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.
Highlights
Since the beginning of the HIV epidemic, men who have sex with men (MSM) have been the predominantly affected risk group in the United States
We identified differences between black and white MSM at the individual, dyadic/sexual network, and community levels
Black MSM have over twice the prevalence of HIV than white men [3,4], and data from HPTN 061 suggest that black MSM have HIV incidence rates over five times those of white MSM [5]
Summary
Since the beginning of the HIV epidemic, men who have sex with men (MSM) have been the predominantly affected risk group in the United States. Black MSM have over twice the prevalence of HIV than white men [3,4], and data from HPTN 061 suggest that black MSM have HIV incidence rates over five times those of white MSM [5] The reasons for these black/white disparities among MSM in HIV prevalence and incidence are unclear, but there is a consensus that differences in individual-level risk behaviors, such as frequency of unprotected anal intercourse (UAI) or numbers of sexual partners, do not account for the observed disparities [6]. The 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
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