Risk factors of chlamydia trachomatis among young black men who have sex with women
Description
Background: Chlamydia trachomatis (Ct) is the most common bacterial sexually transmitted infection in the United States. The rate among Black Americans is disproportionately higher than that of White Americans. Ct acquisition is influenced by factors at different levels of the social-ecological model. Methods: Data was collected through Check It, a community venue-based screening study for Black men aged 15-24 who have sex with women, in New Orleans, Louisiana between 05/17/2017-03/16/2020. Latent class analysis identified classes (patterns) of behaviors and relationship traits. Regression mixture modeling assessed associations between covariates and distal outcomes within classes. Path analysis examined mediation of neighborhood factors on Ct by sexual behaviors. Results: At the individual level, five classes of risk behaviors—including substance use, condomless sex, and multiple recent partners—were identified among 1872 men; Ct prevalence ranged from 7.3%-13.6%. Age and education beyond high school were significant risk factors for two classes and health insurance was significantly protective against Ct for two classes. Among 2906 partners reported, five relationship classes emerged with Ct prevalence ranging from 10.1%-18.3%. Community members provided diverse descriptions of the classes. Age, education, substance use, multiple partners, health insurance, and time in a detention facility were predictive of class membership. The effects of three neighborhood and institutional level factors (everyday discrimination, neighborhood safety, and time in a detention facility) on Ct prevalence were mediated by behaviors (substance use, multiple partners, and condomless sex). The three neighborhood and institutional factors were highly interrelated. Conclusion: This work describes the unique characteristics of this population and can be utilized in risk assessment and delivering sexual health services to young Black men who have sex with women. Understanding risk factors across levels of the social-ecological model supports the need for policy changes that address unequal environments and opportunities that increase the risk of Ct acquisition.