title: Understanding disparities in HIV infection between black and white MSM in the United States.
abstract: OBJECTIVE
  We evaluated several hypotheses for disparities in HIV infection between black and white MSM in the United States, including incarceration, partner HIV status, circumcision, sexual networks, and duration of infectiousness.
  
  
  METHODS
  The 2008 National HIV Behavioral Surveillance System (NHBS), a cross-sectional survey conducted in 21 US cities.
  
  
  METHODS
  MSM were interviewed and tested for HIV infection. For MSM not previously diagnosed with HIV infection, we used logistic regression to test associations between newly diagnosed HIV infection and incarceration history, partner HIV status, circumcision status, and sexual networks (older partners, concurrency, and partner risk behaviors). For HIV-infected MSM, we assessed factors related to duration of infectiousness.
  
  
  RESULTS
  Among 5183 MSM not previously diagnosed with HIV infection, incarceration history, circumcision status, and sexual networks were not independently associated with HIV infection. Having HIV-infected partners [adjusted odds ratio (AOR) = 1.9, 95% confidence interval (CI) = 1.2–3.0] or partners of unknown status (AOR = 1.4, CI = 1.1–1.7) were associated with HIV infection. Of these two factors, only one was more common among black MSM – having partners of unknown HIV status. Among previously diagnosed HIV-positive MSM, black MSM were less likely to be on antiretroviral therapy (ART).
  
  
  CONCLUSIONS
  Less knowledge of partner HIV status and lower ART use among black MSM may partially explain differences in HIV infection between black and white MSM. Efforts to encourage discussions about HIV status between MSM and their partners and decrease barriers to ART provision among black MSM may decrease transmission.
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, USA. AOster@cdc.gov
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Oster
authors.forename: Ryan E
authors.initials: RE
authors.lastname: Wiegand
authors.forename: Catlainn
authors.initials: C
authors.lastname: Sionean
authors.forename: Isa J
authors.initials: IJ
authors.lastname: Miles
authors.forename: Peter E
authors.initials: PE
authors.lastname: Thomas
authors.forename: Lehida
authors.initials: L
authors.lastname: Melendez-Morales
authors.forename: Binh C
authors.initials: BC
authors.lastname: Le
authors.forename: Gregorio A
authors.initials: GA
authors.lastname: Millett
mesh_terms: D000328:Adult; D044383:Black People; D002944:Circumcision, Male / Q000208:ethnology / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000453:epidemiology* / Q000208:ethnology*; D054624:Health Status Disparities; D018451:Homosexuality, Male / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012307:Risk Factors; D012747:Sexual Partners; D014481:United States / Q000453:epidemiology; D047568:Unsafe Sex / Q000208:ethnology / Q000706:statistics & numerical data*; D044465:White People; D001741:Black or African American