Associations of sex work in a sample of black men who have sex with men

Black men who have sex with men (BMSM) occupy a severely marginalized position within society, experiencing high levels of discrimination as a result of their race and sexuality. Research into this population suggests that this social exclusion leaves BMSM susceptible to a variety of interrelated negative health outcomes. As a population they are vulnerable to physical assault, substance/alcohol abuse, depression, unemployment, homelessness, and high rates of HIV infection, all of which are exacerbated by poor access to health care and other social services, and are thus of public health importance. This marginalization leads a disproportionate number of BMSM to turn to sex work to make ends meet and/or to survive. The limited research done into the population suggests that black male sex workers experience similar types of negative health outcomes and comparable inequity in regards to their race and sexuality, but also need to contend with the stigma and illegality associated with engaging in sex work. How this further marginalization translates into the behaviors and health of black male sex workers is poorly understood and demands further research. In this analysis I examined a sample of 1,666 BMSM and compared those who have engaged in sex work (n=94) with those who had not (n=1572). The purpose of this investigation was to understand the associations and health implications involved in black male sex work and if/how they contrasted to a general sample of BMSM. Results from the analysis showed that the sex workers in the sample reported a statistically higher prevalence across every syndemic measure, negative health outcome, and behavioral risk factor except, surprisingly, HIV prevalence. This suggests that behavioral and syndemic risks are not the only contributors to high HIV rates in this sample of BMSM. Although HIV rates did not differ between the two groups, the sex workers did report worryingly high rates of every other negative health outcomes and risk factor. Interventions designed to meet the needs of black male sex workers are crucial for the health of that vulnerable population. Finally, risk factors and syndemic associations traditionally thought to increase HIV rates in a given population did not hold up in this analysis and further research is required to understand what is driving HIV in BMSM