Jobs and jail: How social conditions and social networks influence sexual exchange among African American male substance users

Background: Black male substance-users in the Southeastern US experience some of the highest HIV and other STI rates in the country. Little research has explored how social conditions shape social networks driving HIV-risk behavior including the sale of sex for drugs or money among this population. Methods: Data are from in-depth interviews (n=16) and cross-sectional network study survey data (n=201) from two North Carolina-based studies. Inductive thematic analysis of the qualitative data documented emergent themes regarding the social conditions experienced by black men belonging to high-risk sexual and drug-using networks where sexual exchange is pervasive. Logistic regression models were used to test the association between personal network composition and social support function on the sale of sex for drugs or money. Results: Peer employment and history of incarceration were both associated with selling sex and drug when accounting for all other variables in the model. These findings will be discussed in relation to the qualitative data which revealed a pattern of structural, symbolic and everyday experiences of violence. Historic experiences of social marginalization have resulted in rigid masculine identity scripts, disproportionate incarceration, and limited economic opportunities which has rendered sexual exchange a normative behavior. Conclusions: Findings from this mixed-methods study will inform culturally-responsive network-based interventions to prevent and control transmission of HIV and other STI among this population. Skills- and norms-based interventions that develop new and bolster existing health-promoting network ties, facilitate multifaceted social support through lay health advising, and strengthen health-promoting dynamics within social networks will be discussed.