Associations between economic dependence, sexual behaviours, and sexually transmitted infections among young, Black, gay, bisexual and other men who have sex with men living with and without HIV in Jackson, Mississippi, USA.

Background In the USA, young Black gay, bisexual or other men who have sex with men (YBMSM) bear the largest burden of HIV incidence. The aim of this study is to examine the independent associations between economic dependency on a sexual partner and several HIV risk behaviours and sexual health outcomes among YBMSM living in Jackson, Mississippi, USA.
Methods: Baseline data from 589 YBMSM, with a median age of 22.0 years (IQR=15-25) participating in a brief sex-positive HIV and STI prevention intervention, were used to measure the association between six sexual behaviours, sexually transmissible infections (STIs) status at baseline and economic dependence. Bivariate χ2 associations were tested and regression models adjusted for education level (≤ high school), employment and HIV-status.
Results: In regressions, of the six sexual behaviours reported in the last 90 days and six STIs tested at baseline, economically dependent YBMSM were more likely to report condomless anal receptive sex (aOR=2.19, 95%CI=1.25-3.83), ≥3 partners as a top (aOR=1.99, 95%CI=1.17-340), ≥3 sex partners as a bottom (aOR=2.07, 95%CI=1.24-3.45), ≥3 sex acts as a bottom (aOR=2.10, 95%CI=1.16-3.82) and testing positive for oral gonorrhoea (aOR=2.39, 95%CI=1.18-4.83) after controlling for HIV status, employment and education.
Conclusions: Interventions should consider how poverty, unemployment and economic dependence interact to influence relationship power imbalances, condom use and sexual positioning agency, and sexual health for key populations of MSM.