Date of Award

Spring 5-15-2018

Author's School

Graduate School of Arts and Sciences

Author's Department

Social Work

Degree Name

Doctor of Philosophy (PhD)

Degree Type



HIV remains a critical public health issue facing men who have sex with men (MSM) in the United States. Young MSM (YMSM) ages 13-34 years account for the greatest number of new HIV infections in MSM, with Black YMSM bearing the highest burden of disease. Sexual risk behaviors (e.g. unprotected sex) continue to be the leading transmission mode for HIV among all YMSM and studies have indicated that these behaviors are associated with a number of psychosocial and environmental factors, including adverse childhood experiences (ACEs), exposure to violence, substance use, and mental health problems. Moreover, recent studies based on the syndemic model of HIV risk have shown that exposure to violence, substance use, mental health problems may interact to increase HIV risk in vulnerable populations, including YMSM. However, the relationships among these risk factors and their association with sexual risk behaviors in YMSM are not yet fully understood.

Therefore, the purpose of this cross-sectional, quantitative study was to: 1) describe the degree to which YMSM engage in HIV risk behaviors, are exposed to ACEs and other multiple forms of violence, experience mental health problems, and use substances; 2) identify the ACEs and violence exposure, substance use, and mental health problems that significantly predict HIV risk behaviors in Black and White YMSM; and 3) test the indirect (through substance use and mental health pathways) effects of violence exposure on HIV risk behaviors. Data was collected using structured computer-assisted personal interviews from a convenience sample of 168 Black (97) and White (71) YMSM recruited at AIDS service organizations that provide HIV prevention programs and testing for YMSM in the St. Louis and Kansas City metropolitan areas.

The current study contributed to knowledge regarding HIV risk behaviors and related syndemic risk factors in service-using YMSM. This study was unique in the assessment of adverse childhood experiences, multiple types of violence exposure, experiences of multiple types of mental health problems, and use of multiple substances in a service-using sample of HIV-negative Black and White YMSM, the populations at highest risk for HIV infection in the US. This study found that a substantial proportion of YMSM are exposed to multiple adverse childhood experiences, intimate partner violence, and community violence, all of which were previously unexplored or understudied in YMSM. Additionally, findings from the study identified unique significant mental health and substance use predictors of unprotected anal sex and number of male sex partners for YMSM when controlling for demographic factors. Further, although relationships between adverse childhood experiences or intimate partner violence and HIV risk behaviors were not significant in multiple regression models, this study demonstrated that adverse childhood experiences and intimate partner violence indirectly affect HIV risk behaviors through polydrug use, whereby higher rates of violence exposure lead to more polydrug use, which leads to a higher rate of multiple male sex partners. The results of this study have implications for social work practice and policy changes that lead to integration of mental health and substance use screening and referral into AIDS service organization that provide HIV prevention services. Moreover, results can be used by researchers to adapt theoretical models of HIV risk and prevention for YMSM.


English (en)

Chair and Committee

Wendy F. Auslander

Committee Members

Darrell Hudson, Sean Joe, Katie Plax, Edward Spitznagel,


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Social Work Commons