title: Stuck in the middle: longitudinal HIV-related health disparities among men who have sex with men and women.
abstract: BACKGROUND
  Men who have sex with men and women (MSMW) have been shown in cross-sectional studies to suffer HIV-related health disparities above and beyond those found among men who have sex with men only (MSMO). We conducted a secondary data analysis over a 7-year time frame of participants in the Multicenter AIDS Cohort Study, a long-standing prospective cohort study, to examine whether MSMW had persistently higher rates of depression symptoms, polydrug use, and (among HIV-positive men who have sex with men) HIV viral load levels compared with MSMO.
  
  
  METHODS
  Men were behaviorally defined as bisexual if they reported sexual activity with at least 1 male and 1 female partner between study waves 38 and 50. We used generalized mixed modeling with repeated measures to test differences in CES-D score, polydrug use, and viral load between sexually active MSMO (n = 1514) and MSMW (n = 111), adjusting for age, income, race/ethnicity, and recent seroconversion.
  
  
  RESULTS
  MSMW were significantly more likely than MSMO to have higher CES-D scores, polydrug use, and viral load levels (all P < 0.01). Outcome trajectories did not differ significantly over time between these groups. Black and Hispanic HIV-positive MSMW had higher viral load levels relative to white HIV-positive MSMW (P < 0.01).
  
  
  CONCLUSIONS
  Compared with MSMO, MSMW in the Multicenter AIDS Cohort Study suffer from profound and persistent HIV-related health disparities across biological, behavioral, and psychosocial domains. Further qualitative and quantitative research contextualizing the pathways underlying these disparities is recommended for intervention development targeting MSMW at risk for HIV acquisition and transmission.
authors.affiliation: *Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; †Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; ‡Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; §Department of Medical Social Sciences, Northwestern University, Chicago, IL; ‖Department of Family Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA; ¶Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; and #Department of Medicine, Georgetown University Medical Center, Washington, DC.
authors.forename: M Reuel
authors.initials: MR
authors.lastname: Friedman
authors.forename: Ron
authors.initials: R
authors.lastname: Stall
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Silvestre
authors.forename: Brian
authors.initials: B
authors.lastname: Mustanski
authors.forename: Steve
authors.initials: S
authors.lastname: Shoptaw
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Surkan
authors.forename: Charles R
authors.initials: CR
authors.lastname: Rinaldo
authors.forename: Michael W
authors.initials: MW
authors.lastname: Plankey
mesh_terms: D000328:Adult; D001741:Black or African American; D001727:Bisexuality; D003863:Depression / Q000150:complications / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D020010:Heterosexuality; D006630:Hispanic or Latino; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012725:Sexual Behavior; D012747:Sexual Partners; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000150:complications / Q000821:virology; D019562:Viral Load; D055815:Young Adult