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Ann Epidemiol. 2015 Jun;25(6):445-54. doi: 10.1016/j.annepidem.2015.03.006. Epub 2015 Mar 24.

Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: a prospective observational cohort study.

Author information

1
Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA. Electronic address: patrick.sullivan@emory.edu.
2
Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA.
3
Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA.
4
Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA.
5
Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA.
6
Department of Psychology, Georgia State University, Atlanta.

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.

KEYWORDS:

Cohort studies; HIV incidence; Men who have sex with men; Racial disparities

PMID:
25911980
PMCID:
PMC4433604
DOI:
10.1016/j.annepidem.2015.03.006
[Indexed for MEDLINE]
Free PMC Article

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