Lack of Awareness of Human Immunodeficiency Virus (HIV) Infection: Problems and Solutions With Self-reported HIV Serostatus of Men Who Have Sex With Men.
BACKGROUND
Lack of human immunodeficiency virus (HIV) infection awareness may be a driver of racial disparities in HIV infection among men who have sex with men (MSM). Lack of awareness is typically measured by comparing HIV test result to self-reported HIV status. This measure may be subject to reporting bias and alternatives are needed.


METHODS
The InvolveMENt study examined HIV disparities between black and white MSM from Atlanta. Among HIV-positive participants who did not report knowing they were positive, we examined other measures of awareness: HIV viral load (VL) <1000 copies/mL (low VL), antiretroviral (ARV) drugs in blood, and previous HIV case surveillance report.


RESULTS
Using self-report only, 32% (62 of 192) of black and 16% (7 of 45) of white MSM were not aware of their HIV infection (P = .03). Using self-report and low VL, 25% (48 of 192) black and 16% (7 of 45) white MSM lacked awareness (P = .18). Using self-report and ARVs, 26% (50 of 192) black and 16% (7 of 45) white MSM lacked awareness (P = .14). Using self-report and surveillance report, 15% (28 of 192) black and 13% (6 of 45) white MSM lacked awareness (P = .83).


CONCLUSIONS
Self-report only may overestimate true lack of awareness of HIV status for black MSM. If, as our data suggest, black MSM are not less likely to be aware of their HIV infection than are white MSM, then this factor is not a substantial driver of HIV disparity. Future HIV research that depends on accurate measurement of HIV status awareness should consider including additional laboratory and case surveillance data.
Rollins School of Public Health , Emory University and Emory Center for AIDS Research.
Travis H
TH
Sanchez
Rollins School of Public Health , Emory University and Emory Center for AIDS Research ; Division of Infectious Disease, Department of Medicine , Emory University School of Medicine.
Colleen F
CF
Kelley
Rollins School of Public Health , Emory University and Emory Center for AIDS Research.
Eli
E
Rosenberg
Rollins School of Public Health , Emory University and Emory Center for AIDS Research.
Nicole
N
Luisi
Rollins School of Public Health , Emory University and Emory Center for AIDS Research.
Brandon
B
O'Hara
HIV/AIDS Epidemiology, Georgia Department of Public Health.
Rodriques
R
Lambert
Rollins School of Public Health , Emory University and Emory Center for AIDS Research.
Raphael
R
Coleman
Rollins School of Public Health , Emory University and Emory Center for AIDS Research ; Division of Infectious Disease, Department of Medicine , Emory University School of Medicine.
Paula
P
Frew
School of Public Health , Georgia State University.
Laura F
LF
Salazar
Laboratory of Biochemical Pharmacology , Emory University , Atlanta, Georgia.
Sijia
S
Tao
School of Medicine , Johns Hopkins University , Baltimore, Maryland.
William
W
Clarke
Rollins School of Public Health , Emory University and Emory Center for AIDS Research.
Carlos
C
Del Rio
Rollins School of Public Health , Emory University and Emory Center for AIDS Research.
Patrick S
PS
Sullivan
HIV; MSM; survey; testing