Incidence of HIV Infection in Young Gay, Bisexual, and Other YMSM

Abstract

Content HIV infections continue to rise in a new generation of young, gay, bisexual and other men who have sex with men (YMSM) despite three decades of HIV prevention and recent biomedical technologies to deter infection. Objectives To examine the incidence of HIV and the demographics, behavioral, and structural factors associated with incident infections. Design Cohort study. Participants 600 YMSM who were ages 18-19 at baseline. Results At baseline 6 prevalent cases of HIV were detected. Over the course of 36 months and six additional waves of data collection, we identified 43 (7.2%) incident cases of HIV. Incident infections were marginally higher among those residing in neighborhoods with higher rates of HIV prevalence. Using Cox proportional hazards models we detected that hazard ratios for time to HIV seroconversion were significantly higher for Black YMSM (HR = 7.46) and Mixed/Other race YMSM (HR = 7.99), and older age at sexual debut with another man was associated with a lower risk of HIV seroconversion (HR = 0.50), while low perceived familial SES was marginally associated with an increased risk for HIV seroconversion (HR = 2.45). Conclusions These findings support the disparities for HIV that exist within the population of sexual minority men and suggest that we attend to behavioral, structural and social conditions to effectively tailor HIV prevention for a new generation of YMSM with a keen eyes to the conditions faced by racial and ethnic minority YMSM which heightened their risk for acquiring HIV.

Incidence of HIV Infection and Sexually Transmitted Infections and Related Risk Factors Among Very Young Men Who Have Sex With Men

“…Our findings are consistent with published research 11,12 suggesting that YMSM may be particularly vulnerable to the risk associated with partner selection and partner characteristics given the associations found herein between concurrent partners, HIV infected partners, and incident infections.…”

“…8 The annual and cumulative incidence rates of HIV reported here for YMSM are comparable to published rates for largely older age groups (i.e., 18–29). 8,11,26 To our knowledge, this is the first published study of STI incidence among YMSM and findings indicate annual rates of urogenital STIs as high or higher than the published data for adults MSM. 21 Notably, the annual incidence of both HIV and STIs for minors aged 16–17 are not significantly different from those aged 18–20, suggesting the need for initiating intervention efforts among very young MSM.…”

“…10 Finally, in a recent study of YMSM, ages 18–19, in New York City (N=594), annual HIV incidence was 2.85 per 100 person years with a 3-year cumulative rate of 7.2% over the entire period. 11 An important limitation of these studies and the HIV incidence literature more generally, is that no MSM participants were under the age of 18 at the time of enrollment.…”

“…Factors associated with HIV incidence among YMSM in the studies cited above include Black or other race (vs. White), 8,11 lower level of education (< high school), substance use before or during last sexual episode 8 and having sex with an HIV-positive or unknown status partner. 9 Koblin and colleagues found that among Black MSM in particular, younger men had higher levels of sexual risk (i.e., more likely to report sex with HIV-positive/unknown status partners vs. older men), were more likely to have a sexually transmitted infection (STI) at follow-up, and were less likely to have a usual place for healthcare or to have visited a health care provider recently, 9 thus providing evidence for risk behavior, concomitant STIs, and health care factors as potential reasons for high incidence among younger Black MSM (vs. older).…”

A Multilevel Analysis of Neighborhood Socioeconomic Disadvantage and Transactional Sex with Casual Partners Among Young Men Who Have Sex with Men Living in Metro Detroit

“…Consistent with Social Disorganization Theory 7 , these epidemiologic patterns reinforce the need to consider how contextual characteristics may increase the HIV vulnerability of YGBMSM living in these spaces. For example, prior HIV research has noted that youth who experience socioeconomic challenges are more likely to engage in negative coping behaviors ( e.g ., substance use), experience greater barriers to adopt and sustain health-promoting behaviors ( e.g ., HIV testing), and to engage in behaviors ( e.g., transactional sex) that increase their vulnerability to HIV acquisition 8–12 .…”