Objective
To better understand why HIV
incidence is substantially higher among black than white men who have sex with
men (MSM), we present the first nationally representative estimates of factors
that contribute to transmission – sexual behavior, antiretroviral therapy (ART)
use, and viral suppression – among HIV-infected black and white MSM in the
United States.
Design
The Medical Monitoring
Project (MMP) is a complex sample survey of HIV-infected adults receiving
medical care in the United States.
Methods
We used weighted interview
and medical record data collected during June 2009 to May 2010 to estimate the
prevalence of sexual behaviors, ART use, and viral suppression among sexually
active HIV-infected black and white MSM. We used χ2 tests to assess significant differences between races and
logistic regression models to identify factors that mediated the racial
differences.
Results
Sexual risk behaviors among
black and white MSM were similar. Black MSM were significantly less likely than
white MSM to take ART (80 vs. 91%) and be durably virally suppressed (48 vs.
69%). Accounting for mediators (e.g. age, insurance, poverty, education, time
since diagnosis, and disease stage) reduced, but did not eliminate, disparities
in ART use and rendered differences in viral suppression among those on ART
insignificant.
Conclusion
Lower levels of ART use and
viral suppression among HIV-infected black MSM may increase the likelihood of
HIV transmission. Addressing the patient-level factors and structural
inequalities that contribute to lower levels of ART use and viral suppression among
this group will improve clinical outcomes and might reduce racial disparities
in HIV incidence.
Below: Antiretroviral therapy use
and recent and durable viral suppression among black and white HIV-infected
sexually active MSM receiving medical care – Medical Monitoring Project, United
States, 2009. Recent viral suppression: most recent viral load
documented ≤200 or undetectable; durable viral suppression: all viral loads
past year documented less than 400 or undetectable; all black/white differences
significant at P < 0.01. *95% confidence limits.
Below: Antiretroviral therapy use
among black and white HIV-infected sexually active MSM receiving medical care –
Medical Monitoring Project, United States, 2009
*Adjusted for age, lapse in health coverage, poverty, time
since diagnosis, and disease stage.
Below: Durable viral suppression
among black and white HIV-infected sexually active MSM receiving medical care –
Medical Monitoring Project, United States, 2009
^Adjusted
for age, lapse in health coverage, poverty, time since diagnosis, and
education.
Full article at: http://goo.gl/1FBQ6O
By:
Division of
HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta,
Georgia, USA
Correspondence to Linda Beer, PhD, Division of HIV/AIDS Prevention,
Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS-E46,
Atlanta, GA 30333, USA. Tel: +1 404 639 5268; fax: +1 404 639 8640; Email: vog.cdc@reeBL
More at: https://twitter.com/hiv_insight
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