. • Need to attend to forms of PV that are specific or more unique to sexual minority populations 10

Thank you! • NIDA • Co-Investigators – Nabila El-Bassel – Louisa Gilbert • CNU Team – Patrick Baker – Natalie Bareis – Atrina Brill – Channon Greenfield – Justin Hashimoto – Leona Hess – Y. G. Lee – Justin Manusov – Allen Montes – Omar Martinez – John Page – Rocio Pena – Kimberlyn Shirrells • Community collaborators/colleagues & volunteers • Study participants 11