A Network Science Approach to Sex-Polydrug Use Among Black Sexually Minoritized Men and Transgender Women: The N2 Cohort Study

• Published in: Prevention science Vol. 25; no. 4; pp. 638 - 649
• Main Authors: Shrader, Cho-Hee, Duncan, Dustin T., Knox, Justin, Chen, Yen-Tyng, Driver, Redd, Russell, Jonathan S., Moody, Raymond L., Kanamori, Mariano, Durrell, Mainza, Hanson, Hillary, Eavou, Rebecca, Goedel, William C., Schneider, John A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.05.2024; Springer Nature B.V
• Subjects: Adolescent; Adult; Alcohol; Alcohol use; Amphetamines; Black or African American; Black people; Chicago; Child and School Psychology; Cocaine; Cohort analysis; Cohort Studies; Crack cocaine; Drug abuse; Drug use; Drugs; Ecstasy drug; Female; Harm reduction; Health Psychology; HIV; HIV Infections - prevention & control; Human immunodeficiency virus; Humans; Male; Marijuana; Medicine; Medicine & Public Health; Methamphetamine; Multiple drugs; Neighborhoods; Network analysis; Pleasure; Prevention; Prevention programs; Preventive medicine; Public Health; Respondents; Sexual Behavior; Substance abuse; Substance-Related Disorders - epidemiology; Transgender Persons; Young Adult; Chicago; Condom use; Multilevel modeling; Polysubstance use; Sexual minority men; HIV prevention
• ISSN: 1389-4986; 1573-6695; 1573-6695
• DOI: 10.1007/s11121-023-01639-6

Black sexually minoritized men (SMM) and transgender women (TW) are subgroups with lower rates of substance use and comparable rates of condom use relative to White SMM and TW yet experience heightened vulnerability to HIV. This study sought to explore associations of substance use, including sex-drug use (i.e., drug or alcohol use during sex to enhance sex), and condomless sex among Black SMM and TW. Data were collected from Black SMM and TW living in Chicago, Illinois, enrolled in the Neighborhoods and Networks (N2) cohort study, from November 2018 to April 2019. We used bivariate analyses followed by a multilevel egocentric network analysis to identify factors associated with condomless sex. We conducted Spearman correlation coefficients to examine correlations between pairs of sex-drugs to enhance sex. We used a bipartite network analysis to identify correlates of sex-drug use and condomless sex. A total of 352 Black SMM and TW (egos) provided information about 933 sexual partners (alters). Of respondents, 45% reported condomless sex and 61% reported sex-drug use. In unadjusted analyses, marijuana (34%) and cocaine/crack (5%) sex-drug use were associated with condomless sex ( p  < 0.05). Condomless sex was positively associated with sex-polydrug use, or the use of 2+ drugs or 1 drug and alcohol (OR = 1.48; 95% CI: 1.02–2.14; p  = 0.039), and negatively associated with sharing an HIV-negative serostatus with a sexual partner (OR = 0.57; 95% CI: 0.33–0.98; p  = 0.041), having a different HIV serostatus with a sexual partner (OR = 0.37; 95% CI: 0.21–0.64; p  < 0.001) or not knowing the HIV serostatus of a sexual partner (OR = 0.47; 95% CI: 0.26–0.84; p  = 0.011). The following pairs of sex-polydrug use had Spearman correlation coefficients higher than 0.3: marijuana and alcohol, ecstasy and alcohol, cocaine/crack and ecstasy, and methamphetamine and poppers ( p  < 0.05). HIV prevention interventions for Black SMM and TW designed to reduce HIV transmission through egocentric sexual networks could address sex-drug use through sex-positive and pleasure-centered harm reduction strategies and provide and promote biomedical prevention and care options at supraoptimal levels.