Correlates of HIV acquisition in a cohort of Black men who have sex with men in the United States: HIV prevention trials network (HPTN) 061.
BACKGROUND
Black men who have sex with men (MSM) in the United States (US) are affected by HIV at disproportionate rates compared to MSM of other race/ethnicities. Current HIV incidence estimates in this group are needed to appropriately target prevention efforts.


METHODS
From July 2009 to October 2010, Black MSM reporting unprotected anal intercourse with a man in the past six months were enrolled and followed for one year in six US cities for a feasibility study of a multi-component intervention to reduce HIV infection. HIV incidence based on HIV seroconversion was calculated as number of events/100 person-years. Multivariate proportional hazards modeling with time-dependent covariates was used to identify correlates of HIV acquisition.


RESULTS
Of 1,553 Black MSM enrolled, 1,164 were HIV-uninfected at baseline and included in follow-up. Overall annual HIV incidence was 3.0% (95% confidence interval (CI): 2.0, 4.4%) and 5.9% among men ≤30 years old (95% CI: 3.6, 9.1%). Men ≤30 years old reported significantly higher levels of sexual risk and were more likely to have a sexually transmitted infection diagnosed during follow-up. Younger men also were more likely to not have a usual place for health care, not have visited a health care provider recently, and to have unmet health care needs. In multivariate analysis, age ≤30 years (hazard ratio (HR): 3.4; 95% CI: 1.4, 8.3) and unprotected receptive anal intercourse with HIV-positive or unknown status partners (HR: 4.1; 95% CI: 1.9, 9.1) were significantly associated with HIV acquisition.


CONCLUSIONS
In the largest cohort of prospectively-followed Black MSM in the US, HIV incidence was high, particularly among young men. Targeted, tailored and culturally appropriate HIV prevention strategies incorporating behavioral, social and biomedical based interventions are urgently needed to lower these rates.
Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, USA. bkoblin@nybloodcenter.org
Beryl A
BA
Koblin
Kenneth H
KH
Mayer
Susan H
SH
Eshleman
Lei
L
Wang
Sharon
S
Mannheimer
Carlos
C
del Rio
Steven
S
Shoptaw
Manya
M
Magnus
Susan
S
Buchbinder
Leo
L
Wilton
Ting-Yuan
TY
Liu
Vanessa
V
Cummings
Estelle
E
Piwowar-Manning
Sheldon D
SD
Fields
Sam
S
Griffith
Vanessa
V
Elharrar
Darrell
D
Wheeler
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control*; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology; D055815:Young Adult