ABSTRACT

Black men who have sex with men (BMSM) in the United States experience a disproportionate burden of violence, substance use, physical and mental health conditions relative to other racial groups. BMSM who engage in sex work (BMSM-SW) experience a high burden of psychosocial conditions, sexually transmitted infections, including HIV, and intersectional stigma. This analysis characterizes remuneration and client typologies for BMSM-SW, documents intersectional stigma experienced by BMSM-SW relative to other BMSM, and explores the impact of experienced intersectional stigma on the relationship between sex work engagement and psychosocial syndemic conditions (violence, polydrug use, and depression symptoms). Results show that a majority of BMSM-SW in the sample had female clients and that sex workers were more likely than other BMSM to hire another sex worker. BMSM-SW were more likely than other BMSM to report stigma attributed to race; sexuality; HIV status; socioeconomic status; and “other” attributes, and were more likely to report experiencing stigma across all settings assessed (schools; healthcare; employment; housing; police/courts; and in public/community). Intersectional stigma mediated the relationship between sex work engagement and psychosocial syndemic conditions, accounting for 49% (95% CI: 47.6–50.0%) of the relationship. Interventions for BMSM-SW should include resilience-building components to counteract the effects of intersectional stigma.

摘要

与其他种族群体相比，美国的男男性行为黑人 (BMSM) 承受着不成比例的暴力、药物滥用、身心健康问题的负担。从事性工作的 BMSM（BMSM-SW）承受着心理社会状况、性传播感染（包括艾滋病毒）和交叉耻辱的沉重负担。该分析描述了 BMSM-SW 的报酬和客户类型，记录了 BMSM-SW 相对于其他 BMSM 经历的交叉耻辱，并探讨了经历的交叉耻辱对性工作参与与心理社会综合症之间关系的影响（暴力、多种药物使用、和抑郁症状）。结果显示，样本中大多数 BMSM-SW 都有女性客户，而且性工作者比其他 BMSM 更有可能雇用另一名性工作者。BMSM-SW 比其他 BMSM 更有可能报告因种族造成的耻辱；性欲; 艾滋病毒状况；社会经济状况; 和“其他”属性，并且更有可能报告在所有评估的环境（学校、医疗保健、就业、住房、警察/法院以及公共/社区）中遭受耻辱。交叉耻辱介导了性工作参与度与社会心理综合症之间的关系，占该关系的 49%（95% CI：47.6-50.0%）。BMSM-SW 的干预措施应包括复原力建设成分，以抵消交叉耻辱的影响。