Understanding disparities in HIV infection between black and white men who have sex with men in the United States: data from the national HIV behavioral surveillance system
A. Oster1, R. Wiegand1, C. Sionean1, I. Miles1, L. Melendez-Morales1, P. Thomas1, B. Le2, G. Millett1
1Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, United States, 2Northrop Grumman (Contractor), Atlanta, United States
Background: In the United States, black men who have sex with men (MSM) are disproportionately infected with HIV. This disparity is explained by neither number of partners nor unprotected anal intercourse (UAI) and is only partially explained by less frequent HIV testing. We evaluated several additional hypotheses for higher prevalence of HIV infection among black MSM.
Methods: For the 2008 National HIV Behavioral Surveillance (NHBS) System, a cross-sectional survey conducted in 21 U.S. cities, MSM (black=2194, white=3448) were interviewed and tested for HIV infection. For MSM previously diagnosed with HIV infection, we assessed use of HIV care and antiretroviral therapy. For all other MSM, we used logistic regression to test associations between newly diagnosed HIV infection and partner HIV status, circumcision, incarceration history, and sexual networks (older partners, concurrency, and partner risk behaviors), controlling for sociodemographics, injection drug use, number of UAI partners, and HIV testing history.
Results: Among 636 MSM previously diagnosed with HIV infection, fewer blacks than whites accessed HIV care within three months of diagnosis (prevalence ratio [PR]=0.88, 95% confidence interval [CI]=0.80-0.97) or were on antiretroviral therapy (PR=0.80, CI=0.71-0.91). Among 5003 MSM not known to be HIV-infected, 10% tested positive for HIV infection (whites=4%, blacks=18%). In multivariate analysis, reporting an HIV-positive last partner was associated with HIV infection (adjusted odds ratio=1.8, CI=1.1-2.8 vs. HIV-negative). However, fewer black than white MSM reported an HIV-positive last partner (chi-square p< .0001). HIV infection was associated with control variables (sociodemographics, higher number of UAI partners, no HIV test during past 12 months) but not with circumcision, incarceration, or sexual network variables.
Conclusions: Delay in accessing HIV care and decreased prevalence of antiretroviral therapy may increase infectiousness among HIV-positive black MSM. Prevalence of circumcision, incarceration, or sex with older or high-risk partners does not appear to be responsible for the disparity in HIV infection.