Examining Priorities of Black Men Who Have Sex with Men and Association with HIV Risk Behavior in Baltimore, MD

Background: Black men who have sex with men (BMSM) are disproportionally affected by HIV/AIDS. A challenge for designing HIV/AIDS prevention interventions is that BMSM often face competing concerns in their lives that may make it difficult to prioritize HIV/AIDS prevention. This study aims to describe the competing concerns among BMSM in Baltimore, MD and to assess how these priorities are associated with condom use.

Methods: Sexually active BMSM (aged 18-70) who lived in the Baltimore Metro Area and completed a priority ranking activity were included in the analysis (n=118). The priority ranking exercise consisted of ranking seven domains: housing stability, financial stability, HIV prevention and/or risk prevention, mental health, physical health, relationship with family, and relationship with romantic partner. Participants were shown a card with the seven domains and asked, “Looking at these different aspects of your life, please rate them from 1 to 7 where 1 is the area that you are most concerned about and 7 is the area that you are least concerned about.” Descriptive statistics were used to explore the priority rankings of each domain. Each domain was then categorized as ranked in top three priorities, versus not ranked as one of the top three priorities. Pearson’s chi-square tests were used to assess the relationship between the priority domain and HIV status, age, education, and employment. Multiple multivariate logistic regressions were used to assess the relationship between priority ranking and condom use adjusting for socio-demographics.

Results: Study participants ranked the seven domains in 103 unique patterns. The majority of participants ranked financial stability (67%), physical health (55%), and stable housing (56%) as top priorities. Less often identified as top priorities were mental health (40%), HIV prevention (36%) as well as relationships with family (26%) and romantic partners (23%). Significant and marginally significant correlates of stable housing prioritization included reporting HIV negative status (p=0.03) and employment (p=0.06). Unemployment was found to be significantly associated with physical health prioritization (p=0.02). Identifying HIV prevention/risk reduction (OR: 2.40; 95% CI: 1.04-5.49) and relationship with families (OR: 2.45; 95% CI: 1.03-5.87) as top priorities was significantly associated with condom use.

Conclusions: To increase their relevance HIV/AIDS prevention programs should consider addressing attention to BMSM’s financial, housing and physical health needs. Future research should examine factors that may link condom use and rating of relationship with families as a greater concern.