Relationship power and HIV risk among young Black men who have sex with men in the Southern United States JaNelle M. Ricks A,D , Richard A. Crosby B and Leandro Mena C A Health Behavior and Health Promotion, Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210, USA. B Health, Behavior & Society, University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY 40536, USA. C Division of Infectious Diseases, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA. D Corresponding author. Email: ricks.13@osu.edu Abstract. Background: The purpose of this study was to examine the impact of relationship power on HIV risk behaviour among young Black men who have sex with men (MSM) in the Southern US. Methods: Data from 425 Black/ African American males aged 18–29 years who reported recent anal intercourse with a male partner were analysed. Five selected measures of relationship power were tested for correlation and association with protected receptive anal intercourse using contingency tables and logistic regression analysis. Results: Acts of 100% protected receptive anal intercourse were common (n = 277, 65.2%). Men who reported low barriers to condom negotiation were significantly more likely to report protected acts (P < 0.001). Men who reported 100% protected acts were less likely to report financial dependence on male sexual partners and serosorting behaviour (12.0% vs 20.7%, P = 0.02; 31.5% vs 49.8%, P < 0.001 respectively). Conclusion: Future efforts should further examine the role of relationship power in HIV risk among young Black MSM, including the intersection of individual, dyadic and social-structure risks. Additional keywords: sexual behaviours, social context. Received 24 April 2017, accepted 16 December 2017, published online 1 May 2018 Introduction In the United States (US), young (aged 13–29 years) Black men who have sex with men (YBMSM) carry a disproportionate burden of the HIV epidemic compared with MSM of other race and age groups and the general population. 1 Between 2008 and 2011, YBMSM experienced the largest increase in HIV infections among all racial/ethnic groups. 2 YBMSM in the US have a one-in-four chance of becoming infected by age 25 years. 3 Clearly, living at the intersection of being ‘young’, ‘Black’ and ‘MSM’ reflects sociocultural conditions that introduce a risk for HIV that is unique to other subpopulations (e.g. Latino MSM, older Black MSM) with an elevated risk of this disease. The disparate patterns of this epidemic are not driven entirely by race and gender differences, but are prominently impacted by geography as well. For Black Americans, geographic concentrations mirror patterns of HIV case aggregation. 4 In 2010, 55% of the Nation’s Black population lived in the Southern US. 5 Although this region accounted for only 37% of the total national population, it comprised ~50% of all new HIV infections – the highest proportion of any US region. 6 Of these cases, more than half were diagnosed among Black Americans. Of all Black MSM (BMSM) diagnosed with HIV in 2014, over 60% resided in the South. 7 These prevailing disparities are fostered by social and economic conditions and thus may provide a unique and particularly harsh environment for YBMSM. The Southern US is a highly conservative region, with social conditions that support prejudice, discrimination and overall homophobia, thereby adding to the potential for issues with mental, physical and social health issues among YBMSM living in these conditions. Sexual communication Among YBMSM in the Southern US, HIV is almost exclusively transmitted through sexual contact. 2,6 HIV interventions that recognise and harness the power of relationships are needed. 8–10 Additionally, although pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) approaches have shown efficacy for HIV prevention among MSM populations, Black MSM are less likely than their white counterparts to have access to health care, to screen as eligible for a prescription, and to ultimately be protected by these interventions, despite being threatened by HIV incidence rates nearly triple that of white MSM. 11 Indeed, increased access to biomedical prevention methods should be a priority for these men. However, CSIRO PUBLISHING Sexual Health, 2018, 15, 292–297 https://doi.org/10.1071/SH17084 Journal compilation Ó CSIRO 2018 www.publish.csiro.au/journals/sh