Economic, Legal, and Social Hardships Associated with HIV Risk among Black Men Who Have Sex with Men in Six US Cities

We assessed whether economic, legal, and social hardships were associated with human immunodeficiency virus (HIV) risk among a sample of Black men who have sex with men (MSM) and whether associations were moderated by city of residence. 

The study analyzed baseline and follow-up data from HIV Prevention Trials Network 061 (N = 1553). Binary logistic regression assessed associations between hardships and HIV risk indicators. Multivariate regressions were used to test if city of residence had a moderating effect for hardships and HIV risks. Adjusted analyses showed that Black MSM with recent job loss were more likely to engage in condomless insertive anal intercourse and that those with recent financial crisis were more likely to have had two or more male sexual partners in the past 6 months. Black MSM with recent convictions were more likely to have a sexually transmitted infection at 6 months, while those who were unstably housed were more likely to have a sexually transmitted infection at 12 months. 

There were no city of residence and hardship interaction effects on HIV risks. Hardships are important factors that influence HIV risk for Black MSM. Integrating strategies that address structural factors that influence HIV risk may enhance HIV prevention interventions implementation efforts.

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By:  Nelson LE1,2, Wilton L3,4, Moineddin R5, Zhang N6, Siddiqi A7,8, Sa T6, Harawa N9,10, Regan R11,12, Dyer TP13, Watson CC14, Koblin B15, Del Rio C16,Buchbinder S17, Wheeler DP18, Mayer KH19; HPTN 061 Study Team.

• 1School of Nursing, University of Rochester, Rochester, NY, USA. laron_nelson@urmc.rochester.edu.
• 2Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada. laron_nelson@urmc.rochester.edu.
• 3College of Community and Public Affairs, State University of New York at Binghamton, Binghamton, NY, USA.
• 4Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa.
• 5Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
• 6Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
• 7Dalla Lana School of Public Health, Divisions of Epidemiology and Social & Behavioural Health Sciences, University of Toronto, Toronto, ON, Canada.
• 8Gillings School of Public Health, Department of Health Behavior, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
• 9College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
• 10David Geffen School of Medicine, General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA, USA.
• 11David Geffen School of Medicine, Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA.
• 12School of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA.
• 13School of Public Health, Department of Epidemiology and Biostatistics, University of Maryland College Park, College Park, MD, USA.
• 14School of Public Health, George Washington University, Washington, DC, USA.
• 15New York Blood Center, New York, NY, USA.
• 16Rollins School of Public Health, Hubert Department of Global Health and School of Medicine, Department of Medicine, Emory University, Atlanta, GA, USA.
• 17San Francisco Department of Public Health, HIV Research Section, San Francisco, CA, USA.
• 18School of Social Welfare, State University of New York Albany, Albany, NY, USA.
• 19Fenway Health, The Fenway Institute, Boston, MA, USA. 
• J Urban Health. 2016 Feb 1.

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Psychological Distress, Drug Use, Sexual Risks & Medication Adherence among Young HIV-Positive Black Men Who Have Sex with Men: Exposure to Community Violence Matters

In the USA, Black males are disproportionately affected by community violence and HIV. The aim of this study was to assess whether exposures to community violence are related to psychological distress, drug use, sexual risk behaviors, and medication adherence among a sample of HIV-positive young Black men who had sex with men (YBMSM). Data are from 98 YBMSM ages 18-29 years recruited from Chicago who completed measures on demographics, exposures to community violence, psychological distress, drug use, condomless anal intercourse, and medication adherence. 

Rates of exposure to community violence were high and youth reported victimization and witnessing numerous types of violence in their lifetime. In adjusted logistic regression analyses, models indicate that YBMSM reporting higher levels of exposure to community violence had significantly higher rates of condomless anal intercourse in the previous 6 months (AOR: 5.33, 95%CI: 1.38-20.55). 

Additionally, exposure to community violence was positively associated with psychological distress, hard drug use, and use of marijuana as a sex drug. Adherence to HIV antiretroviral medication was negatively associated with community violence (AOR: 0.36, 95%CI: 0.13-0.97). Rates of exposure to community violence are especially high in urban communities. 

Overall findings suggest that treatment, intervention, and programmatic approaches that include initiatives to address exposure to community violence might correlate with better health-related outcomes for HIV-positive YBMSM.

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By:  Quinn K1, Voisin DR2,3, Bouris A2,3, Schneider J3,4,5.

• 1 Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine , Medical College of Wisconsin , Milwaukee , WI , USA.
• 2 School of Social Service Administration , University of Chicago , Chicago , IL , USA.
• 3 STI/HIV Intervention Network , University of Chicago , Chicago , IL , USA.
• 4 Department of Medicine , University of Chicago , Chicago , IL , USA.
• 5 Department of Public Health Sciences , University of Chicago , Chicago , IL , USA. 
• AIDS Care. 2016 Feb 26:1-7. 

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Engaging Black Men Who Have Sex with Men (BMSM) in Los Angeles in HIV Pre-Exposure Prophylaxis (PrEP) - Video

More at:    http://goo.gl/Tsf5Yu

Sexual Networks and HIV Risk among Black Men Who Have Sex with Men in 6 U.S. Cities

Background

Sexual networks may place U.S. Black men who have sex with men (MSM) at increased HIV risk.

Methods

Self-reported egocentric sexual network data from the prior six months were collected from 1,349 community-recruited Black MSM in HPTN 061, a multi-component HIV prevention intervention feasibility study. Sexual network composition, size, and density (extent to which members are having sex with one another) were compared by self-reported HIV serostatus and age of the men. GEE models assessed network and other factors associated with having a Black sex partner, having a partner with at least two age category difference (age difference between participant and partner of at least two age group categories), and having serodiscordant/serostatus unknown unprotected anal/vaginal intercourse (SDUI) in the last six months.

Results

Over half had exclusively Black partners in the last six months, 46% had a partner of at least two age category difference, 87% had ≤5 partners. Nearly 90% had sex partners who were also part of their social networks. Among HIV-negative men, not having anonymous/exchange/ trade partners and lower density were associated with having a Black partner; larger sexual network size and having non-primary partners were associated with having a partner with at least two age category difference; and having anonymous/exchange/ trade partners was associated with SDUI. Among HIV-positive men, not having non-primary partners was associated with having a Black partner; no sexual network characteristics were associated with having a partner with at least two age category difference and SDUI.

Conclusions

Black MSM sexual networks were relatively small and often overlapped with the social networks. Sexual risk was associated with having non-primary partners and larger network size. Network interventions that engage the social networks of Black MSM, such as interventions utilizing peer influence, should be developed to address stable partnerships, number of partners, and serostatus disclosure.

Sex Partner Characteristics, Condom Use, and HIV Serostatus Disclosure of Community-Recruited Black MSM, Partner-Level Data (N = 4,449 Partners).

Characteristic, n (%)a	Total	Self-Reported HIV-Positive Participant	Self-Reported HIV-Negative Participant	P-value
Partner Level
Gender of sex partners				<0.01
Male	3464 (78)	308 (92)	3156 (77)
Female	800 (18)	18 (5)	782 (19)
Transgender	172 (4)	7 (2)	165 (4)
Partner type				<0.01
Primary partner	707 (16)	80 (24)	627 (15)
Steady, non-primary partner/casual partner	3003 (68)	210 (63)	2793 (68)
Exchange or trade partner/anonymous partner	716 (16)	42 (13)	674 (16)
HIV serostatus of sex partners				<0.01
Among all participants (N = 4446 partners):	2284 (51)	67 (20)	2217 (54)
HIV-negative	311 (7)	142 (43)	169 (4)
HIV-positive	1841 (41)	124 (37)	1717 (42)
HIV serostatus of sex partners				<0.01
Among participants age 18–30 years (N = 1659 partners):	1023 (62)	17 (23)	1006 (63)
HIV-negative	66 (4)	22 (30)	44 (3)
HIV-positive	570 (34)	35 (47)	535 (34)
HIV serostatus of sex partners				<0.01
Among participants age 31+ years (N = 2777 partners):	1261 (45)	50 (19)	1211 (48)
HIV-negative	245 (9)	120 (46)	125 (5)
HIV-positive	1271 (46)	89 (34)	1182 (47)
Frequency of condom use with sex in past 6 months (N = 4361 partners)				0.01
Never	1899 (44)	171 (52)	1728 (43)
Sometimes	740 (17)	52 (16)	688 (17)
Most of the time	398 (9)	18 (5)	380 (9)
Always	1324 (30)	88 (27)	1236 (31)
Disclosure of HIV status to sex partners by self-reported HIV-positive participants (N = 309 partners)	-		-	-
No		106 (34)
Yes		191 (62)
Don’t know/refused to answer		12 (4)

Numbers may not add up to column total due to missing data.

a P-value <0.05 for all variables compared by study city. Site-specific differences may be reflective of different recruitment strategies used by the study sites, rather than of overall differences between cities.

Full article at:   http://goo.gl/HUCW15

By:  Hong-Van Tieu,1,2,* Ting-Yuan Liu,3 Sophia Hussen,4 Matthew Connor,3 Lei Wang,3 Susan Buchbinder,5 Leo Wilton,6,7Pamina Gorbach,8 Kenneth Mayer,9 Sam Griffith,10 Corey Kelly,3 Vanessa Elharrar,11 Gregory Phillips,12 Vanessa Cummings,13 Beryl Koblin,1 Carl Latkin,14 and HPTN 061

William M. Switzer, Editor

¹Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, United States of America

²Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, United States of America

³Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America

⁴Division of Infectious Diseases, Emory School of Medicine, Atlanta, GA, United States of America

⁵Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States of America

⁶Department of Human Development, State University of New York at Binghamton, Binghamton, NY, United States of America

⁷Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa

⁸Department of Epidemiology, School of Public Health, Division of InfectiousDiseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America

⁹Fenway Community Health Center, Boston, MA, United States of America

¹⁰FHI 360, Research Triangle Park, NC, United States of America

¹¹Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America

¹²The George Washington University School of Public Health and Health Services, Department of Epidemiology and Biostatistics, Washington, DC, United States of America

¹³Johns Hopkins University School of Medicine, Baltimore, MD, United States of America

¹⁴Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America

Centers for Disease Control and Prevention, UNITED STATES

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: HVT BAK CL. Performed the experiments: HVT TYL LW SB LW PG KM SG CK VE GP VC BAK CL. Analyzed the data: HVT TYL LW MC BAK CL. Wrote the paper: HVT SH BAK CL.

* E-mail: gro.retnecdoolbyn@ueith

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The Limitations of 'Black MSM' as a Category: Why Gender, Sexuality & Desire Still Matter for Social & Biomedical HIV Prevention Methods

The USA faces disproportionate and increasing HIV incidence rates among Black men who have sex with men (BMSM). 

New biomedical technologies such as pre-exposure prophylaxis (PrEP) have been developed to address their HIV risk. Very little consideration, however, has been given to the diversity obscured by 'BMSM' as a category, to how this diversity relates to men's sexual partnering strategies, or to the relevance of these issues for new HIV prevention methods. 

We conducted a community-based ethnography from June 2013 to May 2014 documenting factors that affect the acceptance of and adherence to PrEP among BMSM. We conducted in-depth interviews with 31 BMSM and 17 community stakeholders, and participant observation. 

To demonstrate the diversity of social identities, we present a taxonomy of indigenous categories organised along the axes of sexual identity, sexual positioning, and gender performance. We analyse how HIV prevention strategies, such as PrEP, may be more effective if programmes consider how gender, sexuality, and sexual desire shape sexual partnering strategies. 

This article underlines the importance of attending to the diversity of sexual and social subjectivities among BMSM, of bringing the study of sexuality back into HIV prevention, and of integrating biomedical prevention approaches into community-based programmes.

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By:  Garcia J1, Parker RG2, Parker C2, Wilson PA2, Philbin M3, Hirsch JS2.

• 1 College of Public Health and Human Sciences , Oregon State University , Corvallis , OR , USA.
• 2 Mailman School of Public Health , Columbia University , New York , NY , USA.
• 3 HIV Center for Clinical and Behavioral Studies , Columbia University , New York , NY , USA. 
• Glob Public Health. 2016 Feb 1:1-23.

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The Association of Uncontrolled HIV Infection and Other Sexually Transmitted Infections in Metropolitan Atlanta Youth

BACKGROUND:

Half of the 19 million sexually transmitted infections (STIs) and 26% of HIV infections annually in the United States occur in youth aged 13-24 years. STIs are a risk factor for HIV acquisition and transmission, but data are lacking on HIV treatment as an intervention to reduce STIs.

METHODS:

A single-centered, retrospective analysis of HIV-infected sexually active adolescents and young adults from January 2009 to December 2011 was performed to compare STI incidence among patients with controlled and uncontrolled HIV and to identify associated risk factors.

RESULTS:

Of 205 enrolled subjects, 59% were male and 92% African American with mean age of 21 years (2.1 SD). Sixty-six percent were horizontally infected, and 19% met the definition of controlled HIV. Forty-seven percent were men who have sex with men, 76% reported condom use, 27% prior sexual abuse, 58% drug use and 50% claimed >5 lifetime sexual partners. Sixty-seven percent contracted a co-STI for a cumulative incidence rate of 35 STIs per 100 person-years. Subjects with uncontrolled HIV had a significantly higher STI incidence than did subjects with controlled infection (42.7 vs. 19.7 per 100 person-years, P < 0.001). Uncontrolled individuals had more STIs (P = 0.01), sexual partners (P = 0.008) and horizontal acquisition (P = 0.001). In an adjusted logistic model, having ≥1 STI was associated with older age (P = 0.033), >5 sexual partners (6-10 partners, P = 0.001; >10, P < 0.001) and no condom use (P = 0.025). Subjects with uncontrolled infection had 2.8 times [95% confidence interval (CI): 1.16-6.94] the odds of ≥1 STI relative to controlled HIV.

CONCLUSIONS:

Uncontrolled HIV increases the incidence of co-STIs among adolescents and young adults. Interventions to improve antiretroviral compliance and reduce risk behaviors are urgently needed.

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By:  Brownstein PS1, Gillespie SE, Leong T, Chahroudi A, Chakraborty R, Camacho-Gonzalez AF.

• 1From the *Department of Pediatrics, Children's Healthcare of Atlanta, Georgia; †Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; ‡Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia; §Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine & Children's Healthcare of Atlanta, Georgia; and ¶Ponce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, Georgia. 

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Concordance of Demographic Characteristics, Sexual Behaviors, and Relationship Attributes among Sex Dyads of Black and White Men Who Have Sex with Men

Differences in individual behaviors have failed to explain racial disparities between Black and White men who have sex with men (MSM). However, reporting of behaviors and partner characteristics are assumed to be non-differentially reported by race. 

From 314 participants, this study used the two-sided data-where sexual partners provide information on each other and their relationship-of 127 dyads of Black and White MSM from Atlanta, GA, to assess the reliability of partner-reported demographic characteristics and the concordance of sexual behaviors and partnership attributes by race. 

We compared proportions of concordance by race using a modified kappa (K _m) to assess chance-corrected agreement. The median difference in age between self- and partner-reports was 0 (0-1) years. 

Compared to self-reports, 97 % of the partners of Black participants and 96 % of the partners of White participants correctly classified their race. We observed poor agreement on pre-sexual discussion (K _m = 0.18) and being in an ongoing relationship (K _m = 0.13), with no differences by race (p = 0.11). 

Although not statistically significant, Black MSM dyads had lower levels of concordance for unprotected anal intercourse in the previous 12 months (68 %) compared to White dyads (90 %), with fair agreement among Black dyads (K _m = 0.26). 

Measures of partner-reported age and race are likely accurate; however, certain self-reported sexual behaviors and partnership attributes may be unreliable and differentially reported by race. 

Our findings highlight the need to assess the validity of measures used to estimate HIV transmission and inform racial disparities research.

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By:  Hernández-Romieu AC1, Sullivan PS2, Rothenberg R3, Grey J2, Luisi N2, Sanchez T2, Siegler AJ2, Rosenberg ES2.

• 1Department of Epidemiology, Rollins School of Public Health, Emory University (http://www.sph.emory.edu/), Atlanta, GA, 30322, USA. alfonso.claudio.hernandez@emory.edu.
• 2Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
• 3Department of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA, USA.

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