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HIV & Black MSM
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Reported by Jules Levin
IAC Wash DC 2012
"NHIV (newly dignosed) BMSM were more likely to be older unemployed engage in unprotected anal intercourse have multiple bacterial STDs, and were more likely to come from cities other than San Francisco" see abstract below
"Nonadherence to HIV testing guidelines, undiagnosed infection and late diagnosis were common, underscoring the need for additional HIV testing and prevention efforts for this population." see abstract below
"Unlike previously published studies, we found a positive association between perceived healthcare-specific racial discrimination and healthcare utilization in a population of HIV negative black MSM....Overall, 19% reported previous healthcare-specific racial discrimination against family, friend, or self, 60% reported seeing a healthcare provider in the past 6 months, and 80% reported being tested for HIV within the past year" see abstract below
"This study demonstrated an extremely high prevalence (60%) of incarceration history among BMSM enrolled in the study, highlighting incarceration as an important public health issue among BMSM." see abstract below
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An evolving concentrated epidemic: comparison of socioeconomic, behavioural and biological factors among newly diagnosed, previously diagnosed and HIV-negative black men who have sex with men in six US cities (HPTN 061)
Presented by Kenneth Mayer (United States).
Powerpoint
Webcast
"NHIV (newly dignosed) BMSM were more likely to be older unemployed engage in unprotected anal intercourse have multiple bacterial STDs, and were more likely to come from cities other than San Francisco.....Structural, behavioral, and biological factors (e.g. unemployment, unprotected anal sex, and STDs, but not increased substance use) are associated with new infections among American BMSM, who differ behaviorally from men who have previously been diagnosed."
K. Mayer1, L. Wang2, B. Koblin3, C. Mao2, S. Mannheimer4, M. Magnus5, C. del Rio6, S. Buchbinder7, L. Wilton8, V. Cummings9, C. Watson5, S. Griffith10, D. Wheeler11, HPTN 061 Protocol Team
1The Fenway Institute/Harvard Medical School, Boston, United States, 2Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Seattle, United States, 3New York Blood Center, New York, United States, 4Harlem Hospital / Columbia University, Department of Medicine/Mailman School of Public Health, New York, United States, 5The George Washington University, Department of Epidemiology and Biostatistics, Washington, United States, 6Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, United States, 7San Francisco Department of Health, HIV Research Division, San Francisco, United States, 8Binghamton University, Department of Human Development, Binghamton, United States, 9Johns Hopkins University School of Medicine, Pathology Department, Baltimore, United States, 10FHI 360, Durham, United States, 11HPTN 061 Protocol Team, New York, United States
Background: Black MSM (BMSM) constitute < 1% of the U.S. population, but >25% of incident HIV infections. Enhanced understanding of factors associated with new interventions can provide data to inform programs needed to address this disproportionate epidemic.
Methods: Between 7/09 and 10/10, BMSM were enrolled in 6 U.S. cities to evaluate feasibility of a multi-component prevention intervention. This analysis focuses on the correlates of being newly diagnosed with HIV, including multivariable logistic regression. HIV testing was performed at study sites; central confirmation of results is underway.
Results: HPTN 061 enrolled 1553 BMSM, whose median age was 39; 43% self-identified as gay/homosexual, 41% bisexual, 3% transgender, 10% straight/heterosexual. Of 96% who agreed to be tested, 10% indicated they were previously HIV-infected (PHIV), while 12% were newly diagnosed with HIV (NHIV). Compared to PHIV, NHIV were younger less likely to use marijuana poppers stimulants or inject drugs reported less internalized homophobia and lower levels of religious affiliation NHIV were more likely to be diagnosed with syphilis and anogenital gonorrhea/chlamydia than PHIV, and more likely to be diagnosed with syphilis or anogenital chlamydia than HIV-uninfected BMSM. Compared to HIV-uninfected BMSM, NHIV BMSM were more likely to be older unemployed engage in unprotected anal intercourse have multiple bacterial STDs, and were more likely to come from cities other than San Francisco.
Conclusions: Structural, behavioral, and biological factors (e.g. unemployment, unprotected anal sex, and STDs, but not increased substance use) are associated with new infections among American BMSM, who differ behaviorally from men who have previously been diagnosed. Given the high rates of HIV infection among BMSM, culturally-tailored programs that encourage repeated HIV/STD testing, engagement in care, and innovative prevention strategies addressing current risks are urgently needed to decrease further spread.
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Non-adherence to HIV testing guidelines and late HIV diagnosis is common among U.S. black men who have sex with men (MSM)
Presented by Sharon Mannheimer (United States).
Powerpoint
Webcast
S. Mannheimer1,2, L. Wang3, H.V. Tieu4, C. del Rio5, S. Buchbinder6, L. Wilton7, S. Glick8, V. Cummings9, K.H. Mayer10, on behalf of the HPTN 061 Study Team
1Harlem Hospital/ Columbia University, Medicine, New York, United States, 2Mailman School of Public Health, Columbia University, Epidemiology, New York, United States, 3Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Seattle, United States, 4New York Blood Center, New York, United States, 5Emory University Rollins School of Public Health, Department of Global Health, Atlanta, United States, 6San Francisco Department of Health, HIV Research Section, San Francisco, United States, 7Binghamton University, Department of Human Development, Binghamton, United States, 8The George Washington University School of Public Health and Health Services, Department of Epidemiology and Biostatistics, Washington, United States, 9Johns Hopkins University Medical School, Pathology Department, Baltimore, United States, 10The Fenway Institute/Harvard Medical School, Boston, United States
Background: US CDC guidelines recommend at least annual HIV testing for those at high risk. Nonadherence to testing guidelines and late diagnosis of infection may contribute to HIV transmission.
Methods:HPTN 061 is a feasibility study of a multi-component HIV prevention intervention for at-risk black MSM in 6 US cities. At enrollment, participants were offered HIV testing. Participants reporting past HIV-uninfected or unknown status at enrollment and no HIV testing within the prior 12 months were considered nonadherent to HIV testing guidelines. Participants with newly diagnosed HIV and CD4 < 200 at time of diagnosis were considered to have late diagnosis. Predictors of nonadherence to testing guidelines and late diagnosis were analyzed using logistic regression models and Fisher's exact tests. HIV test data are from baseline testing performed at study sites; confirmatory testing is underway.
Results: HPTN 061 enrolled 1553 black MSM. At enrollment, 1384 reported no prior HIV diagnosis, and 1335 (96%) of those participants agreed to testing; 98% were male, 3% transgender, 100% black, 8% Latino, with a median age of 39 years; 38% reported incomes below US poverty level, and 67% were unemployed. Among those tested, 309 (23%) reported no HIV test in prior 12 months; testing nonadherence was highest in Atlanta (30%), lowest in DC (18%) and Boston (17%); 185 (14%) reported never testing prior to enrollment. Nonadherence to HIV testing guidelines was independently associated with age >35, (AOR 1.96 [95% CI 1.40-2.75]), unemployment (AOR 1.47 [1.05-2.05]), and living in Atlanta (AOR 1.85 [1.07, 3.21]). 167 (13%) participants had a new HIV diagnosis at enrollment; median CD4 was 445 at diagnosis. Of 157 (94%) with CD4 data, 28 (18%) had a late HIV diagnosis.
Conclusions: Nonadherence to HIV testing guidelines, undiagnosed infection and late diagnosis were common, underscoring the need for additional HIV testing and prevention efforts for this population.
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Sexual networks and HIV risk among black men who have sex with men (BMSM) in the US (HPTN 061)
H.V. Tieu1,2, T.-Y. Liu3, L. Wang3, C. Mao3, P. Gorbach4,5, S. Hussen6, S. Buchbinder7, K. Mayer8, L. Wilton9, C. Kelly3, V. Elharrar10, G. Phillips11, S. Griffith12, V. Cummings13, B. Koblin1, C. Latkin14, HPTN 061 Study Group
1Lindsley F. Kimball Research Institute, New York Blood Center, Laboratory of Infectious Disease Prevention, New York, United States, 2Columbia University Medical Center, Division of Infectious Diseases, Department of Medicine, New York, United States, 3Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, United States, 4School of Public Health, University of California Los Angeles, Department of Epidemiology, Los Angeles, United States, 5David Geffen School of Medicine, University of California Los Angeles, Division of Infectious Diseases, Los Angeles, United States, 6Emory School of Medicine, Division of Infectious Diseases, Atlanta, United States, 7San Francisco Department of Public Health, HIV Research Section, San Francisco, United States, 8The Fenway Institute, Boston, United States, 9Binghamton University, Department of Human Development, Binghamton, United States, 10National Institute of Allergy and Infectious Diseases, National Institutes of Health, Division of AIDS, Bethesda, United States, 11George Washington University, Washington, United States, 12FHI360, Research Triangle Park, United States, 13Johns Hopkins School of Medicine, Department of Pathology, Baltimore, United States, 14Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
Background: The U.S. HIV epidemic has disproportionately affected Black MSM (BMSM), yet this disparity has not been explained by differences in individual risk behaviors. Sexual networks may place BMSM at increased HIV risk, although data is limited.
Methods: Egocentric sexual network data based on prior 6 months from 1,384 community-recruited BMSM enrolled in HPTN 061, a six-city feasibility study of a multi-component HIV prevention intervention, were analyzed. Sexual network composition, size, and density were compared by site. Multivariate logistic regression assessed network factors associated with having exclusively Black sex partners and having serodiscordant unprotected intercourse (SDUI). HIV serostatus data at enrollment are preliminary, based on testing by study sites.
Results: 55% reported having exclusively Black sex partners; rates varied by city (34% in Boston to 85% Atlanta). 87% reported sexual network size of ≤5 partners. 86% had overlap between their sexual and social networks. 49% reported sexual network density of >50%. 49% reported SDUI with partners. Having exclusively Black partners was associated with smaller network size (AOR=8.1,95%CI 3.6-18.1 for 1-2 partners, AOR=2.7,95%CI 1.5-4.7 for 3-5 partners vs. ≥6 partners), age (AOR=0.5,95%CI 0.3-0.8 for 21-30 years, AOR=0.4,95%CI 0.2-0.8 for 31-40 years vs. ≤20 years), being HIV-positive (AOR=1.9,95%CI 1.3-2.8), and not identifying as Latino/Hispanic (AOR=2.6,95%CI 1.6-4.4). SDUI was associated with larger network size (AOR=0.3,95%CI 0.1-0.7 for 1-2 partners vs. ≥6 partners), being HIV-positive (AOR=3.8,95%CI 2.6-5.6), and not identifying as Latino/Hispanic (AOR=1.9,95%CI 1.1-3.0), along with history of incarceration (AOR=1.4,95%CI 1.0-1.9) and physical abuse from intimate partner (AOR=1.5,95%CI 1.1-2.0).
Conclusions: Having exclusively Black partners was associated with smaller network size while SDUI was associated with larger network size. HIV infection was associated with both outcomes. Interventions that address network dynamics of sexual risk and partnering by BMSM should be developed to lower HIV infection rates. Counseling of HIV-infected men about reducing HIV transmission risk behaviors should be emphasized.
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A study of perceived discrimination in black MSM and its association with healthcare utilization and HIV testing
R. Irvin1, L. Wilton2, G. Beauchamp3, L. Wang3, S. Buchbinder1,4
1San Francisco Department of Public Health, HIV Research Section, San Francisco, United States, 2Binghamton University, Department of Human Development, Binghamton, United States, 3Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, United States, 4University of California at San Francisco, Internal Medicine, San Francisco, United States
Background: Previous studies report that generalized and healthcare-specific racial discrimination are associated with underutilization of medical care in African Americans. Black MSM are the subgroup with highest US HIV incidence. To explore barriers to healthcare in black MSM, we evaluated the association of perceived racial discrimination with HIV testing and use of healthcare services in the HPTN 061 cohort.
Methods: HPTN 061 was a feasibility study of a multi-component intervention for black MSM in 6 US cities. Computer-assisted self-interview was used to assess healthcare-specific racial discrimination towards the participant or friends/family. Logistic regression was used to assess the association of discrimination and HIV testing or recent healthcare visit among the 1170 HIV negative participants.
Results: Median age was 39; 46% had attended college, 65% were unemployed, retired, or disabled, 41% uninsured, and 38% had an annual household income < $10,000. Overall, 19% reported previous healthcare-specific racial discrimination against family, friend, or self, 60% reported seeing a healthcare provider in the past 6 months, and 80% reported being tested for HIV within the past year. Seeing a medical provider in the past 6 months was associated with older age (AOR 1.02 [1.00, 1.03]), insurance coverage (AOR 2.46 [1.84, 3.29]) and previous healthcare-specific racial discrimination experience (AOR=1.45 [1.04, 2.02]). HIV testing in the past year was associated with younger age (AOR 0.99 [0.97, 1.00]), employment (AOR 1.44 [1.01, 2.04]) and healthcare discrimination (AOR=1.65 [1.09, 2.52]).
Conclusions: Unlike previously published studies, we found a positive association between perceived healthcare-specific racial discrimination and healthcare utilization in a population of HIV negative black MSM. Possible explanations include differences in discrimination measures or population characteristics compared to previous reports, or interventions that overcome prior discrimination, such as targeted HIV testing campaigns. It will be important for healthcare-specific racial discrimination to be further investigated in black MSM.
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The high prevalence of incarceration among black men who have sex with men (BMSM): associations and implications
R. Brewer1, M. Magnus2, L. Wang3, T. Liu3, K. Mayer4
1Louisiana Public Health Institute, New Orleans, United States, 2George Washington School of Public Health and Health Services, Epidemiology and Biostatistics, Washington, United States, 3Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Seattle, United States, 4Fenway Health / Harvard School of Public Health / Harvard Medical School, Boston, United States
Background: BMSM are disproportionately impacted by HIV and high incarceration rates in the US. Limited data exist on the relationship between incarceration history, HIV status, and demographic, psychosocial, and behavioral characteristics among BMSM.
Methods: Secondary analysis was conducted with cross-sectional data from 1553 Black MSM >18 years of age enrolled in HPTN 061 in six US cities; inclusion criteria included having unprotected anal intercourse with a man in the last 6 months. Incarceration history was defined as the percentage of participants indicating that they had spent one or more days in prison or jail in their lifetime. Univariate and multivariable logistic regression analyses assessed associations between incarceration history, HIV (HIV testing was performed at study sites; confirmation of results is underway), and key demographic, psychosocial, and behavioral characteristics.
Results: Sixty percent of participants reported a previous history of incarceration, ranging from 30% in Washington DC to 70% in Los Angeles, CA (p< 0.001). Men reporting incarceration were more likely to be >35 years of age (p< 0.001), unemployed (p< 0.001), report a household income ≤$30,000 (p< 0.001), have a high school education or less (p< 0.001), and self-identify as heterosexual or straight (p< 0.001). After adjusting for demographic characteristics, incarceration history was associated with being physically abused by an intimate partner [AOR 1.48; 95% CI=1.08-2.04], having any female partner [AOR 1.94; 95% CI=1.35-2.81], and any drug use in the last 6 months [AOR 1.99; 95% CI=1.75-2.74]. No association was found between incarceration history and HIV status.
Conclusions: This study demonstrated an extremely high prevalence (60%) of incarceration history among BMSM enrolled in the study, highlighting incarceration as an important public health issue among BMSM. Since this is a cross-sectional sample of BMSM, inferences about causality cannot be made. Additional longitudinal studies exploring the relationship between incarceration and HIV are needed.
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Webcast provided by The Kaiser Family Foundation
11:00
MOAC0104
Abstract
Powerpoint
Webcast
Trends in HIV prevalence and HIV testing among young MSM: five United States cities, 1994-2008
A. Oster, C. Johnson, B. Le, T. Finlayson, A. Balaji, A. Lansky, J. Mermin, L. Valleroy, D. MacKellar, S. Behel, G. Paz-Bailey, YMS and NHBS Study Groups
Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, United States
A. Oster, United States
11:13
MOAC0101
Abstract
Powerpoint
Webcast
Equal behaviors, unequal risks: the role of partner transmission potential in racial HIV disparities among men who have sex with men (MSM) in the US
E. Rosenberg1, C. Kelley2, B. O'Hara1, P. Frew2, J. Peterson3, T. Sanchez1, C. del Rio4, P. Sullivan1
1Emory University Rollins School of Public Health, Epidemiology, Atlanta, United States, 2Emory University School of Medicine, Infectious Diseases, Atlanta, United States, 3Georgia State University, Psychology, Atlanta, United States, 4Emory University Rollins School of Public Health, Global Health, Atlanta, United States
E. Rosenberg, United States
11:26
MOAC0105
Abstract
Powerpoint
Webcast
An evolving concentrated epidemic: comparison of socioeconomic, behavioural and biological factors among newly diagnosed, previously diagnosed and HIV-negative black men who have sex with men in six US cities (HPTN 061)
K. Mayer1, L. Wang2, B. Koblin3, C. Mao2, S. Mannheimer4, M. Magnus5, C. del Rio6, S. Buchbinder7, L. Wilton8, V. Cummings9, C. Watson5, S. Griffith10, D. Wheeler11, HPTN 061 Protocol Team
1The Fenway Institute/Harvard Medical School, Boston, United States, 2Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Seattle, United States, 3New York Blood Center, New York, United States, 4Harlem Hospital / Columbia University, Department of Medicine/Mailman School of Public Health, New York, United States, 5The George Washington University, Department of Epidemiology and Biostatistics, Washington, United States, 6Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, United States, 7San Francisco Department of Health, HIV Research Division, San Francisco, United States, 8Binghamton University, Department of Human Development, Binghamton, United States, 9Johns Hopkins University School of Medicine, Pathology Department, Baltimore, United States, 10FHI 360, Durham, United States, 11HPTN 061 Protocol Team, New York, United States
K. Mayer, United States
11:39
MOAC0106
Abstract
Powerpoint
Webcast
Correlates of HIV incidence among black men who have sex with men in 6 U.S. cities (HPTN 061)
B. Koblin1, K. Mayer2, S. Eshleman3, L. Wang4, S. Shoptaw5, C. del Rio6, S. Buchbinder7, M. Magnus8, S. Mannheimer9,10, T.-Y. Liu4, V. Cummings3, E. Piwowar-Manning3, S. Fields11, S. Griffith12, V. Elharrar13, D. Wheeler14, HPTN 061 Study Team
1New York Blood Center, Laboratory of Infectious Disease Prevention, New York, United States, 2Fenway Health and Beth Israel Deaconess Hospital, Boston, United States, 3Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, United States, 4Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, United States, 5University of California, Los Angeles, Department of Family Medicine, Los Angeles, United States, 6Emory University Rollins School of Public Health, Department of Global Health, Atlanta, United States, 7San Francisco Department of Public Health, San Francisco, United States, 8George Washington University, School of Public Health and Health Services, Department of Epidemiology and Biostatistics, Washington DC, United States, 9Harlem Hospital/ Columbia University, Department of Medicine, New York, United States, 10Columbia University Mailman School of Public Health, Department of Epidemiology, New York, United States, 11Florida International University-College of Nursing and Health Sciences, Miami, United States, 12FHI 360, Research Triangle Park, United States, 13NIAID, National Institutes of Health, Clinical Prevention Research Branch, Bethesda, United States, 14Loyola University Chicago, Graduate School of Social Work, Chicago, United States
B. Koblin, United States
11:52
MOAC0103
Abstract
Powerpoint
Webcast
Foreign location of birth and time since immigration are associated with HIV status among Latino MSM in the United States
A. Oster1, K. Russell1, R. Wiegand1, B. Le1, E. Valverde1, D. Forrest2, M. Cribbin1, G. Paz-Bailey1, NHBS Study Group
1Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, United States, 2University of Miami, Miami, United States
A. Oster, United States
12:05
MOAC0102
Abstract
Powerpoint
Webcast
Racial disparities in antiretroviral therapy use and viral suppression among sexually active HIV-positive men who have sex with men receiving medical care: United States, Medical Monitoring Project, 2009 data collection cycle
L. Beer, A. Oster, C. Mattson, J. Skarbinski
U.S. Centers for Disease Control and Prevention, Atlanta, United States
L. Beer, United States
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