Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: a prospective observational cohort study.
OBJECTIVE
To describe factors associated with racial disparities in HIV (human immunodeficiency virus) incidence among men who have sex with men (MSM) in the United States.


METHODS
In a longitudinal cohort of black and white HIV-negative MSM in Atlanta, HIV incidence rates were compared by race. Incidence hazard ratios (HRs) between black and white MSM were estimated with an age-scaled Cox proportional hazards model. A change-in-estimate approach was used to understand mediating time-independent and -dependent factors that accounted for the elevated HR.


RESULTS
Thirty-two incident HIV infections occurred among 260 black and 302 white MSM during 843 person-years (PY) of follow-up. HIV incidence was higher among black MSM (6.5/100 PY; 95% confidence interval [CI]: 4.2-9.7) than white MSM (1.7/100 PY; CI: 0.7-3.3) and highest among young (18-24 years) black MSM (10.9/100 PY; CI: 6.2-17.6). The unadjusted hazard of HIV infection for black MSM was 2.9 (CI: 1.3-6.4) times that of white MSM; adjustment for health insurance status and partner race explained effectively all of the racial disparity.


CONCLUSIONS
Relative to white MSM in Atlanta, black MSM, particularly young black MSM, experienced higher HIV incidence that was not attributable to individual risk behaviors. In a setting where partner pool risk is a driver of disparities, it is also important to maximize care and treatment for HIV-positive MSM.
Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA. Electronic address: patrick.sullivan@emory.edu.
Patrick S
PS
Sullivan
Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA.
Eli S
ES
Rosenberg
Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA.
Travis H
TH
Sanchez
Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA.
Colleen F
CF
Kelley
Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA.
Nicole
N
Luisi
Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA.
Hannah L
HL
Cooper
Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA.
Ralph J
RJ
Diclemente
Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA.
Gina M
GM
Wingood
Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA.
Paula M
PM
Frew
Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA.
Laura F
LF
Salazar
Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA.
Carlos
C
Del Rio
Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA.
Mark J
MJ
Mulligan
Department of Psychology, Georgia State University, Atlanta.
John L
JL
Peterson
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D005845:Georgia / Q000453:epidemiology; D015658:HIV Infections / Q000208:ethnology*; D054624:Health Status Disparities; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012309:Risk-Taking; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult
Cohort studies; HIV incidence; Men who have sex with men; Racial disparities