title: Persistently high prevalence and unrecognized HIV infection among men who have sex with men in Baltimore: the BESURE study.
abstract: BACKGROUND
  Given high rates of HIV among Baltimore men who have sex with men (MSM), we examined characteristics associated with HIV prevalence and unrecognized HIV infection among Baltimore MSM at two time points.
  
  
  METHODS
  Cross-sectional behavioral surveys and HIV testing in 2004-2005 and 2008 using venue-based sampling among adult Baltimore men at MSM-identified locations. MSM was defined as sex with a male partner in the past year. Bivariate and backward stepwise regression identified characteristics associated with HIV and unrecognized infection.
  
  
  RESULTS
  HIV prevalence was 37.7% overall in 2004-2005 (n = 645) and 37.5% in 2008 (n = 448), 51.4% and 44.7% among black MSM and 12.9% and 18.3% among non-Hispanic white MSM. Compared with non-Hispanic white MSM, black MSM were 4.0 times (95% confidence interval, 2.3-7.0) more likely to be HIV-positive in 2004-2005 and 2.5 times (95% confidence interval, 1.5-4.0) more likely in 2008. Prevalence of unrecognized HIV infection was 58.4% overall in 2004-2005 and 74.4% in 2008, 63.8% and 76.9% among black MSM and 15.4% and 47.4% among non-Hispanic white MSM. In adjusted models, unrecognized infection was significantly associated with minority race/ethnicity, younger age, and no prior year doctor visits in 2004-2005 and with younger age and no prior year doctor visits in 2008.
  
  
  CONCLUSIONS
  High rates of HIV infection and substantial rates of unrecognized HIV infection among Baltimore MSM, particularly men of color and young men, require urgent public and private sector attention and increased prevention response.
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. dgerman@jhsph.edu
authors.forename: Danielle
authors.initials: D
authors.lastname: German
authors.forename: Frangiscos
authors.initials: F
authors.lastname: Sifakis
authors.forename: Cathy
authors.initials: C
authors.lastname: Maulsby
authors.forename: Vivian L
authors.initials: VL
authors.lastname: Towe
authors.forename: Colin P
authors.initials: CP
authors.lastname: Flynn
authors.forename: Carl A
authors.initials: CA
authors.lastname: Latkin
authors.forename: David D
authors.initials: DD
authors.lastname: Celentano
authors.forename: Heather
authors.initials: H
authors.lastname: Hauck
authors.forename: David R
authors.initials: DR
authors.lastname: Holtgrave
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D015142:Baltimore / Q000453:epidemiology; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral