Duncan Dustin T, Ransome Yusuf, Park Su Hyun, Jackson Skyler D, Kawachi Ichiro, Branas Charles C, Knox Justin, Al-Ajlouni Yazan A, Mountcastle Hayden, Miles Caleb H, Hickson DeMarc A
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.
Soc Sci Med. 2021 Jun;279:113913. doi: 10.1016/j.socscimed.2021.113913. Epub 2021 May 13.
Few studies have examined associations between neighborhood social cohesion and sexual risk behaviors among gay, bisexual, and other sexual minority men (SMM), and none have among Black SMM in the southern U.S. The purpose of the current study is to examine associations between neighborhood social cohesion and sexual risk behaviors among Black SMM in the southern U.S., a population heavily impacted by HIV. We also examined whether these relationships are modified by religious participation for Black SMM in the southern U.S.
Data was obtained from the MARI Study, a sample of Black SMM ages 18-66 years, recruited from the Jackson, MS and Atlanta, GA metropolitan areas (n = 354). Neighborhood social cohesion was assessed with a validated 5-item scale. We conducted multivariable regression analyses to examine the association between neighborhood social cohesion with each of the sexual risk behaviors (e.g., condomless sex and drug use before or during sex), controlling for key confounders. We then performed moderation analysis by religious participation (religious attendance and private religiosity).
Compared to Black SMM with higher perceived neighborhood social cohesion, Black SMM with lower neighborhood social cohesion had increased odds of alcohol use before or during sex (aPR = 1.56; 95% CI = 1.16-2.11) and condomless anal sex with casual partners (aPR = 1.55; 1.03-2.32). However, the magnitude of these associations varied by religious attendance and private religiosity. Black SMM with low religious service attendance had higher risk of alcohol use in the context of sex when perceived neighborhood social cohesion was low; those with high private religiosity had elevated alcohol use in the context of sex when perceived neighborhood social cohesion was low.
Interventions that target connectedness among neighborhood members through community education or mobilization efforts, including the involvement of religious organizations, should be considered for HIV prevention focused on alcohol and condomless sex among Black SMM.
很少有研究探讨社区社会凝聚力与男同性恋者、双性恋者及其他性少数男性（SMM）的性风险行为之间的关联，而在美国南部的黑人SMM中尚无此类研究。本研究的目的是探讨美国南部黑人SMM中社区社会凝聚力与性风险行为之间的关联，这一人群受艾滋病毒影响严重。我们还研究了宗教参与是否会改变美国南部黑人SMM的这些关系。
数据来自MARI研究，该研究样本为18 - 66岁的黑人SMM，从密西西比州杰克逊市和佐治亚州亚特兰大市大都市区招募（n = 354）。社区社会凝聚力用一个经过验证的5项量表进行评估。我们进行了多变量回归分析，以检验社区社会凝聚力与每种性风险行为（如无保护性行为以及性行为前或性行为期间吸毒）之间的关联，并控制关键混杂因素。然后我们通过宗教参与（宗教礼拜出席率和个人宗教信仰程度）进行调节分析。
与认为社区社会凝聚力较高的黑人SMM相比，认为社区社会凝聚力较低的黑人SMM在性行为前或性行为期间饮酒的几率增加（调整后风险比[aPR] = 1.56；95%置信区间[CI] = 1.16 - 2.11），与偶然伴侣进行无保护肛交的几率增加（aPR = 1.55；1.03 - 2.32）。然而，这些关联的程度因宗教礼拜出席率和个人宗教信仰程度而异。宗教礼拜出席率低的黑人SMM在社区社会凝聚力低时性行为中饮酒风险更高；个人宗教信仰程度高的黑人SMM在社区社会凝聚力低时性行为中饮酒增加。
对于以美国南部黑人SMM中酒精使用和无保护性行为为重点的艾滋病毒预防，应考虑通过社区教育或动员努力（包括宗教组织的参与）来增强社区成员之间联系的干预措施。
