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Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: a prospective observational cohort study.
Ann Epidemiol. 2015 Jun; 25(6):445-54.AE

Abstract

PURPOSE

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.

Authors+Show Affiliations

Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA. Electronic address: patrick.sullivan@emory.edu.Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA.Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA.Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA.Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA.Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA.Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA.Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA.Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA.Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA.Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA.Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA.Department of Psychology, Georgia State University, Atlanta.

Pub Type(s)

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

Language

eng

PubMed ID

25911980

Citation

Sullivan, Patrick S., et al. "Explaining Racial Disparities in HIV Incidence in Black and White Men Who Have Sex With Men in Atlanta, GA: a Prospective Observational Cohort Study." Annals of Epidemiology, vol. 25, no. 6, 2015, pp. 445-54.
Sullivan PS, Rosenberg ES, Sanchez TH, et al. Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: a prospective observational cohort study. Ann Epidemiol. 2015;25(6):445-54.
Sullivan, P. S., Rosenberg, E. S., Sanchez, T. H., Kelley, C. F., Luisi, N., Cooper, H. L., Diclemente, R. J., Wingood, G. M., Frew, P. M., Salazar, L. F., Del Rio, C., Mulligan, M. J., & Peterson, J. L. (2015). Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: a prospective observational cohort study. Annals of Epidemiology, 25(6), 445-54. https://doi.org/10.1016/j.annepidem.2015.03.006
Sullivan PS, et al. Explaining Racial Disparities in HIV Incidence in Black and White Men Who Have Sex With Men in Atlanta, GA: a Prospective Observational Cohort Study. Ann Epidemiol. 2015;25(6):445-54. PubMed PMID: 25911980.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: a prospective observational cohort study. AU - Sullivan,Patrick S, AU - Rosenberg,Eli S, AU - Sanchez,Travis H, AU - Kelley,Colleen F, AU - Luisi,Nicole, AU - Cooper,Hannah L, AU - Diclemente,Ralph J, AU - Wingood,Gina M, AU - Frew,Paula M, AU - Salazar,Laura F, AU - Del Rio,Carlos, AU - Mulligan,Mark J, AU - Peterson,John L, Y1 - 2015/03/24/ PY - 2014/11/11/received PY - 2015/02/09/revised PY - 2015/03/09/accepted PY - 2015/4/28/entrez PY - 2015/4/29/pubmed PY - 2016/3/5/medline KW - Cohort studies KW - HIV incidence KW - Men who have sex with men KW - Racial disparities SP - 445 EP - 54 JF - Annals of epidemiology JO - Ann Epidemiol VL - 25 IS - 6 N2 - PURPOSE: 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. SN - 1873-2585 UR - https://www.unboundmedicine.com/medline/citation/25911980/Explaining_racial_disparities_in_HIV_incidence_in_black_and_white_men_who_have_sex_with_men_in_Atlanta_GA:_a_prospective_observational_cohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1047-2797(15)00095-2 DB - PRIME DP - Unbound Medicine ER -