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

2. Disclosure
Funding
National Institute on Drug Abuse (NIDA), Grant # R01DA (“Couple-Based HIV/STI Prevention for Drug-Involved, African American MSM”)
No conflicts of interest with respect to commercial, financial, or other relationships

3. State of Affairs for HIV Among MSM in the U.S.
Some MSM are losing ground more than others
Male-to-male sexual contact represents the largest transmission category
HIV by Risk & Gender, 2014:
File under heading “HIV Surveillance—Epidemiology of HIV Infection (through 2015)” with direct link at
MSM by race ethnicity : (referring page is
MSM are roughly 2% of the U.S. population (
Lifetime risk graphs from CROI
February 24, Conference on Retroviruses and Opportunistic Infections
Figures from February 24, Conference on Retroviruses and Opportunistic Infections

4. HIV: Part of a Syndemic Introduction to Syndemics published in 2009
Unequal Opportunity published in 2007
Lancet (04 March 2017): Syndemic understanding/approach getting greater awareness and application
Criteria for a syndemic
≥2 diseases/health conditions affecting a poplulation
Health burden is more than the sum of the parts
Contextual factors/social forces drive the co-occurrence and/or synergy
Other syndemics (other than SAVA)
HIV & TB
HIV, malnutrition, & food insecurity [in Sub-Saharan Africa]
violence, immigration, depression, type 2 diabetes, & abuse (VIDDA) [among Mexican immigrant women in US]
Hepatitis C [HCV infection], alcohol use, & hepatocelllar carcinoma
“Syndemics involve the adverse interaction of diseases of all types (eg, infections, chronic non-communicable diseases, mental health problems, behavioural conditions, toxic exposure, and malnutrition).”-Singer et al. (2017) Lancet article

5. PV & the Syndemic Among MSM
Mimiaga, M. J. et al. (2015). The effect of psychosocial syndemic production on 4-year HIV incidence and risk behavior in a large cohort of sexually active men who have sex with men. JAIDS, 68,
Stall, R. et al. (2003). Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. American Journal of Public Health, 93,
Mustanski, B. et al. (2017). Prospective effects of a syndemic on HIV and STI incidence and risk behaviors in a cohort of young men who have sex with men. AIDS & Behavior, 21,
Dyer, T. P. et al. (2012). Application of syndemic theory to black men who have sex with men in the Multicenter AIDS Cohort Study. Journal of Urban Health, 89,
Herrick, A., Stall, R., Egan, J., Schrager, S. & Kipke, M. (2014). Pathways towards risk: Syndemic conditions mediate the effect of adversity on HIV risk behaviors among young men who have sex with men (YMSM). Journal of Urban Health, 91,
Parsons, J. T. et al. (2017). Syndemic conditions and HIV transmission risk behavior among HIV-negative gay and bisexual men in a U.S. national sample. Health Psychology 36,

6. 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?

7. 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

8. 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

9. CNU Screening: Measures
Sociodemographics
Gender, Race/ethnicity, Age
Experienced partner violence (PV)
Revised conflict tactics scale (CTS2)
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

10. Analyses Prevalence of PV among this sample of Black MSM
Form: psychological, physical, sexual, injurious, gay- related, 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)

11. 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

12. Thank you! NIDA Co-Investigators CNU Team
Community collaborators/colleagues & volunteers
Study participants
Nabila El-Bassel
Louisa Gilbert
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