White MSM Research Articles

Examining the Authors’ Choice of Secondary Data in Determining What Factors Affect HIV Prevalence in WMSM, BMSM and Transgender Populations

Letter to the Editor, In studies that are based on secondary data, the authors usually have no control over how the data is collected; however, control does exist with regards to which studies the authors choose to use, and this choice should be exercised carefully. In this study, Raymond et al. used a secondary data analysis of three different studies to examine three identified populations: the National HIV Behavioural Surveillance System (2008) was used to analyze the white MSM (WMSM) population; the San Francisco Department of Public Health’s (SFDPH) Black Men Testing (BMT 2009) was used to analyze the black MSM (BMSM) population; and the SFDPH’s HIV Prevention Section had a program called Transfemales Empowered to Advance Community Health (TEACH 2010) that was used for the transfemale population [1]. The secondary data used to assess these three populations was a huge potential source of bias which the authors failed to address. The first issue is that the three data sets come from three different years (2008, 2009, 2010), making this data a little less reliable and comparable. In speculation, for example, if the recession beginning in 2008 caused SES to decrease and HIV to increase it might have had more of an effect on HIV acquisition in 2008 than 2010 which could bias a comparison between WMSM and transfemale populations. If these were the best or only sources the researchers could find, it should have been noted by the authors in the study [2]. A second issue is that the authors made a conclusion that for BMSM, stimulant use appeared to be the strongest factor in risky sexual behaviour and HIV acquisition; however, since the BMSMs data came from a study that recruited black men who were injection drug users (IDUs) it is possible that there was an overestimate in the correlation between BMSMs, HIV prevalence and stimulant used [1]. In conclusion, the secondary data chosen by the authors could have led to bias and an overestimation of correlation between factors and cohorts. Even if these data sources were the only sources available and thus the potential bias was unavoidable, it should have been declared as a study limitation [2]. By ignoring potential source of bias, the authors reduced the transparency of the study which made the findings appear to be less reliable [2].

Finding and Recruiting the Highest Risk HIV-Negative Men Who Have Sex With Men

This study compared the ability of different field and online recruitment venues to reach those at highest risk for HIV infection among HIV-negative men who have sex with men (MSM), given that some subgroups are difficult to reach, and venues vary in the demographic characteristics of the samples they yield. Compared to other venues, dating/hookup websites reached significantly higher-than-expected concentrations of White MSM aged 40 and above, including those who reported unprotected anal intercourse (UAI). Facebook was the most successful venue for the recruitment of MSM who used stimulants, including those who reported UAI. MSM who reported UAI were more likely to be recruited online. This study points to systematic variation in the samples obtained via different recruitment strategies, which should be taken into consideration when designing intervention/prevention programs targeting HIV-negative MSM.

Disparities in HIV transmission risk among HIV-infected black and white men who have sex with men, United States, 2009.

To better understand why HIV incidence is substantially higher among black than white men who have sex with men (MSM), we present the first nationally representative estimates of factors that contribute to transmission - sexual behavior, antiretroviral therapy (ART) use, and viral suppression - among HIV-infected black and white MSM in the United States. The Medical Monitoring Project (MMP) is a complex sample survey of HIV-infected adults receiving medical care in the United States. We used weighted interview and medical record data collected during June 2009 to May 2010 to estimate the prevalence of sexual behaviors, ART use, and viral suppression among sexually active HIV-infected black and white MSM. We used χ tests to assess significant differences between races and logistic regression models to identify factors that mediated the racial differences. Sexual risk behaviors among black and white MSM were similar. Black MSM were significantly less likely than white MSM to take ART (80 vs. 91%) and be durably virally suppressed (48 vs. 69%). Accounting for mediators (e.g. age, insurance, poverty, education, time since diagnosis, and disease stage) reduced, but did not eliminate, disparities in ART use and rendered differences in viral suppression among those on ART insignificant. Lower levels of ART use and viral suppression among HIV-infected black MSM may increase the likelihood of HIV transmission. Addressing the patient-level factors and structural inequalities that contribute to lower levels of ART use and viral suppression among this group will improve clinical outcomes and might reduce racial disparities in HIV incidence.

From (Un)Willingness to InvolveMENt: Development of a Successful Study Brand for Recruitment of Diverse MSM to a Longitudinal HIV Research.

HIV continues to be a major concern among MSM, yet Black MSM have not been enrolled in HIV research studies in proportionate numbers to White MSM. We developed an HIV prevention research brand strategy for MSM. Questionnaires and focus groups were conducted with 54 participants. Descriptive statistics and chi-square analyses were performed and qualitative data were transcribed and content analyzed to identify common themes. Formative research results indicated that younger Black MSM (18-29 years) were less likely to think about joining prevention studies compared to older (≥30 years) Black MSM (x2 = 5.92, P = 0.015). Qualitative and quantitative results indicate four prominent themes related to brand development: (1) communication sources (message deliverer), (2) message (impact of public health messaging on perceptions of HIV research), (3) intended audience (underlying issues that influence personal relevance of HIV research), and (4) communication channels (reaching intended audiences). The findings highlight the importance of behavioral communication translational research to effectively engage hard-to-reach populations. Despite reservations, MSM in our formative study expressed a need for active involvement and greater education to facilitate their engagement in HIV prevention research. Thus, the brand concept of "InvolveMENt" emerged.

Reducing shame in a game that predicts HIV risk reduction for young adult men who have sex with men: a randomized trial delivered nationally over the web

IntroductionMen who have sex with men (MSM) often face socially sanctioned disapproval of sexual deviance from the heterosexual “normal.” Such sexual stigma can be internalized producing a painful affective state (i.e., shame). Although shame (e.g., addiction) can predict risk-taking (e.g., alcohol abuse), sexual shame's link to sexual risk-taking is unclear. Socially Optimized Learning in Virtual Environments (SOLVE) was designed to reduce MSM's sexual shame, but whether it does so, and if that reduction predicts HIV risk reduction, is unclear. To test if at baseline, MSM's reported past unprotected anal intercourse (UAI) is related to shame; MSM's exposure to SOLVE compared to a wait-list control (WLC) condition reduces MSM's shame; and shame-reduction mediates the link between WLC condition and UAI risk reduction.MethodsHIV-negative, self-identified African American, Latino or White MSM, aged 18–24 years, who had had UAI with a non-primary/casual partner in the past three months were recruited for a national online study. Eligible MSM were computer randomized to either WLC or a web-delivered SOLVE. Retained MSM completed baseline measures (e.g., UAI in the past three months; current level of shame) and, in the SOLVE group, viewed at least one level of the game. At the end of the first session, shame was measured again. MSM completed follow-up UAI measures three months later. All data from 921 retained MSM (WLC condition, 484; SOLVE condition, 437) were analyzed, with missing data multiply imputed.ResultsAt baseline, MSM reporting more risky sexual behaviour reported more shame (r s=0.21; p<0.001). MSM in the SOLVE intervention reported more shame reduction (M=−0.08) than MSM in the control condition (M=0.07; t(919)=4.24; p<0.001). As predicted, the indirect effect was significant (point estimate −0.10, 95% bias-corrected CI [−0.01 to −0.23] such that participants in the SOLVE treatment condition reported greater reductions in shame, which in turn predicted reductions in risky sexual behaviour at follow-up. The direct effect, however, was not significant.ConclusionsSOLVE is the first intervention to: (1) significantly reduce shame for MSM; and (2) demonstrate that shame-reduction, due to an intervention, is predictive of risk (UAI) reduction over time.

P3.126 Sex Partner Meeting Place Typologies Reported by Newly Diagnosed HIV-Infected MSM

BackgroundMen who have sex with men (MSM) are affected by HIV more than any other group in the US, accounting for more than half of all new HIV infections annually....

P3.158 Newly Identified HIV Infection Among Patients Diagnosed with Early Syphilis, Chicago, IL, 2006–2011

BackgroundConcomitant HIV and syphilis infections are prevalent among the same risk groups. Increases in syphilis cases among men who have sex with men (MSM) have been characterised by high rates...

Utilization of HIV Prevention Services Across Racial/Ethnic Groups Among Men Who Have Sex with Men in San Francisco, California, 2008

Human Immunodeficiency Virus (HIV) infection in the US is disproportionally higher among Black and Latino men who have sex with men (MSM), compared to other racial/ethnic groups. The 2008 US National HIV Behavioral Surveillance (NHBS) survey of MSM was analyzed to compare utilization of HIV testing, receiving condoms, and individual and group HIV prevention programs among racial/ethnic groups in San Francisco, CA. Using a weighted analysis of the time-location sampling method, racial/ethnic subpopulation estimates were obtained for utilization of these services in the prior 12months. There was no significant difference in utilization of HIV prevention services among Black (N=37), Latino (N=128), and White (N=275) MSM in San Francisco, CA. Overall 60-70% of MSM reported their last HIV test within the past 12months and more than 75% reported receiving condoms in the last 12months. However, less than 15% of MSM reported utilizing individual or group HIV prevention counseling sessions. The NHBS survey demonstrate that the majority of MSM in San Francisco, CA have utilized one or more HIV prevention service in the past 12months and that there were no racial/ethnic disparities in utilization of these services. However, the utilization of individual or group HIV prevention programs is low and HIV testing is below current recommendations for MSM.

The Role of Individual and Neighborhood Factors: HIV Acquisition Risk Among High-Risk Populations in San Francisco

We examined socioeconomic status and social and sexual network factors and their relationship to HIV acquisition risk among HIV-negative Black MSM (BMSM), White MSM (WMSM) and transfemales (male to female transgenders). Geographic analysis examined residential patterns and neighborhood patterns of HIV prevalence in San Francisco. Factors associated with engaging in more episodes of potentially HIV serodiscordant unprotected receptive anal intercourse were analyzed. Transfemales and BMSM were more likely to live in areas of higher HIV prevalence and lower income compared to WMSM. BMSM and transfemales had lower socioeconomic scores (SES) scores compared to WMSM. BMSM were more likely to report serodiscordant partnerships and higher numbers of potentially serodiscordant unprotected sex acts. Decreasing individual SES did not predict serodiscordant partnerships in any group. Increasing neighborhood HIV prevalence predicted an increase in the number of potentially serodiscordant unprotected sex acts among transfemales and BMSM but only significantly so for transfemales. Prevention interventions must consider neighborhood HIV prevalence, and HIV prevalence in social/sexual networks, in addition to considering individual level behavior change or poverty reduction.

HIV Among Black Men Who Have Sex with Men (MSM) in the United States: A Review of the Literature

In 2006, Millett published a seminal literature review that examined 12 hypotheses to explain the high rates of HIV among black MSM. This paper augments Millett's article by reviewing the recent literature on behavioral, biomedical, structural, social contextual, psychosocial, and social network factors that affect HIV rates among black MSM. We searched three databases: PubMed, Scopus, and Google Scholar. First we searched all articles that included black or African American and MSM and HIV. We then searched the following terms for each area: behavioral (drug use during sex, crack cocaine use, and serosorting); biomedical (circumcision, STDs, and STIs); structural (access to care, HIV care, ART, HAART, patient-provider communication, HIV quality of care); social contextual (stigma, discrimination, internalized homophobia, internalized heterosexism, medical mistrust, social isolation, and incarceration); psychosocial (peer support and mental health); and social network (sexual mixing, partner characteristics, and social networks) factors. We identified 39 articles to include in this review. We found inconclusive evidence that incarceration, stigma, discrimination, social isolation, mental health disparities, or social networks explain the elevated rates of HIV among black MSM. We found evidence that the differences in rates of HIV between black and white MSM may be explained by differences in STIs, undiagnosed seropositivity, access to care and treatment services, and use of HAART. There is an overwhelming need for HIV testing, linkage to care, retention in care, and adherence programs for black MSM.

Ethnicity Moderates the Relationship Between Perceived Stress and Benefit Finding in HIV+ Men Who Have Sex with Men (MSM)

Numerous studies conducted within the USA demonstrate higher levels of benefit finding in ethnic minority individuals compared to nonminority individuals living with chronic disease. As benefit finding may be a salient buffer for the effects of stress, the current study examined the association between perceived stress and benefit finding in human immunodeficiency virus (HIV)+ men who have sex with men (MSM) living in the southeast USA and investigated whether ethnicity was a moderator of this relationship. We hypothesized that benefit finding would be greater in ethnic minority MSM than in white MSM and that ethnic minority MSM with high levels of stress would experience greater benefit finding than their white MSM counterparts. The current study utilized baseline (T1) and 3-month follow-up (T2) data drawn from a previous trial of a psychosocial intervention in HIV+ MSM. Participants were 130 HIV+ MSM; 52% were white and 48% belonged to minority ethnic groups (African-American, Caribbean-American, Hispanic). Analyses revealed that benefit finding was greater in ethnic minority MSM at baseline; however, this difference became nonsignificant when age, education level, highly active antiretroviral therapy adherence, and CD4 count were added to the model. Moderated regression analyses revealed a significant interaction between T1 perceived stress and ethnicity in predicting T2 benefit finding, such that higher levels of T1 perceived stress predicted lower levels of T2 benefit finding in ethnic minority MSM only. This association was independent of intervention group assignment. The current study's results highlight potential differences in the relationship between stress and benefit finding processes in white and ethnic minority HIV+ MSM.

HIV/AIDS and Minority Men Who Have Sex With Men: A Meta-Ethnographic Synthesis of Qualitative Research

The World Health Organization (2009) estimates that there are as many as 33 million people currently living with HIV/AIDS throughout the world. Studies also reveal that racial disparities significantly influence HIV/AIDS diagnoses within the U.S. men who have sex with men population (MSM). In recent years, the burden of HIV/AIDS has shifted from White MSM to younger men of color, particularly African Americans and Latinos. The disproportionate effect of the HIV/AIDS epidemic in African American and Latino MSM populations requires that scholars and practitioners work diligently to address cultural and structural factors that uniquely influence such populations. The goal of this article is to synthesize qualitative findings that address cultural and structural factors that influence HIV/AIDS risk in African American and Latino MSM populations using a qualitative meta-synthesis procedure. Ultimately, our analysis suggests that “structure-centered” approaches (Dutta & Basu, 2011) are needed to address this health disparity in meaningful ways.

Putting It All Together

Putting It All Together

An Event-Level Comparison of Risk-Related Sexual Practices Between Black and Other-Race Men Who Have Sex with Men: Condoms, Semen, Lubricant, and Rectal Douching

Black men who have sex with men (MSM) living in the U.S. are disproportionately affected by HIV/AIDS. An online survey of sexual behavior was completed by Black, White, Hispanic/Latino, Asian/Pacific Islander, and other-race MSM (n=11,766) ages 18-87 years. Complete condom use, semen exposure, pre-coital rectal douching (enema use), and lubricant use at last male-partnered sexual event were compared by race, controlling for relevant sociodemographic variables and stratifying by sexual position (receptive, insertive, or both). Across sexual positions, 55-62% of Black MSM reported condom use, 5-8% reported semen exposure, 18-53% reported douching, and 33-43% reported lubricant use. Reported behavioral profiles were not significantly different from other races, except that Black MSM reported greater condom use than White MSM in the insertive position. Although findings argue against disproportionate rates of risk behavior accounting for racial disparities in HIV prevalence, they nonetheless highlight a need for continued behavioral intervention.

Circumcision and HIV Infection among Men Who Have Sex with Men in Britain: The Insertive Sexual Role

The objective was to examine the association between circumcision status and self-reported HIV infection among men who have sex with men (MSM) in Britain who predominantly or exclusively engaged in insertive anal intercourse. In 2007-2008, a convenience sample of MSM living in Britain was recruited through websites, in sexual health clinics, bars, clubs, and other venues. Men completed an online survey which included questions on circumcision status, HIV testing, HIV status, sexual risk behavior, and sexual role for anal sex. The analysis was restricted to 1,521 white British MSM who reported unprotected anal intercourse in the previous 3 months and who said they only or mostly took the insertive role during anal sex. Of these men, 254 (16.7 %) were circumcised. Among men who had had a previous HIV test (n = 1,097), self-reported HIV seropositivity was 8.6 % for circumcised men (17/197) and 8.9 % for uncircumcised men (80/900) (unadjusted odds ratio [OR], 0.97; 95 % confidence interval [95 % CI], 0.56, 1.67). In a multivariable logistic model adjusted for known risk factors for HIV infection, there was no evidence of an association between HIV seropositivity and circumcision status (adjusted OR, 0.79; 95 % CI, 0.43, 1.44), even among the 400 MSM who engaged exclusively in insertive anal sex (adjusted OR, 0.84; 95 % CI, 0.25, 2.81). Our study provides further evidence that circumcision is unlikely to be an effective strategy for HIV prevention among MSM in Britain.

Measuring population transmission risk for HIV: an alternative metric of exposure risk in men who have sex with men (MSM) in the US.

BackgroundVarious metrics for HIV burden and treatment success [e.g. HIV prevalence, community viral load (CVL), population viral load (PVL), percent of HIV-positive persons with undetectable viral load] have important public health limitations for understanding disparities.Methods and FindingsUsing data from an ongoing HIV incidence cohort of black and white men who have sex with men (MSM), we propose a new metric to measure the prevalence of those at risk of transmitting HIV and illustrate its value. MSM with plasma VL>400 copies/mL were defined as having ‘transmission risk’. We calculated HIV prevalence, CVL, PVL, percent of HIV-positive with undetectable viral loads, and prevalence of plasma VL>400 copies/ml (%VL400) for black and white MSM. We used Monte Carlo simulation incorporating data on sexual mixing by race to estimate exposure of black and white HIV-negative MSM to a partner with transmission risk via unprotected anal intercourse (UAI). Of 709 MSM recruited, 42% (168/399) black and 14% (44/310) white MSM tested HIV-positive (p<.0001). No significant differences were seen in CVL, PVL, or percent of HIV positive with undetectable viral loads. The %VL400 was 25% (98/393) for black vs. 8% (25/310) for white MSM (p<.0001). Black MSM with 2 UAI partners were estimated to have 40% probability (95% CI: 35%, 45%) of having ≥1 UAI partner with transmission risk vs. 20% for white MSM (CI: 15%, 24%).DiscussionDespite similarities in other metrics, black MSM in our cohort are three times as likely as white MSM to have HIV transmission risk. With comparable risk behaviors, HIV-negative black MSM have a substantially higher likelihood of encountering a UAI partner at risk of transmitting HIV. Our results support increasing HIV testing, linkage to care, and antiretroviral treatment of HIV-positive MSM to reduce prevalence of those with transmission risk, particularly for black MSM.

Marketing the HIV Test to MSM

Lack of awareness of HIV status is associated with an increased likelihood of HIV transmission. We surveyed 633 men who have sex with men (MSM) from diverse ethnic groups recruited from a variety of community venues in a U.S. Midwestern city with rising HIV infection rates. Our first aim was to describe patterns of sexual risk, annual HIV testing frequency, and venues where information about HIV and HIV testing could be disseminated to inner-city MSM. Our second aim was to identify preferred sources to receive information about HIV testing and determine whether these preferences differed by ethnic background. Results indicated that despite similar proportions of high-sexual risk behaviors, compared with African American and Latino MSM, smaller proportions of non-Hispanic White MSM had received an HIV test in the last 12 months. Despite ethnic differences in health care access, a physician's office was the most common HIV testing site. Overall, a majority conveyed a preference to see advertisements in mainstream media outlets. However, when preferences were stratified by ethnicity, African American MSM were the least likely to prefer receiving information from mainstream media and conveyed a stronger preference to receive information from authority figures than non-Hispanic White and Hispanic MSM.

Prevalence of Urethral Trichomonas vaginalis in Black and White Men Who Have Sex With Men

To the Editor: Trichomonas vaginalis (TV) is a common nonulcerative sexually transmitted infection (STI) that has been associated with increased acquisition of human immunodeficiency virus (HIV) infection in women.1,2 Nucleic acid amplification testing for TV is more sensitive than traditionally used methods of detection, such as wet preparation or culture, and can facilitate the diagnosis of TV infection in both men and women.3 The prevalence of TV is estimated at 3.1% for US women, with black women being disproportionately affected by TV with a prevalence of 13.3%.4 Prevalence estimates among men are variable and reported between 3% and 17% for men attending STI clinics and as high as 72% for male partners of females diagnosed with vaginal TV.5–8 However, data on racial disparities among men are lacking. The incidence of HIV among black men who have sex with men (MSM) is at least 2 to 3 times that of white MSM, and differences in the prevalence of STIs are thought to contribute to disparities in HIV incidence among black and white MSM.9,10 However, the limited data available suggest that TV is a rare cause of urethral and rectal infection in MSM.8,11,12 Given its potential implications for disparities in HIV transmission among MSM, we assessed TV prevalence among community- recruited black and white MSM in the southeast. The Emory InvolveMENt study is currently enrolling a longitudinal cohort with plans to eventually enroll approximately 1000 MSM. The study is designed to examine individual-, dyadic-, and community-level factors that may explain disparities in HIV and STI incidence between black and white MSM. MSM aged 18 to 39 years, regardless of HIV serostatus, who reported having sex with another male in the previous 3 months and not being in a mutually monogamous relationship were recruited from community-based venues and via the internet in Atlanta, GA, surveyed, and tested for urethral TV as part of a standard battery of STI tests. MSM were not queried for symptoms of STI before testing. The presence of TV in urine specimens was assessed using a real-time polymerase chain reaction test that was developed and validated in our Center for AIDS Research Clinical Virology Core laboratory with sensitivity and specificity of 100% and 99.6%, respectively, and a limit of detection of <0.2 organisms per reaction or 40 copies/mL.13 Between July 2010 and February 2012, a total of 319 black MSM (42.0% HIV positive) and 281 white MSM (14.6% HIV positive) were tested for urethral TV at their first InvolveMENt study visit. No man refused TV testing, and 100% of urine specimens were adequate for analysis. None of the urine specimens from black (exact 95% confidence interval, 0%–0.94%) or white (exact 95% confidence interval, 0%–1.06%) MSM tested positive for urethral TV. Given these results, we have discontinued all TV testing in our study. Our data confirm previous studies that suggested TV is not a common cause of urethral infection in MSM. Furthermore, our data add to existing data by showing that clinically important racial disparities in TV prevalence reported among heterosexuals are likely not present among MSM.8,11,12 Our data are limited in that our study was conducted in 1 geographic area (Atlanta, GA) among community-recruited MSM aged 18 to 39 years and may not be generalizable. For example, older MSM or MSM attending STI clinics may have a higher prevalence of TV infection. In addition, we did not assess men for symptoms of urethritis before testing for TV, and TV prevalence could be higher among MSM with symptomatic urethritis. Nonetheless, our data show that differences in TV prevalence by race are not likely to be an important driver of disparities in HIV transmission among black and white MSM. In addition, the inclusion of routine TV screening in asymptomatic, sexually active MSM for clinical or research purpose is likely to be of very low utility.

Failure of Serosorting to Protect African American Men Who Have Sex With Men From HIV Infection

Serosorting is the practice of choosing sex partners or selectively using condoms based on a sex partner's perceived HIV status. The extent to which serosorting protects African American (AA) and Hispanic men who have sex with men (MSM) is unknown. We analyzed data collected from MSM sexually transmitted diseases clinic patients in Seattle, WA, 2001-2010. Men were asked about the HIV status of their anal sex partners in the prior year and about their condom use with partners by partner HIV status. We defined serosorters as MSM who had unprotected anal intercourse (UAI) only with partners of the same HIV status, and compared the risk of testing HIV positive among serosorters and men who reported having UAI with partners of opposite or unknown HIV status (ie, nonconcordant UAI). We used generalized estimating equations to evaluate the association of serosorting with testing HIV positive. A total of 6694 MSM without a prior HIV diagnosis were tested during 13,657 visits; 274 men tested HIV positive. Serosorting was associated with a lower risk of testing HIV positive than nonconcordant UAI among white MSM (2.1 vs. 4.5%, odds ratio [OR]: 0.45, 95% confidence interval [CI]: 0.34-0.61), but not AA MSM (6.8 vs. 6.0%, OR: 1.1, 95% CI: 0.57-2.2). Among Hispanics, the risk of testing HIV positive was lower among serosorters than men engaging in nonconcordant UAI, though this was not significant (4.1 vs. 6.0%, OR: 0.67, 95% CI: 0.36-1.2). In at least some AA MSM populations, serosorting does not seem to be protective against HIV infection.

HIV Infection Among Ethnic Minority and Migrant Men Who Have Sex With Men in Britain

To examine human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) from different ethnic and migrant groups living in Britain. In 2007-2008, a diverse national sample of MSM living in Britain was recruited through Web sites, in sexual health clinics, bars, clubs, and other venues. Men completed an online survey that included questions on HIV testing, HIV status, and sexual behavior. Nine hundred and ninety-one ethnic minority MSM, 207 men born in Central or Eastern Europe (CEE), 136 men born in South or Central America, and 11,944 white British men were included in the analysis. Self-reported HIV seropositivity was low for men of South Asian, Chinese, and "other Asian" ethnicity (range, 0.0%-5.8%) and for men born in CEE (4.5%) but elevated for men born in South or Central America (18.7%), compared with white British men (13.1%) (P < 0.001). There were no significant differences between these groups in high-risk sexual behavior (P = 0.8). After adjusting for confounding factors in a multivariable model, substantial differences in the odds of HIV infection remained for South Asian and Chinese MSM as well as for migrants from CEE, but not for other groups, compared with white British men; for example, South Asian men, adjusted odds ratio 0.43, 95% confidence interval 0.23, 0.79, P = 0.007. There were marked differences in self-reported HIV seropositivity between ethnic minority, key migrant, and white British MSM in this study but not in high-risk sexual behavior. This highlights the importance of health promotion targeting MSM from all ethnic and migrant groups in Britain.