Department of Geography, University of California, Santa Barbara, CA, USA.
Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA.
J Urban Health. 2020 Oct;97(5):609-622. doi: 10.1007/s11524-020-00481-3. Epub 2020 Sep 29.
The places that people go and interact with others, along with the characteristics of those places, determine degrees of sexual health risk and concomitant prevention opportunities for gay, bisexual, and other men who have sex with men (MSM). The objective of this paper is to use syndemic theory to guide analyses of 20 in-depth interviews with African American and Hispanic/Latinx MSM living in Los Angeles. We describe the places in which African American and Latinx MSM interviewees live and socialize, and how these places influence sexual behavior, drug use, and access to health care. We find common spatial patterns in mobility, incongruence in residential and sexual places, and differing geographic patterns of sex by men who use geo-social hook-up apps. Significant instability in home life and varying forms of mobility and risk-taking were a response to cumulative disadvantage and intersecting structural forces including poverty, racism, and homophobia. Our results strongly suggest that geographic mobility is a syndemic factor for HIV risk among MSM in Los Angeles, as mobility amplified negative impacts of other syndemic factors. Innovative place-interventions to reduce HIV incidence and disparities in HIV need to acknowledge the synergistic factors that drive higher HIV incidence among AA and Latinx MSM.
人们去的地方和与他人互动的地方，以及这些地方的特点，决定了同性恋、双性恋和其他与男性发生性关系的男性（MSM）的性健康风险程度和相应的预防机会。本文的目的是利用综合征理论来指导对居住在洛杉矶的非裔美国人和西班牙裔/拉丁裔 MSM 的 20 次深入访谈进行分析。我们描述了非裔美国人和拉丁裔 MSM 受访者居住和社交的地方，以及这些地方如何影响性行为、药物使用和获得医疗保健。我们发现，使用地理社交应用程序的男性的流动性、居住和性场所之间的不和谐以及不同的性行为地理模式存在共同的空间模式。家庭生活的显著不稳定性以及不同形式的流动性和冒险行为是对累积劣势和交叉结构力量的反应，包括贫困、种族主义和恐同症。我们的研究结果强烈表明，地理流动性是洛杉矶 MSM 艾滋病毒风险的综合征因素，因为流动性放大了其他综合征因素的负面影响。为了减少艾滋病毒发病率和艾滋病毒差异，需要采取创新性的地方干预措施，以承认驱动非裔美国人和拉丁裔 MSM 艾滋病毒发病率更高的协同因素。
