A Mixed-Methods Examination of the Influence of Social Conditions and Social Networks on the Sexual Risk Behavior of Structurally Vulnerable African American Male Substance-Users

In spite of a decline in HIV infection among many behavioral risk groups in the US, African American men have experienced an increase in HIV incidence over the last decade. Important gaps exist in understanding how social conditions and social networks shape the HIV risk behaviors of structurally vulnerable African American substance-using men. Manuscript 1 explored how social conditions shape sexual and drug-using norms and behaviors of African American men who have sex with men and women. Using in-depth interviews (n=16), inductive thematic analyses revealed patterns of political, structural, symbolic and everyday experiences of violence that place structurally vulnerable men at risk for HIV. Exposure to violence, ranging from personal addiction and incarceration to institutional racism and homophobia, shaped their masculine identity construction and sexual risk behaviors. Manuscript 2 examined the relationship between composition and social support function of African American men's networks and their sale of sex for drugs or money to men and/or women. It also examined the relationship between dyadic characteristics, social support function, and unprotected sex among these men and their sexual partners. Using cross-sectional network survey data (n=201), multivariate logistic regression analyses revealed that the men's likelihood of selling sex for drugs or money was lower if they had a greater proportion of employed peers. The likelihood of unprotected sex was higher for sexual partner dyads that were categorized as primary sexual and drug partnerships. While the proportion of peers as sources of social support were not protective against the sale of sex for drugs or money, these same forms of social support were predictive of unprotected sex within sexual partner dyads. The findings from this study suggest that the men reside in social environments that are not supportive of HIV prevention. The study calls attention to the persistent influence of violence on masculine identity construction and sexual risk behavior. It is especially pertinent to understand how men's evaluation of their social roles may shape their risk behaviors. Additionally, the influence of sexual partner dyad characteristics and social support on unprotected sex merit further exploration of how risk perceptions and behaviors are socially organized.Doctor of Philosoph