Understanding Racial HIV/STI Disparities in Black and White Men Who Have Sex with Men: A Multilevel Approach

Abstract

BackgroundThe reasons for black/white disparities in HIV epidemics among men who have sex with men have puzzled researchers for decades. Understanding reasons for these disparities requires looking beyond individual-level behavioral risk to a more comprehensive framework.Methods and FindingsFrom July 2010-Decemeber 2012, 803 men (454 black, 349 white) were recruited through venue-based and online sampling; consenting men were provided HIV and STI testing, completed a behavioral survey and a sex partner inventory, and provided place of residence for geocoding. HIV prevalence was higher among black (43%) versus white (13% MSM (prevalence ratio (PR) 3.3, 95% confidence interval (CI): 2.5–4.4). Among HIV-positive men, the median CD4 count was significantly lower for black (490 cells/µL) than white (577 cells/µL) MSM; there was no difference in the HIV RNA viral load by race. Black men were younger, more likely to be bisexual and unemployed, had less educational attainment, and reported fewer male sex partners, fewer unprotected anal sex partners, and less non-injection drug use. Black MSM were significantly more likely than white MSM to have rectal chlamydia and gonorrhea, were more likely to have racially concordant partnerships, more likely to have casual (one-time) partners, and less likely to discuss serostatus with partners. The census tracts where black MSM lived had higher rates of poverty and unemployment, and lower median income. They also had lower proportions of male-male households, lower male to female sex ratios, and lower HIV diagnosis rates.ConclusionsAmong black and white MSM in Atlanta, disparities in HIV and STI prevalence by race are comparable to those observed nationally. We identified differences between black and white MSM at the individual, dyadic/sexual network, and community levels. The reasons for black/white disparities in HIV prevalence in Atlanta are complex, and will likely require a multilevel framework to understand comprehensively.

Minimal Awareness and Stalled Uptake of Pre-Exposure Prophylaxis (PrEP) Among at Risk, HIV-Negative, Black Men Who Have Sex with Men

“…Further, a recent longitudinal study in Atlanta documented a 43.4% HIV prevalence rate and a 6.6% annual HIV incidence rate among BMSM. 8 The HIV epidemiology in the state of Georgia suggests a public health crisis among BMSM that demands for urgent attention.…”

Development of an Agent-Based Model to Investigate the Impact of HIV Self-Testing Programs on Men Who Have Sex With Men in Atlanta and Seattle (Preprint)

“…HIV prevalence among Seattle MSM is estimated at 11% [personal communication with Dr. Susan Buskin, 24 October 2017], and HIV incidence has been decreasing over the last decade [45]. The HIV prevalence among MSM in Atlanta is estimated to be much higher at 28% [46] with fewer MSM aware of their HIV infections [47] less access to PrEP, and a more diverse population with large disparities in HIV by race [48].The data sources for parameterizing our model for each city are presented in Table 2 with additional detail in the appendix (Table A1). Because the original model was structured to examine racial differences in incidence, where race-stratified estimates were available, we utilized those estimates to create race-weighted composite estimates for the overall population in each city.…”

“…Because the original model was structured to examine racial differences in incidence, where race-stratified estimates were available, we utilized those estimates to create race-weighted composite estimates for the overall population in each city. HIV testing and network-based behavioral data were collected in a prospective cohort study [46] and an egocentric sexual network study [49] of MSM living in Atlanta and cross-sectional surveys of MSM in Seattle [36,50].…”

“…For Atlanta, the proportions of the four tester types were estimated using data from the Man Project [49] and InvolveMENt [46]. The Man Project was a cross-sectional chain-referral sexual network study among 314 MSM.…”

Are Partner Race and Intimate Partner Violence Associated with Incident and Newly Diagnosed HIV Infection in African-American Men Who Have Sex with Men?

“…9-11 Millett et al found that Black MSM had 11.5 times greater odds of reporting Black sex partners when compared to other MSM. 12 Studies in Atlanta, 13 New York, 14 and San Francisco 9 have also shown that Black MSM are more likely than non-Black MSM to have Black sex partners. A study by Hernandez-Romieu et al found that HIV prevalence among Black MSM sexual networks was 36% compared to only 4% among White MSM sexual networks.…”