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Series Papers

HIV-Related Disparities Among Black MSM and Associations with Structural Factors Gregorio Millett Centers for Disease Control and Prevention Washington, DC July 24, 2012. Series Papers. Meta-Analysis 1. Meta-Analysis 2. Purpose: Estimate HIV prevalence black MSM vs. general populations

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Series Papers

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  1. HIV-Related Disparities AmongBlack MSM and Associations with Structural Factors Gregorio MillettCenters for Disease Control and PreventionWashington, DCJuly 24, 2012

  2. Series Papers Meta-Analysis 1 Meta-Analysis 2 Purpose: Estimate HIV prevalence black MSM vs. general populations black populations across the world Assess HIV prevalence among black MSM by African and Caribbean countries that criminalize homosexual behavior Sample 129,976 black MSM in North America, Caribbean, Europe and Africa • Purpose: • Explain HIV-related racial disparities among US MSM • HIV-positive MSM • young MSM • Are there similar racial disparities among MSM in Canada, UK and US? • Sample: • 106,148 black MSM and 581577 MSM of other races/ethnicities • 174 US studies, 13 UK studies and 7 US studies

  3. HIV Prevalence Among Black MSM vs. General Black Populations Across Diaspora • HIV prevalence disparities among black MSM vs. general populations • U.S. 72x more likely to be HIV+ • Canada 73X more likely to be HIV+ • UK111X more likely to be HIV+

  4. HIV Risk Behavior & HIV InfectionBlack vs. Other MSM, U.S. & U.K.

  5. Structural-Level Experiences &Resiliency, U.S. Black MSM vs. Other MSM

  6. HIV-Related Summary ORs by Rank– Black MSM vs. Other MSM Partner characteristics Structural inequalities HIV clinical outcomes Sexual risk behaviors Drug use Nongay identity Circumcision

  7. Disparities persist between black and other MSM throughout treatment cascade Undiagnosed HIV OR, 6.38 (4.33-9.39) HIV Detection Diagnosed HIV+ OR, 3.00 (2.06-4.40) ART utilization/ access OR, 0.56 (0.41-0.76) >200 CD4 cells/mm3 before ART initiation OR, 0.40 (0.26-0.62) ART adherence OR, 0.50 (0.33-0.76) HIV suppression OR, 0.51 (0.31-0.83) Viral Suppression (Millett, 2012)

  8. Lower income (<$20k) OR, 3.42 (1.94-6.01) Undiagnosed HIV OR, 6.38 (4.33-9.39) HIV Detection Diagnosed HIV+ OR, 3.00 (2.06-4.40) Health insurance coverage OR,0.47 (0.29-0.77) Healthcare visits OR, 0.61 (0.42-0.90) ART utilization/ access OR, 0.56 (0.41-0.76) >200 CD4 cells/mm3 before ART initiation OR, 0.40 (0.26-0.62) ART adherence OR, 0.50 (0.33-0.76) HIV suppression OR, 0.51 (0.31-0.83) Viral Suppression (Millett, 2012)

  9. Criminalization of Homosexuality & HIV Prevalence Disparities by Region

  10. Other Noteworthy Findings Young Black vs. Other Young MSM • Less likely to engage in • Any substance use • Amphetamine use • Injection drug use • Crack cocaine use • Sex during drug use • Yet, more likely to have HIV (5x), STI (7x), undiagnosed HIV (45% greater likelihood) • HIV-related factors for young black MSM • Young sex debut (65% greater) • Childhood sexual abuse (82% greater) • Older sex partners (52% greater) Overall sample • No difference in • Serodiscordant sex • Perceived susceptibility/ tx optimism • Sex network variables (eg, concurrency, same-race partners) • Greater risk of serconversion even if engage in serosorting/strategic positioning • Less • Sex during drug use • Poppers • Amphetamines • Any drugs associated with HIV infection

  11. Summary • Criminalization of homosexual activity is associated with a 2-fold increase in HIV prevalence among black MSM across African and Caribbean countries • Association only statistically significant for Caribbean countries • Both reviews establish • Similar patterns in greater risk for HIUV infection among black MSM across countries • Addressing structural barriers is essential to eliminating disparities and achieving health equity for black MSM at higher risk for HIV infection worldwide and should be targeted for HIV prevention and care efforts • Black MSM • 8.5x more likely to be HIV+ vs. black populations worldwide • 15x more likely to be HIV+ vs. general populations • Risk behavior does not explain HIV disparities in UK or US black MSM, and late ART access for black MSM in both countries • Disparities greatest for structural, clinical, network variables associated with HIV infection • Future interventions must focus here • Black MSM 40% more likely to engage in any protective behavior, despite greater exposure to any structural barrier

  12. Acknowledgments • David Malebranche, USA • Sean Rourke, Canada • Patrick Wilson, USA • Jonathan Elford, UK • Kevin Fenton, USA • Riley Steiner, USA • John Peterson, USA • Stephen Flores, USA • William Jeffries, USA • Charles Heilig, USA • Trevor Hart, Canada • Tim Lane, USA • Robert Remis, Canada

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