Sexual orientation and social network size moderate associations between stigma and problematic alcohol use among male sex workers in the US Northeast: an observational study

Pablo K Valente; Alberto Edeza; Lynne Klasko-Foster; Matthew J Mimiaga; Kenneth H Mayer; Steven A Safren; Katie B Biello

doi:10.1071/SH20137

Sexual orientation and social network size moderate associations between stigma and problematic alcohol use among male sex workers in the US Northeast: an observational study

Sex Health. 2020 Nov;17(5):429-436. doi: 10.1071/SH20137.

Authors

Pablo K Valente¹, Alberto Edeza¹, Lynne Klasko-Foster², Matthew J Mimiaga³, Kenneth H Mayer⁴, Steven A Safren⁵, Katie B Biello⁶

Affiliations

¹ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA; and Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA.
² Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA.
³ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA; and Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA; and Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, 2nd Floor, Providence, RI 02912, USA; and Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, 700 Butler Drive, Box G-BH, Providence, RI 02906, USA; and The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA.
⁴ The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA; and Harvard University Medical School, 25 Shattuck Street, Boston, MA 02115, USA; and Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
⁵ Department of Psychology, University of Miami, PO Box 248185, Coral Gables, FL 33124, USA.
⁶ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA; and Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA; and Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, 2nd Floor, Providence, RI 02912, USA; and The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA; and Corresponding author. Email: katie_biello@brown.edu.

PMID: 33176902
PMCID: PMC8628357
DOI: 10.1071/SH20137

Abstract

Background Stigma is associated with poor health among sexual minority individuals. However, no studies have examined the relationship between stigma and problematic drinking among male sex workers (MSWs). This study examined the relationship between sex work stigma and problematic alcohol use among MSWs.

Methods: Using baseline data from a cohort of 98 MSWs in the US Northeast enrolled between 2015 and 2016, we used logistic regression to examine associations between sex work stigma and hazardous drinking (Alcohol Use Disorders Identification Test (AUDIT) score ≥8) and sex work while drunk, and tested whether sexual orientation (gay vs non-gay identified) and social network size moderated these associations.

Results: Almost half the sample (n = 46; 44%) reported hazardous drinking and 56 MSWs (57%) reported engaging in sex work while drunk. Sex work stigma was associated with hazardous drinking (adjusted odds ratio (aOR) 1.2, 95% confidence interval (CI) 1.05-1.36). Sexual orientation marginally moderated this relationship (P = 0.07), such that it was only significant among gay-identified MSWs (aOR 1.91, 95% CI 1.11-3.28), not among non-gay MSW. Similarly, sexual orientation moderated the effect of sex work stigma on sex work while drunk (P = 0.02), which was only significant among gay-identified MSWs (aOR 1.65, 95% CI 1.05-1.60). Social network size also moderated the effect of sex work stigma on sex work while drunk (P = 0.02), which was only significant among MSWs with small networks (aOR 1.26, 95% CI 1.00-1.58), suggesting large networks can be protective.

Conclusions: Gay MSWs may be particularly vulnerable to alcohol-related effects of stigma. Future interventions should consider engaging social networks to curb problematic drinking among MSWs.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Alcohol Drinking / epidemiology
Alcoholic Intoxication / epidemiology*
Alcoholism / epidemiology*
Cross-Sectional Studies
Humans
Male
New England / epidemiology
Sex Workers / psychology*
Sexual Behavior / psychology*
Sexuality / psychology
Social Networking*
Social Stigma*
Social Support

Grants and funding

R21 DA035113/DA/NIDA NIH HHS/United States