Geographic Mobility, Place Attachment, and the Changing Geography of Sex among African American and Latinx MSM Who Use Substances in Los Angeles

• Published in: Journal of urban health 2020-10, Vol.97 (5), p.609-622
• Main Authors: Cassels, Susan, Meltzer, Dan, Loustalot, Colin, Ragsdale, Amy, Shoptaw, Steve, Gorbach, Pamina M.
• Format: Article
• Language: English
• Subjects: Adult; Bisexuality - statistics & numerical data; Black or African American - statistics & numerical data; Epidemiology; Geography; Health Informatics; Hispanic or Latino - statistics & numerical data; HIV Infections - epidemiology; Homophobia - statistics & numerical data; Homosexuality, Male - statistics & numerical data; Humans; Interpersonal Relations; Los Angeles - epidemiology; Male; Medicine; Medicine & Public Health; Middle Aged; Poverty - statistics & numerical data; Public Health; Risk Factors; Sexual and Gender Minorities - statistics & numerical data; Sexual Behavior - statistics & numerical data; Substance-Related Disorders - epidemiology; Syndemic; Young Adult
• ISSN: 1099-3460; 1468-2869
• DOI: 10.1007/s11524-020-00481-3

The places that people go and interact with others, along with the characteristics of those places, determine degrees of sexual health risk and concomitant prevention opportunities for gay, bisexual, and other men who have sex with men (MSM). The objective of this paper is to use syndemic theory to guide analyses of 20 in-depth interviews with African American and Hispanic/Latinx MSM living in Los Angeles. We describe the places in which African American and Latinx MSM interviewees live and socialize, and how these places influence sexual behavior, drug use, and access to health care. We find common spatial patterns in mobility, incongruence in residential and sexual places, and differing geographic patterns of sex by men who use geo-social hook-up apps. Significant instability in home life and varying forms of mobility and risk-taking were a response to cumulative disadvantage and intersecting structural forces including poverty, racism, and homophobia. Our results strongly suggest that geographic mobility is a syndemic factor for HIV risk among MSM in Los Angeles, as mobility amplified negative impacts of other syndemic factors. Innovative place-interventions to reduce HIV incidence and disparities in HIV need to acknowledge the synergistic factors that drive higher HIV incidence among AA and Latinx MSM.