Structural Determinants of Black MSM HIV Testing Coverage (2011-2016)

• Authors: Barbara Tempalski, National Development and Research Institutes; Stephanie Beane, Emory University; Hannah Cooper, Emory University; Samuel R Friedman, New York University; Sarah C McKetta, Columbia University; Umedjon Ibragimov, Emory University; Leslie D Williams, University of Illinois at Chicago; Ronald Stall, University of Pittsburgh
• Journal Title: AIDS AND BEHAVIOR
• Volume: Volume 24, Number 9
• Publisher: SPRINGER/PLENUM PUBLISHERS | 2020-03-02, Pages 2572-2587
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1007/s10461-020-02814-4
• Subjects: Health Sciences, Public Health
• Keywords: Science & Technology; Social Sciences; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; Social Sciences, Biomedical; Biomedical Social Sciences; Structural determinants; HIV testing; Black MSM; Theory of community action; US Metropolitan Statistical Areas; Place research; SYRINGE EXCHANGE PROGRAMS; METROPOLITAN-AREAS; INJECT DRUGS; SOCIAL-MOVEMENTS; WEST HOLLYWOOD; HARM REDUCTION; PUBLIC-HEALTH; UNITED-STATES; MEN; SEX

Abstract

Over 30 years into the US HIV/AIDS epidemic, Black men who have sex with men (BMSM) continue to carry the highest burden of both HIV and AIDS cases. There is then, an urgent need to expand access to HIV prevention and treatment for all gay and bisexual men, underscoring the importance of the federal initiative ‘Ending the Epidemic: A Plan for America’. This research examines structural factors associated with BMSM HIV testing coverage over time (2011–2016) in 85 US Metropolitan Statistical Areas (MSAs). We calculated MSA-specific annual measures of BMSM HIV testing coverage (2011–2016). Variables suggested by the Theory of Community Action (i.e., need, resource availability, institutional opposition and organized support) were analyzed as possible predictors of coverage using multilevel modeling. Relationships between BMSM HIV testing and the following covariates were positive: rates of BMSM living with HIV (b = 0.28), percent of Black residents employed (b = 0.19), Black heterosexual testing rate (b = 0.46), health expenditures per capita (b = 0.16), ACT UP organization presence in 1992 (b = 0.19), and syringe service presence (b = 0.12). Hard drug arrest rates at baseline (b = − 0.21) and change since baseline (b = − 0.10) were inversely associated with the outcome. Need, resources availability, organized support and institutional opposition are important determinants of place associated with BMSM HIV testing coverage. Efforts to reduce HIV incidence and lessen AIDS-related disparities among BMSM in the US require improved and innovative HIV prevention approaches directed toward BMSM including a fuller understanding of structural factors that may influence place variation in BMSM testing patterns and risk behavior in places of high need.