Black men who have sex with men (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. However, syndemic perspectives have not been applied to understanding past-year STI burden among BMSM-SW in the U.S. Sexually active Black MSM ≥ 18 years old were recruited from Black Pride events in six U.S. cities (n = 4421) between 2014 and 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. A total of 254 (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 < $10,000. In multivariable models, BMSM-SW were significantly more likely to report intimate partner violence, assault victimization, polydrug use, and depression symptoms; they were also more likely to report past-year gonorrhea, chlamydia, and syphilis. Syndemic conditions mediated the relationship between past-year sex work and past-year STI burden, constituting a significant indirect effect. BMSM-SW in the U.S. face severe biopsychosocial health disparities. Interventions developed for BMSM engaged in sex work are lacking. Our results suggest that interventions containing safer sex work education and sex-positive biobehavioral HIV/STI prevention alongside substance use, mental health, employment, and education components will be most effective.

从事性工作的男男性行为者 (MSM) (BMSM-SW) 的艾滋病毒和性传播感染 (STI) 患病率升高。此外，与其他男男性行为群体相比，BMSM-SW 已被证明具有更高的导致 HIV 危险行为和发病率的综合性心理社会健康状况的发生率，以及更差的护理结果。然而，在美国 BMSM-SW 中，过去一年的性传播感染负担尚未应用综合观点 从美国六个城市的 Black Pride 活动中招募 18 岁以上的性活跃黑人 MSM（n = 4421) 2014 年至 2017 年。多变量逻辑回归评估了过去一年性工作参与的相关性；BMSM-SW 是否有更高的流行病几率；以及 BMSM-SW 是否有更高的自我报告的过去一年 STI 诊断的几率。结构方程模型评估了性工作参与、流行病和受社会人口统计和性伴侣数量控制的性传播感染之间的关系。共有 254 名 (5.7%) 黑人 MSM 报告了过去一年的性工作，其中 45.3% 为 HIV 阳性。BMSM-SW 明显更有可能是西班牙裔，报告过去一年的双性恋行为，并报告年收入 < 10,000 美元。在多变量模型中，BMSM-SW 更有可能报告亲密伴侣暴力、攻击受害、多种药物使用和抑郁症状；他们也更有可能报告过去一年的淋病、衣原体和梅毒。流行病在过去一年的性工作和过去一年的性传播感染负担之间起中介作用，构成了显着的间接影响。美国的 BMSM-SW 面临严重的生物心理社会健康差异。缺乏为从事性工作的 BMSM 制定的干预措施。我们的研究结果表明，包含更安全的性工作教育和性阳性生物行为 HIV/STI 预防以及物质使用、心理健康、就业和教育部分的干预措施将是最有效的。缺乏为从事性工作的 BMSM 制定的干预措施。我们的研究结果表明，包含更安全的性工作教育和性阳性生物行为 HIV/STI 预防以及物质使用、心理健康、就业和教育部分的干预措施将是最有效的。缺乏为从事性工作的 BMSM 制定的干预措施。我们的研究结果表明，包含更安全的性工作教育和性阳性生物行为 HIV/STI 预防以及物质使用、心理健康、就业和教育部分的干预措施将是最有效的。