Date of Award

Spring 5-14-2021

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Public Health

First Advisor

Laura F. Salazar, PhD

Second Advisor

Richard Rothenberg, MD, MPH

Third Advisor

Madeline Sutton, MD, MPH

Abstract

Background: The burden of HIV in the South remains disproportionate among Black MSM, who account for 48% of HIV diagnoses among MSM. Reasons for these disparities include higher-level structural and social factors, as well as psychosocial factors, that influence individual sexual risk behaviors, including neighborhood conditions, discrimination, depression, resilience, and religiosity/spirituality. The purpose of this dissertation is to examine the relationship between perceived neighborhood context and sexual risk behaviors among Black MSM in the South.

Methods: The dissertation utilized data from the MARI study, which included 412 Black MSM from Jackson, MS and Atlanta, GA. The theoretical framework was based on the modified social ecological model. Statistical methods include exploratory factor analysis, bivariate and multivariable logistic regression, and simple mediation and parallel multiple mediation analyses.

Results: A 4-factor solution was identified in the exploratory factor analysis, which translated to 4 domains measuring the latent construct, perceived neighborhood context: neighborhood problems, social cohesion and safety, neighborhood violence, and LGBT-friendliness. In the multivariable logistic regression analyses, social cohesion and safety was significantly associated with consistent condom use during anal sex in the past 12 months with both a main and a casual partner, consistent condom use during vaginal sex in the past 12 months, and using alcohol or drugs before or during sex. LGBT-friendliness was significantly associated with consistent condom use during anal sex in the past 12 months with a casual partner, and asking the last casual sex partner’s HIV status prior to sex. Neighborhood violence was significantly associated with exchanging sex for money. In both the simple mediation and parallel multiple mediation analyses, depression significantly mediated the relationship between 2 domains of perceived neighborhood context (i.e., social cohesion and safety, and LGBT-friendliness), and consistent condom use during anal sex in the past 12 months with a casual partner.

Conclusions: Salient domains of perceived neighborhood context may be determinants of sexual risk behaviors through depression. Structural interventions are needed to improve neighborhood infrastructure to increase social cohesion and safety, reduce violence, provide an LGBT-friendly environment, and include mental health resources to reduce HIV burden among Black MSM in the South.

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