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Understanding racial HIV/STI disparities in black and white men who have sex with men: a multilevel approach.
PLoS One 2014; 9(3):e90514Plos

Abstract

BACKGROUND

The reasons for black/white disparities in HIV epidemics among men who have sex with men have puzzled researchers for decades. Understanding reasons for these disparities requires looking beyond individual-level behavioral risk to a more comprehensive framework.

METHODS AND FINDINGS

From July 2010-December 2012, 803 men (454 black, 349 white) were recruited through venue-based and online sampling; consenting men were provided HIV and STI testing, completed a behavioral survey and a sex partner inventory, and provided place of residence for geocoding. HIV prevalence was higher among black (43%) versus white (13% MSM (prevalence ratio (PR) 3.3, 95% confidence interval (CI): 2.5-4.4). Among HIV-positive men, the median CD4 count was significantly lower for black (490 cells/µL) than white (577 cells/µL) MSM; there was no difference in the HIV RNA viral load by race. Black men were younger, more likely to be bisexual and unemployed, had less educational attainment, and reported fewer male sex partners, fewer unprotected anal sex partners, and less non-injection drug use. Black MSM were significantly more likely than white MSM to have rectal chlamydia and gonorrhea, were more likely to have racially concordant partnerships, more likely to have casual (one-time) partners, and less likely to discuss serostatus with partners. The census tracts where black MSM lived had higher rates of poverty and unemployment, and lower median income. They also had lower proportions of male-male households, lower male to female sex ratios, and lower HIV diagnosis rates.

CONCLUSIONS

Among black and white MSM in Atlanta, disparities in HIV and STI prevalence by race are comparable to those observed nationally. We identified differences between black and white MSM at the individual, dyadic/sexual network, and community levels. The reasons for black/white disparities in HIV prevalence in Atlanta are complex, and will likely require a multilevel framework to understand comprehensively.

Authors+Show Affiliations

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.Department of Psychology, Georgia State University, Atlanta, Georgia, United States of America.Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.Department of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America.Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.Institute of Public Health, Georgia State University, Atlanta, Georgia, United States of America.Department of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America.Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.Department of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America.Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

24608176

Citation

Sullivan, Patrick S., et al. "Understanding Racial HIV/STI Disparities in Black and White Men Who Have Sex With Men: a Multilevel Approach." PloS One, vol. 9, no. 3, 2014, pp. e90514.
Sullivan PS, Peterson J, Rosenberg ES, et al. Understanding racial HIV/STI disparities in black and white men who have sex with men: a multilevel approach. PLoS ONE. 2014;9(3):e90514.
Sullivan, P. S., Peterson, J., Rosenberg, E. S., Kelley, C. F., Cooper, H., Vaughan, A., ... Sanchez, T. H. (2014). Understanding racial HIV/STI disparities in black and white men who have sex with men: a multilevel approach. PloS One, 9(3), pp. e90514. doi:10.1371/journal.pone.0090514.
Sullivan PS, et al. Understanding Racial HIV/STI Disparities in Black and White Men Who Have Sex With Men: a Multilevel Approach. PLoS ONE. 2014;9(3):e90514. PubMed PMID: 24608176.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Understanding racial HIV/STI disparities in black and white men who have sex with men: a multilevel approach. AU - Sullivan,Patrick S, AU - Peterson,John, AU - Rosenberg,Eli S, AU - Kelley,Colleen F, AU - Cooper,Hannah, AU - Vaughan,Adam, AU - Salazar,Laura F, AU - Frew,Paula, AU - Wingood,Gina, AU - Diclemente,Ralph, AU - del Rio,Carlos, AU - Mulligan,Mark, AU - Sanchez,Travis H, Y1 - 2014/03/07/ PY - 2013/08/16/received PY - 2014/02/01/accepted PY - 2014/3/11/entrez PY - 2014/3/13/pubmed PY - 2014/12/31/medline SP - e90514 EP - e90514 JF - PloS one JO - PLoS ONE VL - 9 IS - 3 N2 - BACKGROUND: The reasons for black/white disparities in HIV epidemics among men who have sex with men have puzzled researchers for decades. Understanding reasons for these disparities requires looking beyond individual-level behavioral risk to a more comprehensive framework. METHODS AND FINDINGS: From July 2010-December 2012, 803 men (454 black, 349 white) were recruited through venue-based and online sampling; consenting men were provided HIV and STI testing, completed a behavioral survey and a sex partner inventory, and provided place of residence for geocoding. HIV prevalence was higher among black (43%) versus white (13% MSM (prevalence ratio (PR) 3.3, 95% confidence interval (CI): 2.5-4.4). Among HIV-positive men, the median CD4 count was significantly lower for black (490 cells/µL) than white (577 cells/µL) MSM; there was no difference in the HIV RNA viral load by race. Black men were younger, more likely to be bisexual and unemployed, had less educational attainment, and reported fewer male sex partners, fewer unprotected anal sex partners, and less non-injection drug use. Black MSM were significantly more likely than white MSM to have rectal chlamydia and gonorrhea, were more likely to have racially concordant partnerships, more likely to have casual (one-time) partners, and less likely to discuss serostatus with partners. The census tracts where black MSM lived had higher rates of poverty and unemployment, and lower median income. They also had lower proportions of male-male households, lower male to female sex ratios, and lower HIV diagnosis rates. CONCLUSIONS: Among black and white MSM in Atlanta, disparities in HIV and STI prevalence by race are comparable to those observed nationally. We identified differences between black and white MSM at the individual, dyadic/sexual network, and community levels. The reasons for black/white disparities in HIV prevalence in Atlanta are complex, and will likely require a multilevel framework to understand comprehensively. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/24608176/Understanding_racial_HIV/STI_disparities_in_black_and_white_men_who_have_sex_with_men:_a_multilevel_approach_ L2 - http://dx.plos.org/10.1371/journal.pone.0090514 DB - PRIME DP - Unbound Medicine ER -