Understanding disparities in viral suppression among Black MSM living with HIV in Atlanta Georgia

• Type of Material: Article
• Authors: Patrick Sullivan, Emory University; Justin Knox, Columbia University; Jeb Jones, Emory University; Jennifer Taussig, Rollins School of Public Health; Mariah Valentine Graves, Rollins School of Public Health; Greg Millett, Foundation for AIDS Research; Nicole Luisi, Rollins School of Public Health; Eric Hall, Rollins School of Public Health; Travis Sanchez, Emory University; Carlos del Rio, Emory University; Colleen Kelley, Emory University; Eli Rosenberg, Emory University; Jodie Guest, Emory University
• Language: English
• Date: 2021-04-01
• Publisher: Wiley & Sons Ltd
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1002/jia2.25689
• Title of Journal or Parent Work: Journal of the International AIDS Society
• Volume: 24
• Issue: 4
• Start Page: e25689
• End Page: e25689
• Grant/Funding Information: This work was supported by the National Institutes of Health (R01AI112723 and K01AA028199). This work was supported by the Center for AIDS Research at Emory University (P30AI050409).
• Keywords: HIV; racial disparities; viral suppression; men who have sex with men; care cascade
• Research Categories: Sociology, Ethnic and Racial Studies; Health Sciences, Immunology; Biology, Virology

Abstract

INTRODUCTION: Due to factors associated with structural racism, Black men who have sex with men (MSM) living with HIV are less likely to be virally suppressed compared to white MSM. Most of these data come from clinical cohorts and modifiable reasons for these racial disparities need to be defined in order to intervene on these inequities. Therefore, we examined factors associated with racial disparities in baseline viral suppression in a community-based cohort of Black and white MSM living with HIV in Atlanta, GA. METHODS: We conducted an observational cohort of Black and white MSM living with HIV infection in Atlanta. Enrolment occurred from June 2016 to June 2017 and men were followed for 24 months; laboratory and behavioural survey data were collected at 12 and 24 months after enrolment. Explanatory factors for racial disparities in viral suppression included sociodemographics and psychosocial variables. Poisson regression models with robust error variance were used to estimate prevalence ratios (PR) for Black/white differences in viral suppression. Factors that diminished the PR for race by ≥5% were considered to meaningfully attenuate the racial disparity and were included in a multivariable model. RESULTS: Overall, 26% (104/398) of participants were not virally suppressed at baseline. Lack of viral suppression was significantly more prevalent among Black MSM (33%; 69/206) than white MSM (19%; 36/192) (crude Prevalence Ratio (PR) = 1.6; 95% CI: 1.1 to 2.5). The age-adjusted Black/white PR was diminished by controlling for: ART coverage (12% decrease), housing stability (7%), higher income (6%) and marijuana use (6%). In a multivariable model, these factors cumulatively mitigated the PR for race by 21% (adjusted PR = 1.1 [95% CI: 0.8 to 1.6]). CONCLUSIONS: Relative to white MSM, Black MSM living with HIV in Atlanta were less likely to be virally suppressed. This disparity was explained by several factors, many of which should be targeted for structural, policy and individual-level interventions to reduce racial disparities.