Substance use and sexual risk mediated by social support among Black men.

Substance use and sexual risk mediated by social support among Black men.

Health and social disparities are widespread among men who have sex with men (MSM). Although literature indicates that Black MSM (BMSM) are no more likely than other MSM to report sexual risk behaviors, such as unprotected anal intercourse, studies have reported that buying and trading sex appear to be important risk factors for BMSM. Substance use generally is not significantly greater among BMSM than other MSM, studies have found that BMSM report more powder and crack cocaine use than other MSM. The lack of adequate coping skills and social support for BMSM has also been documented. This paper examines differences in substance use, sexual risk behaviors and social support among Black and non-black MSM, in a sample of 515 men participating in a randomized intervention trial. BMSM reported higher rates of substance dependence (72.2% vs. 59.5%, P=.015) and buying sex (49.1% vs. 17.4%, P<.000) than non-Black MSM. BMSM also reported lower levels of social support than other MSM on all measures included in the study; e.g., getting help and emotional support from others (38.0% vs. 52.8%, P<.006). Mediation analyses showed that BMSM’s higher rates of substance dependence and buying sex are partially mediated by lower levels of social support. Our data appear to show that lack of social support is an important influence on risk behaviors among BMSM. Qualitative data also supported these findings. Sexual risk and substance use prevention interventions should address BMSM’s capacity to build adequate and supportive relationships.

在男男性行为者（MSM）中，健康和社会差异普遍存在。尽管文献表明，黑人男男性行为者（BMSM）报告无保护肛交等性风险行为的可能性并不比其他男男性行为者更高，但研究报告称，买性和卖性似乎是黑人男男性行为者的重要风险因素。研究发现，一般来说，黑人男男性行为者的物质使用情况并不比其他男男性行为者严重得多，但黑人男男性行为者报告使用粉末状和块状可卡因的情况比其他男男性行为者更多。也有文献记载黑人男男性行为者缺乏足够的应对技能和社会支持。本文在参与一项随机干预试验的515名男性样本中，研究了黑人和非黑人男男性行为者在物质使用、性风险行为和社会支持方面的差异。黑人男男性行为者报告的物质依赖率（72.2%对59.5%，P = 0.015）和买性比例（49.1%对17.4%，P < 0.000）均高于非黑人男男性行为者。在研究包含的所有指标上，黑人男男性行为者报告的社会支持水平也低于其他男男性行为者；例如，从他人处获得帮助和情感支持（38.0%对52.8%，P < 0.006）。中介分析表明，黑人男男性行为者较高的物质依赖率和买性比例部分是由较低的社会支持水平所介导的。我们的数据似乎表明，缺乏社会支持对黑人男男性行为者的风险行为有重要影响。定性数据也支持这些发现。性风险和物质使用预防干预措施应关注黑人男男性行为者建立充分和支持性人际关系的能力。