Concomitant Socioeconomic, Behavioral, and Biological Factors Associated with the Disproportionate HIV Infection Burden among Black Men Who Have Sex with Men in 6 US Cities

• Type of Material: Article
• Authors: Kenneth H. Mayer, Beth Israel Deaconess Medical Center; Lei Wang, Fred Hutchinson Cancer Research Center; Beryl Koblin, New York Blood Center; Sharon Mannheimer, Harlem Hospital; Manya Magnus, George Washington University; Carlos Del Rio, Emory University; Susan Buchbinder, San Francisco Department of Health; Leo Wilton, Binghamton University; Vanessa Cummings, Johns Hopkins University; Christopher C. Watson, George Washington University; Estelle Piwowar-Manning, Johns Hopkins University; Charlotte Gaydos, Johns Hopkins University; Susan H. Eshleman, Johns Hopkins University; William Clarke, Johns Hopkins University; Ting-Yuan Liu, Fred Hutchinson Cancer Research Center; Cherry Mao, Fred Hutchinson Cancer Research Center; Samuel Griffith, FHI 360; Darrell Wheeler, Loyola University Chicago
• Language: English
• Date: 2014-01-31
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
• License: Creative Commons Creative Commons CC0 1.0 Universal
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0087298
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 9
• Issue: 1
• Start Page: e87298
• End Page: e87298
• Grant/Funding Information: HPTN 061 grant support was provided by the National Institute of Allergy and Infectious Disease (NIAID), National Institute on Drug Abuse (NIDA) and National Institute of Mental Health (NIMH): Cooperative Agreements UM1 AI068619, UM1 AI068617, and UM1 AI068613.; Additional site funding was provided by the Fenway Institute CRS: Harvard University CFAR (P30 AI060354) and CTU for HIV Prevention and Microbicide Research (UM1 AI069480).; This project received support from the Hope Clinic of the Emory Vaccine Center CRS and The Ponce de Leon Center CRS: Emory University HIV/AIDS CTU (5U01 AI069418), CFAR (P30 AI050409) and CTSA (UL1 RR025008).; Further support came from the George Washington University CRS: District of Columbia Developmental CFAR (P30 AI087714); Harlem Prevention Center CRS and NY Blood Center/Union Square CRS: Columbia University CTU (5U01 AI069466) and ARRA funding (3U01 AI069466-03S1).; Finally, this paper was also supported by the San Francisco Vaccine and Prevention CRS: ARRA funding (3U01 AI069496-03S1, 3U01 AI069496-03S2) in addition to the UCLA Vine Street CRS: UCLA Department of Medicine, Division of Infectious Diseases CTU (U01 AI069424).
• Keywords: HIV; Science & Technology; HIV epidemiology; HIV diagnosis and management; Multidisciplinary Sciences; Sexually transmitted diseases; Men who have sex with men; HIV infections; Chlamydia infection; Religion
• Research Categories: Health Sciences, Epidemiology

Abstract

Background: American Black men who have sex with men (MSM) are disproportionately affected by HIV, but the factors associated with this concentrated epidemic are not fully understood. Methods: Black MSM were enrolled in 6 US cities to evaluate a multi-component prevention intervention, with the current analysis focusing on the correlates of being newly diagnosed with HIV compared to being HIV-uninfected or previously diagnosed with HIV. Results: HPTN 061 enrolled 1553 Black MSM whose median age was 40; 30% self-identified exclusively as gay or homosexual, 29% exclusively as bisexual, and 3% as transgender. About 1/6th (16.2%) were previously diagnosed with HIV (PD); of 1263 participants without a prior HIV diagnosis 7.6% were newly diagnosed (ND). Compared to PD, ND Black MSM were younger (p<0.001); less likely to be living with a primary partner (p<0.001); more likely to be diagnosed with syphilis (p<0.001), rectal gonorrhea (p = 0.011) or chlamydia (p = 0.020). Compared to HIV-uninfected Black MSM, ND were more likely to report unprotected receptive anal intercourse (URAI) with a male partner in the last 6 months (p<0.001); and to be diagnosed with syphilis (p<0.001), rectal gonorrhea (p = 0.004), and urethral (p = 0.025) or rectal chlamydia (p<0.001). They were less likely to report female (p = 0.002) or transgender partners (p = 0.018). Multivariate logistic regression analyses found that ND Black MSM were significantly more likely than HIV-uninfected peers to be unemployed; have STIs, and engage in URAI. Almost half the men in each group were poor, had depressive symptoms, and expressed internalized homophobia. Conclusions: ND HIV-infected Black MSM were more likely to be unemployed, have bacterial STIs and engage in URAI than other Black MSM. Culturally-tailored programs that address economic disenfranchisement, increase engagement in care, screen for STIs, in conjunction with safer sex prevention interventions, may help to decrease further transmission in this heavily affected community.