Understanding the HIV disparities between black and white men who have sex with men in the USA using the HIV care continuum: a modelling study

Abstract

Background Black/white disparities in HIV incidence and prevalence among men who have sex with men (MSM) in the United States remain largely unexplained. We examined the impact on HIV prevalence and incidence of interventions that decrease disparities in HIV care. Deciding which interventions have most impact on reducing disparities is critical. Methods Using available US Centers for Disease Control and Prevention (CDC) estimates, we constructed HIV care continua for black and white MSM for 2009-2010. These estimates were used as parameters in a deterministic model to yield estimated race-specific transmissions, transmission rates, incidence rates, and rate-ratios (RR). We examined the impact of changes in the care continuum for black MSM on transmission and incidence rates. Findings Marked disparities were found throughout the care continuum: ultimately, 16% of black and 34% of white MSM achieved viral suppression. Based on these care continua, 9,833 and 9,710 new HIV transmissions were estimated annually respectively from HIV-positive black and white MSM (transmission RR=1·36 and incidence RR=7·92). In a model where black and white MSM have identical care outcomes, transmission RR=1·00 and incidence RR=5·80. Scenarios of 95% diagnosis, 95% retention, and concurrent 95% diagnosis and 95% retention respectively yield transmission RR=1·00, 1·02, 0·56, and incidence RR=5·81, 5·93, 3·28. Interpretation Disparities in HIV transmission rates may be reduced by improving the HIV care continuum outcomes, but existing racial disparities in HIV prevalence will likely continue to drive higher incidence among black MSM for decades to come.

HIV incidence among gay men and other men who have sex with men in 2020: where is the epidemic heading?

“…29 With growing HIV incidence, the racial disparities in the burden of HIV among MSM, now understood to be largely secondary to socioeconomic determinants of HIV, became increasingly marked from 2002 to 2011. 28,30,31 Notably, the US is estimated to account for over 30% of total infections in high-income countries with now consistently demonstrated disparities across income levels, and along ethnic and racial lines. 20,32 While the US has a higher absolute burden, similar sociodemographic trends have also been observed in several other countries.…”

Effects of a Laboratory Health Information Exchange Intervention on Antiretroviral Therapy Use, Viral Suppression, and Racial/Ethnic Disparities

“…This suggestion is consistent with at least one recent modeling study of HIV incidence among Black MSM. 3,4 …”

“…1,2 Blacks have the highest incidence of HIV infections, the highest prevalence of undiagnosed HIV and the greatest mortality among racial/ethnic groups. 3-5 They are least likely to be linked to and retained in care, to receive ART, and to achieve HIV RNA VS. 6,7 Latinos are disproportionately affected, as well. The annual incidence of HIV among Latinos is approximately three times that of Whites.…”

Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States

“…Because of a confluence of race-specific gaps in clinical care for testing and treatment of HIV and related STIs [6], the most highly effective prevention strategies, such as early antiretroviral therapy, have benefited WMSM at greater levels than BMSM as a function of differential access to healthcare [47]. We rooted our model structure and parameters in empirical data to forecast how realistic representations of the PrEP continuum could impact HIV incidence for both black and white MSM over the next decade [30].…”

“…The causes of these disparities have been challenging to quantify, as many measures of behavior associated with HIV acquisition often indicate lower risk for BMSM than WMSM [4,5]. Initiation and retention into HIV medical care, however, have been consistently worse metrics for BMSM [6], especially in the Southern US [7]. The US National HIV/AIDS Strategy has among its goals to reduce new HIV diagnoses by 25% overall and to reduce racial disparities in diagnoses on a relative scale by 15% [8].…”