title: Multilevel risk factors for greater HIV infection of black men who have sex with men in New York City.
abstract: BACKGROUND
  There is a large and disproportionate burden of HIV in black men who have sex with men (MSM) which is not adequately explained by racial/ethnic differences in risk behaviors. However, social factors may account for this disparity in HIV infection. We examine the extent to which both individual risk behaviors and social factors reduce the effect of black race and may account for the disparity in HIV infection of black MSM.
  
  
  METHODS
  In a cross-sectional study in New York City in 2011, MSM were venue sampled, interviewed, and HIV tested. Variables associated (P < 0.10) both with black race and testing HIV positive were analyzed using multivariate logistic regression.
  
  
  RESULTS
  Of 416 participants who were HIV tested and did not self-report being positive, 19.5% were black, 41.1% were Hispanic, 30.5% were white, and 8.9% were of other race/ethnicity. Overall, 8.7% tested positive (24.7% of blacks, 7.6% of Hispanics, 1.0% of whites, and 5.4% of other). The effect of black race versus non-black race/ethnicity with testing HIV positive declined by 49.2%, (crude odds ratio, 6.5 [95% confidence interval, 3.2-13.3] vs. adjusted odds ratio, 3.3 [95% confidence interval, 1.5-7.5]), after adjustment for having a black last sex partner, not having tested for HIV in the past 12 months, Brooklyn residency, and having an annual income less than US$20,000.
  
  
  CONCLUSIONS
  Greater HIV infection risk of black MSM may result from social factors and less frequent HIV testing than from differences in risk behaviors. To reduce the disparity in HIV infection of black MSM, multilevel interventions that both ameliorate social risk factors and increase the frequency of HIV testing are needed.
authors.affiliation: From the *HIV Epidemiology Program, New York City Department of Health and Mental Hygiene, New York, NY; †Department of Epidemiology, University of Washington, Seattle, WA; ‡Department of Anthropology, John Jay College of Criminal Justice, New York, NY; and §College of Nursing, New York University, New York, NY.
authors.forename: Alan
authors.initials: A
authors.lastname: Neaigus
authors.forename: Kathleen H
authors.initials: KH
authors.lastname: Reilly
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Jenness
authors.forename: Travis
authors.initials: T
authors.lastname: Wendel
authors.forename: David M
authors.initials: DM
authors.lastname: Marshall
authors.forename: Holly
authors.initials: H
authors.lastname: Hagan
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000208:ethnology / Q000517:prevention & control* / Q000635:transmission; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data*; D018451:Homosexuality, Male / Q000208:ethnology; D006801:Humans; D008297:Male; D008913:Minority Groups; D009519:New York City / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior / Q000208:ethnology / Q000523:psychology; D012747:Sexual Partners