title: Understanding racial HIV/STI disparities in black and white men who have sex with men: a multilevel approach.
abstract: BACKGROUND
  The reasons for black/white disparities in HIV epidemics among men who have sex with men have puzzled researchers for decades. Understanding reasons for these disparities requires looking beyond individual-level behavioral risk to a more comprehensive framework.
  
  
  RESULTS
  From July 2010-December 2012, 803 men (454 black, 349 white) were recruited through venue-based and online sampling; consenting men were provided HIV and STI testing, completed a behavioral survey and a sex partner inventory, and provided place of residence for geocoding. HIV prevalence was higher among black (43%) versus white (13% MSM (prevalence ratio (PR) 3.3, 95% confidence interval (CI): 2.5-4.4). Among HIV-positive men, the median CD4 count was significantly lower for black (490 cells/µL) than white (577 cells/µL) MSM; there was no difference in the HIV RNA viral load by race. Black men were younger, more likely to be bisexual and unemployed, had less educational attainment, and reported fewer male sex partners, fewer unprotected anal sex partners, and less non-injection drug use. Black MSM were significantly more likely than white MSM to have rectal chlamydia and gonorrhea, were more likely to have racially concordant partnerships, more likely to have casual (one-time) partners, and less likely to discuss serostatus with partners. The census tracts where black MSM lived had higher rates of poverty and unemployment, and lower median income. They also had lower proportions of male-male households, lower male to female sex ratios, and lower HIV diagnosis rates.
  
  
  CONCLUSIONS
  Among black and white MSM in Atlanta, disparities in HIV and STI prevalence by race are comparable to those observed nationally. We identified differences between black and white MSM at the individual, dyadic/sexual network, and community levels. The reasons for black/white disparities in HIV prevalence in Atlanta are complex, and will likely require a multilevel framework to understand comprehensively.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Sullivan
authors.affiliation: Department of Psychology, Georgia State University, Atlanta, Georgia, United States of America.
authors.forename: John
authors.initials: J
authors.lastname: Peterson
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Eli S
authors.initials: ES
authors.lastname: Rosenberg
authors.affiliation: Department of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America.
authors.forename: Colleen F
authors.initials: CF
authors.lastname: Kelley
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Hannah
authors.initials: H
authors.lastname: Cooper
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Adam
authors.initials: A
authors.lastname: Vaughan
authors.affiliation: Institute of Public Health, Georgia State University, Atlanta, Georgia, United States of America.
authors.forename: Laura F
authors.initials: LF
authors.lastname: Salazar
authors.affiliation: Department of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America.
authors.forename: Paula
authors.initials: P
authors.lastname: Frew
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Gina
authors.initials: G
authors.lastname: Wingood
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Ralph
authors.initials: R
authors.lastname: Diclemente
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Carlos
authors.initials: C
authors.lastname: del Rio
authors.affiliation: Department of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America.
authors.forename: Mark
authors.initials: M
authors.lastname: Mulligan
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Travis H
authors.initials: TH
authors.lastname: Sanchez
mesh_terms: D044383:Black People; D015658:HIV Infections / Q000453:epidemiology; D018451:Homosexuality, Male / Q000208:ethnology*; D006801:Humans; D008297:Male; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D044465:White People