Syndemic health disparities and STI burden among Black MSM engaged in sex work in the United States

INTRODUCTION: Black MSM engaged in sex work (BMSM-SW) experience elevated HIV and sexually transmitted infection (STI) prevalence. Further, BMSM-SW have been shown to have higher rates of syndemic psychosocial health conditions which contribute to HIV risk behavior and incidence, and poorer care outcomes than other groups of men who have sex with men (MSM). However, syndemic perspectives have not been applied to understanding past-year STI burden among BMSM-SW in the U.S. METHODS: Sexually active Black MSM ≥ 18 years old were recruited from Black Pride events in six U.S. cities (n=4421) between 2014–2017. Multivariable logistic regressions assessed correlates of past-year sex work engagement; whether BMSM-SW had higher odds of syndemic conditions; and whether BMSM-SW had higher odds of self-reported, past-year STI diagnoses. Structural equation models assessed relationships between sex work engagement, syndemic conditions, and STI controlled for sociodemographics and number of sexual partners. RESULTS: Two hundred fifty-four (5.7%) Black MSM reported past-year sex work, of whom 45.3% were HIV-positive. BMSM-SW were significantly more likely to be Hispanic, to report past-year bisexual behavior, and to report annual income