Intersectional Experienced Stigma and Psychosocial Syndemic Conditions in a Sample of Black Men Who Have Sex with Men Engaged in Sex Work (BMSM-SW) from Six US Cities

ABSTRACT

Black men who have sex with men (BMSM) in the United States experience a disproportionate burden of violence, substance use, physical and mental health conditions relative to other racial groups. BMSM who engage in sex work (BMSM-SW) experience a high burden of psychosocial conditions, sexually transmitted infections, including HIV, and intersectional stigma. This analysis characterizes remuneration and client typologies for BMSM-SW, documents intersectional stigma experienced by BMSM-SW relative to other BMSM, and explores the impact of experienced intersectional stigma on the relationship between sex work engagement and psychosocial syndemic conditions (violence, polydrug use, and depression symptoms). Results show that a majority of BMSM-SW in the sample had female clients and that sex workers were more likely than other BMSM to hire another sex worker. BMSM-SW were more likely than other BMSM to report stigma attributed to race; sexuality; HIV status; socioeconomic status; and “other” attributes, and were more likely to report experiencing stigma across all settings assessed (schools; healthcare; employment; housing; police/courts; and in public/community). Intersectional stigma mediated the relationship between sex work engagement and psychosocial syndemic conditions, accounting for 49% (95% CI: 47.6–50.0%) of the relationship. Interventions for BMSM-SW should include resilience-building components to counteract the effects of intersectional stigma.

Acknowledgments

We thank the Center for Black Equity and local Black Pride organizations for partnering with us to implement POWER, the community-based organizations who performed onsite HIV testing on the study’s behalf, the thousands of study participants who volunteered their time to contribute to this research, and members of the POWER Study Team who made data collection possible.

The local Black Pride organizations are as follows: D.C. Black Pride, Detroit’s Hotter than July, Houston Splash, In the Life Atlanta, Memphis Black Pride, and Philadelphia Black Pride. The community-based organizations who performed onsite HIV testing are as follows: Atlanta: AID Atlanta, AIDS Health Care Foundation, NAESM; Detroit: Community Health Awareness Group, Horizons Project, Unified; Houston: Avenue 360, Houston AIDS Foundation, Positive Efforts; Memphis: Friends for Life; Philadelphia: Access Matters, Philadelphia FIGHT; Washington, D.C.: Us Helping Us.

Declarations

There are no conflicts of interest to report for any of this paper’s contributing authors. This original, unpublished manuscript has not been submitted for review to any other journal, and has been read and approved by all co-authors. All study procedures were approved by the University of Pittsburgh Institutional Review Board. Data collection was supported by the National Institutes of Nursing Research grant R01NR013865 and analysis was partially supported by a National Institute of Mental Health training grant T32-MH094174 (PIs: Rinaldo, Hawk).

Disclosure Statement

No potential conflict of interest was reported by the authors.

Supplementary Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00224499.2022.2072799.

Additional information

Funding

This work was supported by the National Institute of Mental Health [T32-MH094174]; National Institute of Nursing Research [R01NR013865].