A critical literature review to identify possible causes of higher rates of HIV infection among young black and Latino men who have sex with men

Race and Sexual Identity Differences in PrEP Continuum Outcomes Among Latino Men in a Large Chicago Area Healthcare Network

U.S. HIV incidence is threefold higher among Latino individuals than non-Latino Whites. Pre-exposure prophylaxis (PrEP) uptake remains low among Latino men. Most HIV studies view Latino communities as a monolithic group, ignoring racial and sexual diversity. This analysis examines PrEP-related outcomes including eligibility, first prescription, and second prescription across race and sexual identity in a sample of Latino cisgender men (n = 8271) who sought services from a healthcare network in Chicago in 2012-2019. Logistic regression was used to calculate adjusted odds ratios. Latino-only participants had lower odds of PrEP eligibility and first prescription compared to White-Latino participants. No other significant differences by race were detected. While bisexual participants had equivalent odds of PrEP eligibility, they had lower odds of first PrEP prescription compared to gay participants. Heterosexual participants also had lower odds of PrEP eligibility and initiation. Future research should address unique factors shaping PrEP-related outcomes among diverse Latino populations.

Geographic Mobility, Place Attachment, and the Changing Geography of Sex among African American and Latinx MSM Who Use Substances in Los Angeles

The places that people go and interact with others, along with the characteristics of those places, determine degrees of sexual health risk and concomitant prevention opportunities for gay, bisexual, and other men who have sex with men (MSM). The objective of this paper is to use syndemic theory to guide analyses of 20 in-depth interviews with African American and Hispanic/Latinx MSM living in Los Angeles. We describe the places in which African American and Latinx MSM interviewees live and socialize, and how these places influence sexual behavior, drug use, and access to health care. We find common spatial patterns in mobility, incongruence in residential and sexual places, and differing geographic patterns of sex by men who use geo-social hook-up apps. Significant instability in home life and varying forms of mobility and risk-taking were a response to cumulative disadvantage and intersecting structural forces including poverty, racism, and homophobia. Our results strongly suggest that geographic mobility is a syndemic factor for HIV risk among MSM in Los Angeles, as mobility amplified negative impacts of other syndemic factors. Innovative place-interventions to reduce HIV incidence and disparities in HIV need to acknowledge the synergistic factors that drive higher HIV incidence among AA and Latinx MSM.

Increasing uptake of evidence-based screening services though a community health worker-delivered multimodality program: study protocol for a randomized pragmatic trial

BACKGROUND

Underserved ethnic minority populations experience significant disparities in HIV, hepatitis C virus (HCV), colorectal cancer (CRC), and cervical cancer incidence and mortality. Much of the excess burden of these diseases among underserved communities is due to lack of preventive care, including screening. Barriers to disease screening include low awareness, lack of access to care and health insurance, and cultural beliefs regarding disease prevention. Our current trial aims to examine community health worker (CHW)-delivered, home-based multi-modality screening for HIV, HCV, CRC, and cervical cancer simultaneously.

DESIGN

We are conducting a randomized pragmatic trial among 900 Haitian, Hispanic, and African-American participants from diverse underserved communities in South Florida. People between the ages of 50 and 65 who have not had appropriate HIV, HCV, CRC, and cervical cancer screening per United States Preventive Services Task Force (USPSTF) recommendations are eligible for the study. Participants are recruited by CHWs and complete a structured interview to assess multilevel determinants of disease risk. Participants are then randomized to receive HIV, HCV, CRC, and cervical cancer screening via navigation to care by a CHW (Group 1) or via CHW-delivered home-based screening (Group 2). The primary outcome is completion of screening for each of these diseases within 6 months post-enrollment.

DISCUSSION

Our trial is among the first to examine the effectiveness of a CHW-delivered, multimodality, home-based disease-screening approach. If found to be effective, this approach may represent a cost-effective strategy for disease screening within underserved and underscreened minority groups.

TRIAL REGISTRATION

Clinical Trials.gov # NCT02970136, registered November 21, 2016.

HIV Prevention Research on Men Who Have Sex With Men: A Scoping Review of Systematic Reviews, 1988-2017

In the United States, men who have sex with men (MSM) are disproportionately affected by HIV. To identify research gaps and inform HIV prevention for MSM, we conducted a scoping review of systematic reviews using CDC's Prevention Research Synthesis database. Eligibility criteria comprised English-language systematic reviews focused on HIV prevention for MSM, published during 1988-2017, and included at least one U.S. primary study. We coded data type, subpopulations, topics, and key findings. To assess study quality, we used the Assessment of Multiple Systematic Reviews (AMSTAR). Among 129 relevant systematic reviews, study quality was high or moderate for 63%. Most common topics were sexual behavior and disease vulnerability. The most frequently mentioned MSM subgroups were HIV-positive, Black or African American, and young. Research gaps include Hispanic/Latino MSM, pre-exposure prophylaxis (PrEP), treatment as prevention, social determinants of health, health disparities, syndemics, and protective factors for sexual health.

Sexual Partner Characteristics, Relationship Type, and HIV Risk Among a Community Venue-based Sample of Urban Adolescent and Young Adult Men Who Have Sex with Men

Few studies have examined sexual partnerships and HIV risk in diverse samples of African American/black and Hispanic/Latino adolescent and young adult men who have sex with men (YMSM), a group that have a high burden of HIV in the U.S. A community-venue recruitment approach was used, which identified significant differences in HIV risk by sexual partner type among 1215 YMSM. Those with casual partners had a higher number of sexual partners, had more STIs, and were more likely to engage in transactional sex, to use alcohol, marijuana, or other substances compared with those with main partners only. Among those with female sexual partners, many used condoms "every time" when engaging in vaginal sex with casual partners, but a sizeable proportion "never/rarely" used condoms with their main partners. Our findings demonstrate a need for tailored HIV prevention education and counseling with necessary skills regarding consistent and correct condom use with all sexual partnerships.

Challenges in Translating PrEP Interest Into Uptake in an Observational Study of Young Black MSM

BACKGROUND

HIV incidence among US young, black men who have sex with men (YBMSM) is high, and structural barriers (eg lack of health insurance) may limit access to Pre-exposure prophylaxis (PrEP). Research studies conducted with YBMSM must ensure access to the best available HIV prevention methods, including PrEP.

METHODS

We implemented an optional, nonincentivized PrEP program in addition to the standard HIV prevention services in a prospective, observational cohort of HIV-negative YBMSM in Atlanta, GA. Provider visits and laboratory costs were covered; participant insurance plans and/or the manufacturer assistance program were used to obtain drugs. Factors associated with PrEP initiation were assessed with prevalence ratios and time to PrEP initiation with Kaplan-Meier methods.

RESULTS

Of 192 enrolled YBMSM, 4% were taking PrEP at study entry. Of 184 eligible men, 63% indicated interest in initiating PrEP, 10% reported no PrEP interest, and 27% wanted to discuss PrEP again at a future study visit. Of 116 interested men, 46% have not attended a PrEP initiation appointment. Sixty-three men (63/184; 34%) initiated PrEP; 11/63 (17%) subsequently discontinued PrEP. The only factor associated with PrEP initiation was reported sexually transmitted infection in the previous year (prevalence ratio 1.50, 95% confidence interval: 1.002 to 2.25). Among interested men, median time to PrEP initiation was 16 weeks (95% confidence interval: 7 to 36).

CONCLUSIONS

Despite high levels of interest, PrEP uptake may be suboptimal among YBMSM in our cohort even with amelioration of structural barriers that can limit use. PrEP implementation as the standard of HIV prevention care in observational studies is feasible; however, further research is needed to optimize uptake for YBMSM.

Self-Perceived Viral Load and Sexual Risk Behavior Among Known HIV-Positive MSM in San Francisco, 2014

BACKGROUND

Self-perceived viral suppression status among men who have sex with men (MSM) may impact HIV risk transmission behaviors.

METHODS

We conducted a 2014 cross-sectional survey of MSM in San Francisco and assessed differences in sexual risk behavior among known HIV-positive MSM based on viral suppression of HIV. We collected demographics, self-perceived viral load status, and sexual risk behavior and tested for viral load levels through laboratory assays. Men were categorized in a hierarchical schema of sexual risk behavior categories based on responses to questions regarding recent partners' HIV status, condom use, and sexual positioning. We used Fisher exact tests to assess for differences based on self-perceived viral load status.

RESULTS

Out of a sample of 96 known HIV-positive men, 59 men self-reported an undetectable HIV viral load and 9 men self-reported a detectable viral load consented to confirmatory laboratory testing. The sample of self-reported undetectable men had gradually larger proportions of higher-risk sexual practices, whereas the sample of detectable men was evenly distributed across sexual practices. This association was not statistically significant (P = 0.91).

CONCLUSION

Self-perceived viral suppression may influence sexual practices of known HIV-positive MSM, but small sample size, especially within the detectable category, hinders our ability to determine statistical significance. More research is necessary to assess how HIV-positive men account for viral load in sexual decision-making practices, and this research may inform resource allocation and clinical recommendations to maintain the health of MSM populations.

Place Still Matters: Racial/Ethnic and Geographic Disparities in HIV Transmission and Disease Burden

Neighborhood-level structural interventions are needed to address HIV/AIDS in highly affected areas. To develop these interventions, we need a better understanding of contextual factors that drive the pandemic. We used multinomial logistic regression models to examine the relationship between census tract of current residence and mode of HIV transmission among HIV-positive cases. Compared to the predominantly white high HIV prevalence tract, both the predominantly black high and low HIV prevalence tracts had greater odds of transmission via injection drug use and heterosexual contact than male-to-male sexual contact. After adjusting for current age, gender, race/ethnicity, insurance status, and most recently recorded CD4 count, there was no statistically significant difference in mode of HIV transmission by census tract. However, heterosexual transmission and injection drug use remain key concerns for underserved populations. Blacks were seven times more likely than whites to have heterosexual versus male-to-male sexual contact. Those who had Medicaid or were uninsured (versus private insurance) were 23 and 14 times more likely, respectively, to have injection drug use than male-to-male sexual contact and 10 times more likely to have heterosexual contact than male-to-male sexual contact. These findings can inform larger studies for the development of neighborhood-level structural interventions.

Willingness to use pre-exposure prophylaxis among Black and White men who have sex with men in Atlanta, Georgia

PrEP willingness may be different among black and white men who have sex with men (MSM) given known disparities in HIV incidence, sociodemographic factors, and healthcare access between these groups. We surveyed 482 black and white HIV-negative MSM in Atlanta, GA about their willingness to use pre-exposure prophylaxis (PrEP) and facilitators and barriers to PrEP willingness. Overall, 45% (215/482) of men indicated interest in using PrEP. Engaging in recent unprotected anal intercourse (UAI) was the only factor significantly associated with PrEP willingness in multivariate analyses (OR 1.73, 95% CI 1.13, 2.65). Willing men identified "extra protection" against HIV as the most common reason for interest in using PrEP, whereas unwilling men most commonly cited not wanting to take medication daily, and this reason was more common among white MSM (42.3% of white MSM vs. 28.9% of black MSM, p = 0.04). Most men indicated willingness to use PrEP if cost was <50 dollars/month; however, more black MSM indicated willingness to use PrEP only if cost were free (17.9% of white MSM vs. 25.9% of black MSM, p = 0.03). Overall, these data are useful to scale up PrEP interventions targeting at-risk MSM in Atlanta and highlight the need for implementation of low cost-programs, which will be especially important for black MSM.

Identity Conflict and Sexual Risk for Black and Latino YMSM

Young (aged 18-30) Black and Latino men who have sex with men are at a higher risk of contracting HIV than their White counterparts. In order to better understand the unique nature of sexual risk-taking, we examined the extent to which ethnic group, ethnic identity, and sexual pride predicted condomless anal sex with casual partners among 161 young men who have sex with men (YMSM) who identify as Black or Latino. Negative binomial regressions were conducted using a cross-sectional design. Sexual pride was a negative predictor of condomless anal sex across all participants, but this effect was moderated by ethnic exploration and ethnic group; the relationship between sexual pride and condomless anal sex was strengthened by greater ethnic exploration among Latino YMSM, and weakened by greater ethnic exploration among Black YMSM. Implications for intersectional identity, identity conflict, and HIV prevention among young gay men of color are discussed.

Prospective Effects of a Syndemic on HIV and STI Incidence and Risk Behaviors in a Cohort of Young Men Who Have Sex with Men

Young men who have sex with men continue to be highly affected by HIV. To improve understanding of the role that multiple co-occurring health issues (i.e., syndemics) play in HIV acquisition, sophisticated modeling methods are needed. The purpose of this study was to use structural equation modeling to understand the structure of the syndemic and to test its longitudinal association with condomless anal sex. Data are from a longitudinal study of 450 YMSM. A primary syndemic component comprised of substance use, violence, and internalizing mental health factors significantly predicted the number of condomless anal sex partners in the full sample. Analyses exploring associations by race/ethnicity found a significant association among White YMSM, but not among Black or Latino YMSM. Higher-order factor modeling suggests these psychosocial factors form a syndemic in all racial/ethnic groups, but the syndemic, as conceptualized here, may be less relevant to racial/ethnic minority YMSM.

Determinants of HIV Transmission Risk Among HIV-Infected Persons Engaged in Care

People living with HIV (PLWH) engaged in medical care represent an accessible group to focus HIV prevention efforts. In an analysis of 1,883 PLWH from 2007 and 2015, we determined the proportion at risk of HIV transmission and identified factors associated with HIV transmission risk using multivariable mixed effects logistic regression models with random intercepts. HIV transmission risk was defined by an HIV viral load > 1,500 copies/mL and self-reported unprotected sex. We found that 174 (9.2%) individuals were at risk for HIV transmission at least once. Factors associated with HIV transmission risk included younger age (adjusted OR [95% CI] per decade decrease = 2.30 [1.84, 2.89]), illicit drug use (adjusted OR = 5.36 [3.02, 9.56]), depression (adjusted OR = 1.88 [1.10, 3.21]), and education <12th grade (adjusted OR = 2.05 [1.15, 3.67]). Thus, nearly 1 in 10 HIV-infected individuals engaged in care between 2007 and 2015 were potentially at risk of transmitting HIV. Behavioral interventions to decrease HIV transmission should focus on younger, less educated patients who are depressed and actively using illicit drugs.

Self-reported historic human immunodeficiency virus (HIV) testing in a Brazilian blood donor HIV case-control study

BACKGROUND

There has been increased worldwide emphasis on the many benefits of human immunodeficiency virus (HIV) serostatus awareness for both infection prevention and improved treatment outcomes. Previous studies indicate that donors may use blood donation to be tested; the objectives of this analysis were to assess, among donors with previously undisclosed risk behavior in the 12 months before donation, the frequency of those who have previously been tested for HIV and the demographic and behavioral factors associated with such testing.

STUDY DESIGN AND METHODS

In this secondary analysis from an HIV case-control study of blood donors in Brazil, we analyzed the response to the question, "Other than blood donation, have you ever been tested for HIV?" Demographic and disclosed risk behaviors associated with previous testing were determined.

RESULTS

The study included 341 HIV-positive cases and 791 HIV-negative controls (1:2 case/control ratio). Overall, 31% of blood donors (40% of cases and 26% of controls) reported having been tested for HIV outside of blood donation. History of HIV testing varied according to sex, HIV status, and reported sexual risk behavior.

CONCLUSION

Although it is encouraging that previous testing was more frequent in donors with acknowledged sexual risk behavior in Brazil, 60% still had not been tested for HIV outside of the blood donation setting. Educating donors on the importance of not using blood centers as a means to get tested for HIV in Brazil, especially if they engage in higher risk behaviors, and seeking alternate testing venues instead could improve the safety of donated blood.

The importance of assessing self-reported HIV status in bio-behavioural surveys

In bio-behavioural surveys measuring prevalence of infection with human immunodeficiency virus (HIV), respondents should be asked the results of their last HIV test. However, many government authorities, nongovernmental organizations, researchers and other civil society stakeholders have stated that respondents involved in such surveys should not be asked to self-report their HIV status. The reasons offered for not asking respondents to report their status are that responses may be inaccurate and that asking about HIV status may violate the respondents’ human rights and exacerbate stigma and discrimination. Nevertheless, we contend that, in the antiretroviral therapy era, asking respondents in bio-behavioural surveys to self-report their HIV status is essential for measuring and improving access to – and coverage of – services for the care, treatment and prevention of HIV infection. It is also important for estimating the true size of the unmet needs in addressing the HIV epidemic and for interpreting the behaviours associated with the acquisition and transmission of HIV infection correctly. The data available indicate that most participants in health-related surveys are willing to respond to a question about HIV status – as one of possibly several sensitive questions about sexual and drug use behaviours. Ultimately, normalizing the self-reporting of HIV status could help the global community move from an era of so-called exceptionalism to one of destigmatization – and so improve the epidemic response worldwide.

Depression and Co-Occurring Health Determinants of Hispanic Men with HIV Infection in the U.S.-Mexico Border Region: A Pilot Study

HIV infection among Hispanic men is a public health concern. Certain factors have been identified that may contribute to the high rates of HIV infection among Hispanic men such as migration, acculturation, poverty, and depression. Hispanic men with HIV infection are at risk for additional co-occurring health issues. Given limited research few studies have focused specifically on Hispanic men with HIV infection residing in a U.S.-Mexico border community. This pilot study surveyed participants (n = 39), to better understand co-occurrence of health determinants, especially depression among Hispanic men with HIV infection. The study's findings indicate that clinicians need to be aware that factors may influence depression among people with Hispanic men with HIV infection. Clinicians also need awareness of the impact of depression on adherence to HIV care and treatment among Hispanic men with HIV infection. More research is needed to explore the relationship of HIV-related stigma, HIV disclosure, social support, and depression among Hispanic men with HIV infection.

Thriving and Adapting: Resilience, Sense of Community, and Syndemics among Young Black Gay and Bisexual Men

We examined resilience associated with the avoidance of psychosocial health conditions (i.e., syndemics) that increase vulnerability for HIV among young Black gay and bisexual men. We used analytic induction to compare a sample of 23 men who showed no evidence of syndemic conditions to a sample of 23 men who experienced syndemic conditions. The men who avoided syndemics reported supportive relationships with people who helped them to develop a strong sense of identity, provided them with opportunities to give back to their communities, and promoted positive norms about health. In contrast, the men experiencing syndemic conditions described numerous instances of trauma and oppression that infringed upon their desire to form positive relationships. Among these men, experiences of oppression were associated with shame, identity incongruence, social isolation, relational disconnection, mistrust of men, and expectations of further marginalization. We examined participants' experiences through the framework of the psychosocial sense of community. Results of this study provide evidence for using strength-based intervention strategies to prevent syndemic conditions. Findings suggest that to attenuate socio-structural barriers to health and comorbid psychosocial health concerns, interventions must address young men's social isolation and promote positive identity and sense of community.

The Association Between Alcohol Consumption and Condom Use: Considering Correlates of HIV Risk Among Black Men Who Have Sex with Men

Epidemiological data indicate Black men who have sex with men (MSM) are the most at-risk group for HIV infection. However, the factors driving this disparity are not fully understood. Condom use remains a significant point of intervention in mitigating sexually transmitted infections. Alcohol consumption is highly prevalent among Black MSM, has a significant role in the culture of sex, and may significantly interfere with condom use. This review will examine the relationship between alcohol consumption and condom use among Black MSM. In this review we, (a) discuss the prevalence of alcohol use among MSM and its association with condom use; (b) consider the role of alcohol in the culture of MSM; (c) review the literature on the relationship between alcohol and condom use; and (d) discuss the role of several empirically-supported moderating variables in strengthening the relationship between alcohol use and noncondom use. This review places the finding and implications for HIV risk among Black MSM in the context of the broader literature on MSM.

Non-Parental Adults in the Social and Risk Behavior Networks of Sexual Minority Male Youth

The presence of non-parental adults (NPAs), or adults outside of caregivers (e.g., extended family, natural mentors), in the lives of adolescents and emerging adults has received a rapidly expanding amount of empirical attention in the last decade. Sexual minority male youth (SMMY) face disproportionate risks of abuse and victimization in relationships with parents and peers. Yet, despite the fact that this group, therefore, may be both potentially vulnerable to negative interpersonal influences but also poised to benefit from additional relationships, NPA involvement in the lives of SMMY is currently not well understood in the extant literature. This study sought to examine and characterize the involvement of NPAs in the social and risk networks of SMMY (n = 175; 54% African American, 21% Hispanic/Latino, 14% Caucasian; ages 17-23). Most SMMY identified at least one NPA, such as friends and grandparents, in their networks. Three categories of relationships were identified, Strictly Social, which only involved social interactions; Complex, which were both social and involved substance use and/or sexual activity; and Risky, which purely consisted of substance use or sexual activity. Relationships were rated as emotionally "closer" among ethnic minority SMMY, although, racial/ethnic similarity between SMMY and NPAs was not associated with relationship closeness. In addition, relationships involving female and heterosexual NPAs were also rated as stronger. These findings suggest the potential usefulness of considering multiple types of relationships between SMMY and NPAs when designing intervention and prevention efforts. Moreover, African American and Latino SMMY, who represent the most vulnerable sub-groups of SMMY in terms of HIV-risk, may be particularly poised to benefit from positive NPA relationships.

Correlates of internalized homonegativity among black men who have sex with men

Black men who have sex with men (MSM) carry a disproportionate burden of HIV in the United States. Such disparities cannot be attributed to individual behavioral risk factors alone, prompting the exploration of social and contextual factors experienced by minority MSM. Societal homonegativity and the internalization of those attitudes by Black MSM may play an important role in understanding racial and ethnic disparities in HIV incidence and prevalence. This study explores the correlates of internalized homonegativity in a large multi-site sample of Black MSM. Findings reveal a number of significant contextual and psychosocial factors related to internalized homonegativity including religiosity, resilience, and gay community acculturation, which have important implications for HIV risk, HIV testing, and social and psychological wellbeing for Black MSM.

The Role of Geographic and Network Factors in Racial Disparities in HIV Among Young Men Who have Sex with Men: An Egocentric Network Study

The objective of this study was to characterize and compare individual and sexual network characteristics of Black, White, and Latino young men who have sex with men (YMSM) as potential drivers of racial disparities in HIV. Egocentric network interviews were conducted with 175 diverse YMSM who described 837 sex partners within 167 sexual-active egos. Sexual partner alter attributes were summarized by ego. Descriptives of ego demographics, sexual partner demographics, and network characteristics were calculated by race of the ego and compared. No racial differences were found in individual engagement in HIV risk behaviors or concurrent sexual partnership. Racial differences were found in partner characteristics, including female gender, non-gay sexual orientations, older age, and residence in a high HIV prevalence neighborhood. Racial differences in relationship characteristics included type of relationships (i.e., main partner) and strength of relationships. Network characteristics also showed differences, including sexual network density and assortativity by race. Most racial differences were in the direction of effects that would tend to increase HIV incidence among Black YMSM. These data suggest that racial disparities in HIV may be driven and/or maintained by a combination of racial differences in partner characteristics, assortativity by race, and increased sexual network density, rather than differences in individual's HIV risk behaviors.

Lawrence JS, Amirkhanian YA, Dickson-Gomez JD. Social Media Use and High-Risk Sexual Behavior Among Black Men Who Have Sex with Men: A Three-City Study

Black men who have sex with men (MSM) bear a disproportionate burden of human immunodeficiency (HIV) incidence in the United States. Little research has focused on the associations between social media use and sexual behavior among Black MSM. 205 Black MSM completed measures assessing social media use and sexual behaviors. Men spent an average of 34 h per week on social media sites. 53 % arranged sexual hookups online in the previous 3 months, and did so a mean of 10 times. Overall, users of social media and men who arranged sexual hookups online engaged in more risky behaviors than non-users and men who did not arrange sexual hookups online. However, partner-level data indicated that men engaged in fewer risky behaviors with partners met online compared to partners met in other ways such as at bars or through friends. Social media-based interventions designed to decrease HIV transmission among racial minority MSM are needed.

Beyond the ball: implications for HIV risk and prevention among the constructed families of African American men who have sex with men

African American men who have sex with men (AAMSM) are disproportionately burdened by new and existing HIV infections. In spite of this, few HIV prevention interventions have been developed that meet the specific needs of AAMSM and that are culturally appropriate and build on strengths and resources. In this paper, we examine constructed families, including those who belong to houses and those who do not, from a three city sample of 196 AAMSM. Results show that the majority of AAMSM who belong to constructed families do not participate in houses or balls. Both house and non-house affiliated constructed families are important sources of social support among AAMSM. Participants reported limited success in spreading HIV messages at ball events, but talk about HIV within their constructed families. Social network approaches to HIV prevention may capitalize on existing social ties within constructed families to promote safer sexual behaviors.

Social discrimination and resiliency are not associated with differences in prevalent HIV infection in black and white men who have sex with men

OBJECTIVES

To examine the associations of homophobia, racism, and resiliency with differences in prevalent HIV infection in black and white men who have sex with men (MSM).

METHODS

The Involve[ment]t study is a cohort of black and white MSM aged 18-39 years in Atlanta, GA, designed to evaluate individual, dyadic, and community level factors that might explain racial disparities in HIV prevalence. Participants were recruited irrespective of HIV serostatus from community-based venues and from Internet advertisements and were tested for HIV. We assessed respondents' demographics, whether they had engaged in unprotected anal intercourse (UAI) within the past 6 months, and attitudes about perceived homophobia, perceived racism, and personal resiliency.

RESULTS

Compared with white MSM, black MSM were less likely to report UAI in the past 6 months [odds ratio (OR): 0.59, confidence interval (CI): 0.44 to 0.80], more likely to be HIV positive (OR: 5.05, CI: 3.52 to 7.25), and--among those HIV positive--more likely to report not being aware of their HIV infection (OR: 2.58, CI: 1.18 to 5.65). Greater perceived racism was associated with UAI in the black sample (partial odds ratio: 1.48, CI: 1.10 to 1.99). Overall, perceived homophobia, perceived racism, and resilience were not associated with prevalent HIV infection in our samples. Greater resilience was associated with less perceived homophobia in both black and white samples (Spearman r = -0.27, P < 0.001, for both).

CONCLUSION

Future studies of social discrimination at the institutional and network level, than at the individual level, may explain differences in HIV infection in black and white MSM.

Dynamic social support networks of younger black men who have sex with men with new HIV infection

Rising rates of HIV infection among younger black men who have sex with men (YBMSM) in the USA have generated a public health emergency. Living with HIV requires deep and persistent social support often available only from close confidants. Enlisting endogenous support network members into the care of HIV-infected YBMSM may help shape sustainable supportive environments, leading to long-term improvements in mental and HIV-specific health outcomes. The present study examined trends in support network change over time after new HIV diagnoses among 14 YBMSM. Participants completed a social network survey that utilized sociograms to record support confidants (SCs) preceding HIV diagnosis and at one and nine months postdiagnosis. Reported SCs included family of origin, friends, sex partners, and other associates. Analysis revealed three distinct patterns of change: high gain, high turnover, and stable networks. These patterns offer valuable insights into the social support of YBMSM during the period following diagnosis. This research underscores a growing movement to embrace key support figures in the lives of YBMSM, who may be critical to promoting overall health and adherence to HIV-care.

Utilization of HIV prevention services across racial/ethnic groups among men who have sex with men in San Francisco, California, 2008

Human Immunodeficiency Virus (HIV) infection in the US is disproportionally higher among Black and Latino men who have sex with men (MSM), compared to other racial/ethnic groups. The 2008 US National HIV Behavioral Surveillance (NHBS) survey of MSM was analyzed to compare utilization of HIV testing, receiving condoms, and individual and group HIV prevention programs among racial/ethnic groups in San Francisco, CA. Using a weighted analysis of the time-location sampling method, racial/ethnic subpopulation estimates were obtained for utilization of these services in the prior 12 months. There was no significant difference in utilization of HIV prevention services among Black (N=37), Latino (N=128), and White (N=275) MSM in San Francisco, CA. Overall 60-70 % of MSM reported their last HIV test within the past 12 months and more than 75 % reported receiving condoms in the last 12 months. However, less than 15 % of MSM reported utilizing individual or group HIV prevention counseling sessions. The NHBS survey demonstrate that the majority of MSM in San Francisco, CA have utilized one or more HIV prevention service in the past 12 months and that there were no racial/ethnic disparities in utilization of these services. However, the utilization of individual or group HIV prevention programs is low and HIV testing is below current recommendations for MSM.

Network correlates of sexual health advice seeking and substance use among members of the Los Angeles House and Ball communities

House and Ball communities (HBCs), represent a prime context for human immunodeficiency virus prevention with African American young men who have sex with men and transgender persons. This study sought to understand the composition and function of social support and sexual networks of HBC members in Los Angeles, California (N = 263). Participants were recruited using venue-based sampling and asked to report on sexual health advice seeking, alcohol use and illicit substance use. Participants were more likely to seek sexual health advice from social support network members compared with sexual network members [odds ratio (OR): 2.50, P < 0.001]. HBC members were more likely to get drunk (OR: 1.57; P < 0.05) and use illicit substances (OR: 1.87; P < 0.10) with House members and sexual network members compared with non-House members and social support network members. Health promotion programs tailored for the HBC should encourage open communication regarding sexual health; these interventions must include information about the role of substance use in sexual risk taking.

Adapting the VOICES HIV behavioral intervention for Latino men who have sex with men

Latino men who have sex with men (MSM) are disproportionately impacted by HIV/AIDS, but few behavioral interventions address their prevention needs. Adaptation of evidence-based interventions is a pragmatic strategy that builds upon lessons learned and has the potential to fill gaps in prevention programming. Yet there are few reports of how transfers are executed and whether effectiveness is achieved. This research reports on the adaptation of VOICES/VOICES, a single-session intervention designed for heterosexual adults, into No Excuses/Sin buscar excuses for Latino MSM. To test the adapted intervention, 370 at-risk Latino MSM were enrolled in a randomized trial. At a three-month follow-up, there was a sharper decrease in unprotected intercourse in the intervention group compared to controls (59 % vs. 39 %, ANOVA p < 0.05, F = 4.10). Intervention participants also reported more condom use at last intercourse (AOR = 1.69; 95 % CI 1.02-2.81, p < 02). Findings support use of adapted models for meeting prevention needs of high-priority populations.

The impact of patient race on clinical decisions related to prescribing HIV pre-exposure prophylaxis (PrEP): assumptions about sexual risk compensation and implications for access

Antiretroviral pre-exposure prophylaxis (PrEP) has received increasing recognition as a viable prescription-based intervention for people at risk for HIV acquisition. However, little is known about racial biases affecting healthcare providers' willingness to prescribe PrEP. This investigation sought to explore medical students' stereotypes about sexual risk compensation among Black versus White men who have sex with men seeking PrEP, and the impact of such stereotypes on willingness to prescribe PrEP. An online survey presented participants (n = 102) with a clinical vignette of a PrEP-seeking, HIV-negative man with an HIV-positive male partner. Patient race was systematically manipulated. Participants reported predictions about patient sexual risk compensation, willingness to prescribe PrEP, and other clinical judgments. Bootstrapping analyses revealed that the Black patient was rated as more likely than the White patient to engage in increased unprotected sex if prescribed PrEP, which, in turn, was associated with reduced willingness to prescribe PrEP to the patient.

Sex, HIV, and the Internet: Exploring Variations in the Online Profiles of MSM in the United States

With the increasing pervasiveness of social media, the Internet has become an important venue for dating and sex. Not only does the Internet introduce a unique array of opportunities and risks for men who have sex with men (MSM), it also presents a valuable means through which to study sexual behavior. In this study, data on what men report in their online profiles were collected from two dating/hookup websites to explore possible geographical differences in men's sexual preferences and expectations (N = 5,588). Across the 15 selected cities, significant differences emerged in reported HIV status and stated preference for safer sex (condom use). These patterns suggest important contextual and demographic variations and point to a need for targeted, population-specific interventions and further research to identify the underlying social and psychological constructs. With a better understanding of the local factors driving risky sexual behavior, health communication messages and tailored online interventions could be developed to address the needs and concerns of specific groups.

Social support network characteristics and sexual risk taking among a racially/ethnically diverse sample of young, urban men who have sex with men

Associations between social support network characteristics and sexual risk among racially/ethnically diverse young men who have sex with men (YMSM) were examined using egocentric network data from a prospective cohort study of YMSM (n = 501) recruited in New York City. Bivariate and multivariable logistic regression analyses examined associations between social support network characteristics and sexual risk taking behaviors in Black, Hispanic/Latino, and White YMSM. Bivariate analyses indicated key differences in network size, composition, communication frequency and average relationship duration by race/ethnicity. In multivariable analyses, controlling for individual level sociodemographic, psychosocial and relationship factors, having a sexual partner in one's social support network was associated with unprotected sexual behavior for both Hispanic/Latino (AOR = 3.90) and White YMSM (AOR = 4.93). Further examination of key network characteristics across racial/ethnic groups are warranted in order to better understand the extant mechanisms for provision of HIV prevention programming to racially/ethnically diverse YMSM at risk for HIV.

Homophobia is associated with sexual behavior that increases risk of acquiring and transmitting HIV infection among black men who have sex with men

We investigated whether the experience of homophobic events increases the odds of engaging in unprotected anal intercourse (UAI) among black men who have sex with men (MSM) and whether social integration level buffered the association. Participants (N = 1,154) reported homophobic events experienced in the past 12 months. Social integration measures included social support, closeness with family members and friends, attachment to the black gay community, openness about sexuality within religious communities, and MSM social network size. Logistic regression analyses indicated that experiencing homophobia was associated with (1) UAI among men not previously diagnosed with HIV and (2) sexual HIV transmission risk behavior among men who knew they were HIV-infected. None of the social integration measures buffered these associations. Homophobia may promote acquisition and transmission of HIV infection among black MSM. Interventions are needed to reduce homophobia experienced by black MSM.

Laying the groundwork for an HIV prevention intervention: a descriptive profile of the Los Angeles House and Ball communities

African American young men who have sex with men (AAYMSM) represent the largest proportion of new HIV infections among MSM. While evidence-based interventions are lacking, all too often HIV interventions are implemented in a community without thoroughly understanding its needs, risks and assets. AAYMSM are not homogenous; subgroups exist that may require different approaches to be effective. The House and Ball communities represent one such subgroup. A community-engaged, mixed-methods approach was used. Participant observations, qualitative interviews (N = 26), and a survey at House/Ball events (N = 252) were completed. Survey data broadly describe the community. For example: 69 % of survey respondents identify as gay; 25 % as bisexual; 13 % reported recent use of ecstasy and 11 % recently participated in sex exchange. The depth of qualitative data is key for intervention development. For example, while the survey provides broad descriptions of respondents' involvement in the House and Ball communities, leaders provided in-depth descriptions of the structure of the House and Ball scene-something vital to the development of HIV prevention programs within these communities. This kind of rigorous study is recommended prior to implementing an intervention. Findings are discussed in relation to leveraging the communities' supportive aspects to design culturally relevant HIV prevention programs.

An event-level comparison of risk-related sexual practices between black and other-race men who have sex with men: condoms, semen, lubricant, and rectal douching

Black men who have sex with men (MSM) living in the U.S. are disproportionately affected by HIV/AIDS. An online survey of sexual behavior was completed by Black, White, Hispanic/Latino, Asian/Pacific Islander, and other-race MSM (n=11,766) ages 18-87 years. Complete condom use, semen exposure, pre-coital rectal douching (enema use), and lubricant use at last male-partnered sexual event were compared by race, controlling for relevant sociodemographic variables and stratifying by sexual position (receptive, insertive, or both). Across sexual positions, 55-62% of Black MSM reported condom use, 5-8% reported semen exposure, 18-53% reported douching, and 33-43% reported lubricant use. Reported behavioral profiles were not significantly different from other races, except that Black MSM reported greater condom use than White MSM in the insertive position. Although findings argue against disproportionate rates of risk behavior accounting for racial disparities in HIV prevalence, they nonetheless highlight a need for continued behavioral intervention.