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APHA Oral Presentation Poster: Sexual Coercion and Risk for Drug Use and STIs in MSM


Sexual Coercion is Associated with Elevated Risks for Illicit Drug Use and Sexually Transmitted Infection in Men who have Sex Men

 Clay Porter M.P.H.;  Cherell Rivers, MPH; Katharine Hawks, MPH; Sophia Wang, M.S., Nicole Holt, Dr. P.H.; Jiangtao Luo, Ph.D. and Hongyun Fu, Ph.D.

Introduction

•     Gay, bisexual and other men who have sex with men (MSM) face Syndemic health disparities associated with their sexual identities, including experiences of sexual coercion and victimization, higher rates of illicit drug use and sexually transmitted infections (STIs).
•     Syndemic theory (Singer, 1996) is used to explain the concentration of multiple epidemics in certain populations due to harmful social conditions such that they mutually reinforce each other and synergistically amplify the burden of disease.
•     Existing literature on the prevalence and correlates of sexual coercion, substance abuse and STIs among MSM has primarily focused on sexual minority populations outside the United States.
•     This is the first study to investigate the interassociations of STIs and illicit drug use in MSM who have histories of sexual coercion using data from the 2013-2017 National Survey of Family Growth (NSFG); which is among the only nationally-representative health-related surveys that collects information on sexual orientation.

Methods

•     NSFG is a cross-sectional probability survey of the noninstitutionalized civilian population in the U.S. aged 15-50 years that collects health-related information-including incident forced-sex, drug use and STIs.
•     We examined a sample of males (N=569) from 2013-2017 NSFG who reported ever having oral or anal sex with a male, and categorized them as MSM.
•     Multivariable logistic regression analysis was used to assess associations between sexual coercion and illicit drug use (marijuana, crack, cocaine, methamphetamine, and non-prescription drug injection) and STIs (gonorrhea, chlamydia, herpes, syphilis, and genital warts) in the past 12 months.
•     Analysis: SPSS software package, adjusting for sampling weights.

Conclusions and Discussions

•     Findings supported strong interassociation between sexual coercion and illicit drug use and STIs in MSM: Over 18% of MSM reported experiences of sexual coercion, in childhood or as adults, among which 78% occurred before age 16; 45% used illicit drugs and 19% reported having STIs in past 12 months.
•     Our analysis demonstrates disparities among MSM linked to the syndemics of sexual coercion, drug use and STIs; and highlight the need for innovative research and development of programs that understand the synergistic risk factors and health consequences associated with forced sex among MSM.
•     Scant attention to sexual minority health in research and development of data collection instruments is hindering prevention efforts among MSM who have experienced sexual coercion.
•     We need to increase the number of nationally-representative health-related surveys that collect information on sexual orientation and behavior; and encourage further qualitative and longitudinal quantitative studies that illustrate how sexual coercion is related to future health outcomes and elevated risk.
•     Stigma, shame, and self-denial that is often experienced by MSM, exacerbates disparities; and leaves sexual minorities uniquely vulnerable to disease syndemics, especially risk behaviors associated with histories of sexual coercion.


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