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

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.