Housing Instability and HIV Risk-Taking Behaviors among a cohort of Black Men who have sex with Men in Atlanta Open Access

Harris, Angelique (Spring 2020)

Permanent URL: https://etd.library.emory.edu/concern/etds/xd07gt96x?locale=en


Young Black men who have sex with men (YBMSM) are disproportionally affected by HIV incidence in the United States when compared to White MSM despite not engaging in higher rates of HIV sexual risk-taking behaviors. BMSM are also disproportionally affected by homelessness, a structural factor associated with higher HIV prevalence and HIV risk behaviors. However, little is known about how housing insecurity is associated with HIV risk behaviors among YBMSM. Data from the Ele[men]t study, a cohort study among 469 sexually active HIV+ and HIV- YBMSM aged 18 to 30 from Atlanta, was used for this analysis. Housing insecurity was defined as experiencing homelessness in the past 6 months, moving more than once in the past 6 months, and/or reporting feeling very worried about future housing situations. Bivariate analyses were performed to assesses the association between housing insecurity and socio-economic factors, sexual behaviors, and substance use behaviors. Unadjusted and adjusted multivariable logistic regression with predicted margins was used to estimate prevalence ratios for housing insecurity and condomless anal sex, use of water or oil-based lubricant during anal sex, HIV testing within the past 6 months, and current adherence to ART medication. 103 of the YBMSM in our sample experienced housing insecurity in the past 6 months. The prevalence of education level, income level, and having health insurance significantly differed based on housing insecurity status. The multivariable analysis of the association between housing insecurity and condomless anal sex was non-significant with an adjusted prevalence ratio (PR) of 0.99, 95% (CI: 0.88-1.11). Similar non-significant results were observed for use of silicon or water-based lubricant, PR of 0.95, 95% (CI: 0.51-1.76). Among HIV- participants, the association between housing insecurity and HIV testing at least every 6 months was not significant with a PR of 1.11, 95% CI: (0.89-1.40). Lastly, among HIV positive participants, there was not a significant difference for currently taking HIV medication based on housing instability with a PR of 1.03 (95% CI: (0.84-1.25)). These findings suggest that despite the challenges of housing insecurity, it is not associated with HIV sexual risk-taking, prevention, or treatment behaviors among YBMSM in Atlanta. 

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