# Everyday Discrimination and Vulnerability to HIV Transmission Among Sexual and Gender Minorities of Color in Raleigh-Durham, North Carolina

## TL;DR

This study finds that everyday discrimination and substance use are linked to higher sexual activity among sexual and gender minority people of color, increasing HIV risk in the southern U.S.

## Contribution

The study provides new empirical evidence on the relationship between discrimination, substance use, and HIV risk behaviors in SGM of color in the South.

## Key findings

- Most participants reported experiencing everyday discrimination in the past year.
- Higher discrimination scores were significantly associated with increased sexual activity.
- Recreational drug use was also strongly linked to higher sexual activity levels.

## Abstract

Sexual and gender minority (SGM) individuals of color face disproportionate HIV burdens in the United States, partly due to the effects of discrimination. Discrimination may drive behaviors linked to HIV risk, including increased sexual activity and substance use, but these relationships remain underexplored in the Southern U.S. We conducted a cross-sectional analysis using data from a social network survey of adult persons of color assigned male sex at birth (AMAB) who have sex with other AMAB individuals in Raleigh-Durham, North Carolina. Everyday discrimination was measured using the five-item Everyday Discrimination Scale (EDS), summed by the number of situations reported. Participants were categorized by sexual activity level—high (≥ 3 partners in the past 6 months) or low (0–2 partners). Multivariable logistic regression was used to assess associations between EDS scores, substance use, and sexual activity. Among 100 participants (median age 32), 79% identified as Black/African American, 22% as Latinx, 55% were living with HIV, and 10% identified as gender diverse. Most (87%) reported experiencing at least one type of everyday discrimination in the past year. EDS scores were significantly higher among those with high sexual activity (median 4 vs. 3, p = 0.007). In adjusted models, both EDS (OR 1.76; 95% CI 1.25–2.61) and recreational drug use (OR 4.69; 95% CI 1.59–15.5) were associated with high sexual activity. Discrimination and substance use are significantly associated with elevated sexual activity among SGM of color. Multilevel interventions addressing these factors are needed to improve HIV prevention outcomes in this population.