Condom Use and Female Sex Partner Dyads of African American Men Who Have Sex with Men and Women

Introduction: Research about the relationship between disclosure of bisexual identity or behavior and condom use has generally used global measures. Using a social network approach allows for a more nuanced and precise understanding of the relationship between disclosure and risk behaviors. The goals of this social network study are to describe the female sexual dyads of men who have sex with men and women (MSMW) and examine the association between disclosure of same-sex behavior to female sex partners (FSPs) and condom use.

Methods: Data for the current study were from the baseline survey from Unity iN Diversity, a pilot HIV risk-reduction intervention for African American MSM conducted in Baltimore. Of the 226 participants, 62 were MSMW.  Recruitment was through venue-based outreach, print advertisement, referrals from agencies, and websites. Participants described their social networks using a modified inventory based on the Arizona Social Support Inventory. Participants named individuals who could provide social support and with whom they socialized and had sex in the past 3 months. After names were generated, participants described each social network member, including age, race, length known, level of trust, HIV status, partner type, HIV risk sex behaviors, whether conversations about sex harm reduction had occurred, condom use, drug use, and whether they knew the participant had sex with men. Condom use was measured as a 4-point ordinal variable, ranging from never to always use condoms. Descriptive data analysis and logistic regression with generalized estimating equations were conducted, as each FSP is nested within each MSMW.

Results: On average each man listed 1.74 FSPs (SD=1.05, range=1 – 7), for a total of 108 dyads. Nearly all FSPs were black. On average, dyads had known one another for 89 months (SD=114.0, range=1 – 456). About one-third of partners were main partners, 45.4% were casual partners, and 19.4% were exchange partners. Less than one-quarter of dyads had discussed getting tested for HIV together, but 59.3% had discussed their HIV status. About one-quarter of female sex partners knew the participant has sex with men. Only 1 woman did not treat the participant well because he is a MSM. After controlling for relationship and FSP characteristics, disclosure of same-sex behavior is positively associated with condom use.

Conclusions: Encouraging MSMW to disclose to their female partners that they have sex with men may be an effective intervention to increase condom use and decrease risk of HIV transmission. However, in order for these interventions to be possible, a less biphobic society, in addition to a less homophobic society, is needed. Future research should assess the temporality of this relationship.