By Derek T. Dangerfield II, PhD
My research to-date coupled with my experience as the PI and Peer Change Agent for an HIV prevention intervention has made it immensely clear to me that public health and clinical researchers need frameworks to better understand what is considered sexual “risk” for HIV and other STIs to better engage Black gay and bisexual men. It is important to understand the precursors, consequences, and changes of sexual behaviors particularly for racial and sexual minority men (SMM) generally because the sexual epidemiology among SMM creates subgroups of vulnerability within the community and can exacerbate health disparities
In November 2023, I launched PRIISE (Prevention Research and Innovations In Sexual Epidemiology), a behavioral and social science lab to coalesce and advance my research in sexual health for racial and sexual minority men. The fundamental mission of PRIISE is to highlight the significance of sexual epidemiology and improve community health for SMM.
“Sexual epidemiology” focuses on the distribution, correlates, determinants, and consequences of sexual behavior. Although sexuality discourse is underdiscussed in society and public health generally, the sexual epidemiology of SMM requires an intentional focus because sexual health antecedents and outcomes are uniquely impacted in ways that the fields of prevention science and medicine do not address. Moreover, promoting healthy sexual behaviors contributes to the overall health and wellness of SMM as people.
Behaviors that are integral to healthy relationships are often obscured. For example, one of the most under addressed topics in SMM sexual epidemiology is sexual positioning (i.e., receptive and insertive anal intercourse, oral sex). The most apparent case for highlighting sexual positioning behaviors is that the risks for acquiring or transmitting HIV and other STIs via condomless anal sex vary according to sexual positioning practices. Specifically, studies consistently show that men who participate in receptive anal intercourse are more likely to acquire HIV and rectal STIs compared to men who only practice insertive anal intercourse. The risks for extragenital STIs, from which bacteria develop resistance, are also conferred via oral sex practices. Some SMM also practice contextual “top” and “bottom” practices leading to a range of versatility (practicing both RAI and IAI). We published a conceptual framework of the psychosocial factors that affect “top, bottom, and versatility behaviors among SMM in 2017. Some studies also suggest that sexual role preferences may be associated with health behaviors such as healthcare utilization and PrEP for HIV prevention.
For more almost 10 years, I have published several studies calling for a greater understanding of the sexual epidemiology of SMM and the ways in which same-sex sexuality may contribute to community health. However, there are still no consistent measures to study sexual positioning, sexual roles, or a understand how sexual epidemiology creates subgroups of vulnerability for SMM. There is also still little discussion on how these dynamics vary across different ethnic groups and subcultures of SMM such as the house/ballroom community or leather community where concepts of masculinity and femininity, relationship types, power dynamics, and HIV status may vary in meaning and influence HIV/STI vulnerability. Given the extant literature, it is likely that sexual epidemiology for SMM is impacted by social, psychological, and demographic factors such as age, race, perceptions of risk, health beliefs, and critical periods along the life course. Therefore, articulating how sexual epidemiology among SMM manifests to increase or reduce sexual health vulnerability can provide additional insights into modifiable risk factors and contexts for health interventions.