HIV Transmission Potential and Sex Partner Concurrency: Evidence for Racial Disparities in HIV Risk Among Gay and Bisexual Men (MSM)

Carla Tilchin,Christina M Schumacher,Errol Fields,Carl A Latkin,Jacky M Jennings,Matthew M Hamill,Anne Rompalo,Adena Greenbaum,Jessica Wagner,Khalil G Ghanem

doi:10.1007/s10461-021-03430-6

Carla Tilchin, Christina M Schumacher + Show 8 more

Open Access

https://doi.org/10.1007/s10461-021-03430-6

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Abstract

We determined whether racial disparities in HIV infection among gay and bisexual men (MSM) may be partially explained by racial differences in the HIV transmission potential (i.e. mixing of people living with HIV and people not living with HIV or of unknown HIV serostatus) and density (i.e. sex partner concurrency) of sexual networks. Data included a behavioral survey, testing for HIV, and an egocentric sexual network survey. Mixed effects logistic regressions were used for hypothesis testing. Black (vs. non-Black) MSM were more likely to not know their partner’s HIV serostatus (21.8% vs. 9.6%). Similar proportions reported sex partner concurrency (67.1% vs. 68.0%). In adjusted analyses, among Black MSM, sex partner concurrency significantly increased the odds of an HIV transmission potential partnership (TPP), and this association was not significant among non-Black indexes. The association between an HIV TPP and sex partner concurrency may help explain persistent racial disparities in HIV prevalence.

Highlights

Gay and bisexual men (MSM) continue to bear a disproportionate burden of HIV
Transmission potential occurs in sexual partnerships or mixing between people living with HIV with viremia and people at risk of acquiring HIV infection (i.e. HIV negative) [7]
Prior work has suggested that there may be higher transmission potential in Black MSM (BMSM) networks due to increased prevalence of HIV infection among BMSM [1], decreased knowledge of positive HIV serostatus among BMSM [8], decreased communication of HIV serostatus among BMSM [9], decreased viral suppression among BMSM [10], and decreased HIV pre-exposure prophylaxis (PrEP) use among HIV negative BMSM compared to other MSM [11]

Summary

Introduction

Gay and bisexual men (MSM) continue to bear a disproportionate burden of HIV. In 2018, MSM accounted for 66% of new HIV infections in the United States [1]. Transmission potential occurs in sexual partnerships or mixing between people living with HIV with viremia and people at risk of acquiring HIV infection (i.e. HIV negative) [7]. Prior work has suggested that there may be higher transmission potential in BMSM networks (vs non-BMSM networks) due to increased prevalence of HIV infection among BMSM [1], decreased knowledge of positive HIV serostatus among BMSM [8], decreased communication of HIV serostatus among BMSM [9], decreased viral suppression among BMSM [10], and decreased HIV pre-exposure prophylaxis (PrEP) use among HIV negative BMSM compared to other MSM [11]. Racial homophily, when combined with these factors of serostatus knowledge, communication, and virologic non-suppression, could lead to increased transmission potential within and among the sexual networks of BMSM

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