Associations of Race/Ethnicity with Prevalence of HIV and HIV-Related Behaviors Among Young Men Who Have Sex With Men

Using data from a multi-site venue-based survey of male subjects aged 15 to 22 years, researchers examined racial/ethnic differences in demographics, partner type, partner type-specific condom use, drug use, and HIV prevalence in 3316 US black, multiethnic black, Latino, and white men who have sex with men (MSM).

The investigators further estimated associations of these factors with HIV infection and their influence on racial/ethnic disparities in HIV prevalence.

Study participants were drawn from 7 urban centers in the US.

Results

HIV prevalences were 16% for both black and multiethnic black participants, 6.9% for Latinos, and 3.3% for whites. Paradoxically, potentially risky sex and drug-using behaviors were generally reported most frequently by whites and least frequently by blacks.

In a multiple logistic regression analysis, positive associations with HIV included older age, being out of school or work, sex while on crack cocaine, and anal sex with another male regardless of reported condom use level.

Differences in these factors did not explain the racial/ethnic disparities in HIV prevalence, with both groups of blacks experiencing more than 9 times and Latinos experiencing approximately twice the fully adjusted odds of infection compared with whites.

Conclusions

The inability here and elsewhere to account for racial differences in HIV prevalence among young men is troubling, according to the authors. Their findings in this study call into question the assumption that homosexual and bisexual men of color are at elevated risk for HIV because they have not responded to or been reached by existing HIV prevention efforts.

According to self-report, black and Latino men do not appear to be at higher risk because they are more likely than white men to have more partners, have unprotected sex, have sex with non steady or exchange partners, use stimulants, or inject drugs. Although levels of adherence to prevention can be greatly improved among all young MSM, these data suggest that the elevated risk among MSM of color may result from processes more complex than a higher likelihood of unprotected sex or drug use.

Given the high HIV prevalence among the 17- and 18-year-old men of color surveyed and the dramatically higher prevalence among men aged 19 and 20 years, targeted efforts to prevent further spread of HIV among MSM and their partners, both male and female, should start in early adolescence.

Implementation of effective interventions at this developmental stage requires overcoming numerous political challenges and employing culturally relevant approaches and materials.

Prevention efforts should further specifically address HIV risk in steady partnerships, given that anal sex with steady partners emerged in these data and elsewhere as an important potential risk factor. Unprotected sex among uninfected monogamous partners is not risky for HIV transmission. Nevertheless, it is unlikely that most of the young MSM sampled had established both that their relationship was mutually monogamous and that their partners, or themselves in some cases, did not have HIV before initiating unprotected anal sex. Venue-based strategies could be used to recruit young MSM, particularly those who are unemployed and out of school, into prevention programs.

The authors conclude, “Future research on HIV in MSM populations should explicitly address alternative hypotheses for racial/ethnic disparities by examining the age and racial/ethnic makeup of the respondents' sexual networks, measuring potential misreporting with questions that assess participants' tendencies to provide inconsistent and socially desirable responses, and employing qualitative techniques to identify other influences on HIV risk.”

“Venue selection can be expanded and recruitment methods enhanced to help increase participation and ensure inclusion of a representative sample of each racial/ethnic group, and race/ethnic-specific studies can be conducted to provide sufficient numbers for within-group comparisons.”

04/05/04

Reference
N T Harawa and others. Associations of Race/Ethnicity with HIV Prevalence and HIV-Related Behaviors Among Young Men Who Have Sex With Men in 7 Urban Centers in the United States. Journal of Acquired Immune Deficiency Syndromes 35(5): 526-536. April 15, 2004