Explaining Racial Disparities in HIV Incidence in a Prospective Cohort of Black and White Men Who Have Sex With Men in Atlanta, GA: A Prospective Observational Cohort Study
Abstract
Purpose To describe factors associated with racial disparities in HIV 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 (HR) 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 823 person-years (PY) of followup. HIV incidence was higher among black MSM (6.5/100PY; 95% CI: 4.2, 9.7) than white MSM (1.7/100PY; CI: 0.7, 3.3), and highest among young (18–24 years) black MSM (10.9/100PY; 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.
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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