Association of discrimination-related trauma with sexual risk among HIV-positive African American men who have sex with men

Objectives: We investigated whether 1 form of traumatic stress, discriminationrelated trauma (e.g., physical assault because of race), was associated with unprotected analintercourse, especially whencompared with non-discriminationrelated trauma, among African American men who have sex with men. Methods: A convenience sample of 131 HIV-positive African American men who have sex with men receiving antiretroviral treatment completed audio computer-assisted self-interviews that covered unprotected anal intercourse, interpersonal trauma, and whether trauma was because of discrimination on the basis of race/ethnicity, HIV serostatus, or sexual orientation. Results: Sixty percent reported at least 1 interpersonal trauma; they attributed at least 1 trauma to being gay (47%), African American (17%), or HIV positive (9%). In a multivariate regression, experiencing discrimination-related trauma was significantly associated with unprotected anal intercourse (adjusted odds ratio [AOR] = 2.4;95% confidence interval [CI]= 1.0, 5.7; P =.04), whereas experiencing non-discrimination-related trauma was not (AOR = 1.3;95% CI = 0.6, 3.1; P =.53). Conclusions: HIV-positive African American men who have sex with men experience high levels of discrimination-related trauma, a stressor associated with greater risk taking. HIV prevention interventions should consider the potential damaging effects of discrimination in the context of trauma.