title: Investigating a sexual network of black men who have sex with men: implications for transmission and prevention of HIV infection in the United States.
abstract: BACKGROUND
  HIV infections increased 48% among young Black men who have sex with men (MSM) in the United States between 2006 and 2009. Incomplete understanding of this trend undermines prevention strategy development. We investigated a sexual network to characterize the risk environment in which young Black MSM acquire HIV.
  
  
  METHODS
  Persons reported to the state after diagnosis of HIV or syphilis were included, along with sexual partners. We used network mapping alongside descriptive and bivariate statistics to characterize network connections. Generalized linear models assessed predictors of having untraceable sex partners.
  
  
  RESULTS
  The network included 398 individuals and 419 sexual relationships. Three-quarters were Black (n = 299); 92% were MSM. Median age at first network appearance was 26 years and decreased over time (P < 0.001). HIV prevalence was at least 29% (n = 117); serostatus was unknown for 47% of the network, either because they were untraceable (n = 150) or refused HIV testing (n = 39). One in 5 network members diagnosed with HIV had a subsequent incident sexually transmitted infection. In multivariable models, one-time encounters increased the risk of having an untraceable partner (risk ratio = 4.51, 95% CI: 2.27 to 8.97), whereas being acutely HIV infected at diagnosis reduced it (risk ratio = 0.27, 95% CI: 0.08 to 0.89).
  
  
  CONCLUSIONS
  HIV prevalence in this sexual network of young Black MSM rivals that of sub-Saharan Africa, reflecting dramatically increased risk of acquiring HIV from the moment one entered the network. Prevention efforts for this population must consider the effect of sexual networks on HIV risk and find ways of leveraging network structure to reduce transmission.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7030, USA. churt@med.unc.edu
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Hurt
authors.forename: Steve
authors.initials: S
authors.lastname: Beagle
authors.forename: Peter A
authors.initials: PA
authors.lastname: Leone
authors.forename: Alyssa
authors.initials: A
authors.lastname: Sugarbaker
authors.forename: Emily
authors.initials: E
authors.lastname: Pike
authors.forename: JoAnn
authors.initials: J
authors.lastname: Kuruc
authors.forename: Evelyn M
authors.initials: EM
authors.lastname: Foust
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eron
authors.forename: Myron S
authors.initials: MS
authors.lastname: Cohen
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Hightow-Weidman
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology; D055815:Young Adult