Engaging Young, Black Men who Have Sex with Men in HIV Testing Using Social Network Strategies: Opportunities and Challenges

Abstract

Men who have sex with men (MSM) continue to account for the majority of new infections with HIV in the USA. While the estimated HIV incidence among MSM has changed little in the past two decades, a substantially increased proportion of new infections are among gay and bisexual men who are young and black. Black MSM comprised 55% of the HIV infections diagnosed among MSM aged 15–29 years, while only 12% of the general population is black [1]. The wide disparity in HIV risk among black MSM in the USA is a complex issue involving poverty, access to healthcare, stigma and homophobia [2]. Prior research has shown that despite having higher HIV prevalence, black MSM do not engage in riskier sexual or drug – using than other MSM [3–6]. Epidemiologic evidence suggests the higher burden of HIV among black MSM is linked to at least two factors. First, black MSM are less likely to be aware of their positive HIV status than nonblack MSM [7]. Those unaware of their status go untreated and therefore have nonsuppressed viral loads, making them infectious to their sex partners [8]. Second, the sexual networks of black MSM tend to be assortative, or primarily comprised of other black MSM [9]. The probability of being exposed to HIV increases, if sexual partners are drawn from high HIV prevalence populations; more so when high-risk individuals like black MSM lack awareness of their HIV status. For the above reasons, efforts to reduce the high prevalence of HIV among black MSM must include effective interventions that increase HIV testing. The US Centers for Disease Control and Prevention (CDC) have recommended that MSM at risk for HIV should undergo screening at least annually [10]. However, results from the National HIV Behavioral Surveillance System showed that 30% of high-risk black MSM recruited in 20 US cities had not been tested in the past year, and found cases of previously undiagnosed HIV infection even among those who reported