Concomitant socioeconomic, behavioral, and biological factors associated with the disproportionate HIV infection burden among Black men who have sex with men in 6 U.S. cities.
BACKGROUND
American Black men who have sex with men (MSM) are disproportionately affected by HIV, but the factors associated with this concentrated epidemic are not fully understood.


METHODS
Black MSM were enrolled in 6 US cities to evaluate a multi-component prevention intervention, with the current analysis focusing on the correlates of being newly diagnosed with HIV compared to being HIV-uninfected or previously diagnosed with HIV.


RESULTS
HPTN 061 enrolled 1553 Black MSM whose median age was 40; 30% self-identified exclusively as gay or homosexual, 29% exclusively as bisexual, and 3% as transgender. About 1/6(th) (16.2%) were previously diagnosed with HIV (PD); of 1263 participants without a prior HIV diagnosis 7.6% were newly diagnosed (ND). Compared to PD, ND Black MSM were younger (p<0.001); less likely to be living with a primary partner (p<0.001); more likely to be diagnosed with syphilis (p<0.001), rectal gonorrhea (p = 0.011) or chlamydia (p = 0.020). Compared to HIV-uninfected Black MSM, ND were more likely to report unprotected receptive anal intercourse (URAI) with a male partner in the last 6 months (p<0.001); and to be diagnosed with syphilis (p<0.001), rectal gonorrhea (p = 0.004), and urethral (p = 0.025) or rectal chlamydia (p<0.001). They were less likely to report female (p = 0.002) or transgender partners (p = 0.018). Multivariate logistic regression analyses found that ND Black MSM were significantly more likely than HIV-uninfected peers to be unemployed; have STIs, and engage in URAI. Almost half the men in each group were poor, had depressive symptoms, and expressed internalized homophobia.


CONCLUSIONS
ND HIV-infected Black MSM were more likely to be unemployed, have bacterial STIs and engage in URAI than other Black MSM. Culturally-tailored programs that address economic disenfranchisement, increase engagement in care, screen for STIs, in conjunction with safer sex prevention interventions, may help to decrease further transmission in this heavily affected community.
The Fenway Institute of Fenway Health and the Infectious Disease Division of Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America.
Kenneth H
KH
Mayer
Vaccine and infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America.
Lei
L
Wang
Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America.
Beryl
B
Koblin
Department of Medicine, Harlem Hospital and Columbia University, New York, New York, United States of America.
Sharon
S
Mannheimer
The Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, United States of America.
Manya
M
Magnus
Department of Global Health and Emory Center for AIDS Research, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America ; HIV Research Section San Francisco Department of Health, San Francisco, California, United States of America.
Carlos
C
del Rio
HIV Research Section San Francisco Department of Health, San Francisco, California, United States of America.
Susan
S
Buchbinder
Department of Human Development, Binghamton University, Binghamton, New York, United States of America.
Leo
L
Wilton
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
Vanessa
V
Cummings
The Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, United States of America.
Christopher C
CC
Watson
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
Estelle
E
Piwowar-Manning
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
Charlotte
C
Gaydos
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
Susan H
SH
Eshleman
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
William
W
Clarke
Vaccine and infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America.
Ting-Yuan
TY
Liu
Vaccine and infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America.
Cherry
C
Mao
FHI 360, Durham, North Carolina, United States of America.
Samuel
S
Griffith
School of Social Work, Loyola University Chicago, Chicago, Illinois, United States of America.
Darrell
D
Wheeler
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data*; D002947:Cities; D015658:HIV Infections / Q000208:ethnology* / Q000517:prevention & control / Q000635:transmission; D018451:Homosexuality, Male / Q000208:ethnology* / Q000523:psychology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012725:Sexual Behavior / Q000208:ethnology* / Q000523:psychology; D012923:Social Class; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult