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Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors

Millett, Gregorio Aa; Flores, Stephen Aa; Peterson, John Lb; Bakeman, Rogerb

doi: 10.1097/QAD.0b013e3282e9a64b
Epidemiology and Social

Objective: To identify factors that contribute to the racial disparity in HIV prevalence between black and white men who have sex with men (MSM) in the United States.

Methods: A comprehensive literature search of electronic databases, online bibliographies, and publication reference lists yielded 53 quantitative studies of MSM published between 1980 and 2006 that stratified HIV risk behaviors by race. Meta-analyses were performed to compare HIV risks between black and white MSM across studies.

Results: Compared with white MSM, black MSM reported less overall substance use [odds ratio (OR), 0.71; 95% confidence interval (CI), 0.53–0.97], fewer sex partners (OR, 0.64; 95% CI, 0.45–0.92), less gay identity (OR, 0.29; 95% CI, 0.17–0.48), and less disclosure of same sex behavior (OR, 0.42; 95% CI, 0.30–0.60). HIV-positive black MSM were less likely than HIV-positive white MSM to report taking antiretroviral medications (OR, 0.43; 95% CI, 0.30–0.61). Sexually transmitted diseases were significantly greater among black MSM than white MSM (OR, 1.64; 95% CI, 1.07–2.53). There were no statistically significant differences by race in reported unprotected anal intercourse, commercial sex work, sex with a known HIV-positive partner, or HIV testing history.

Conclusions: Behavioral risk factors for HIV infection do not explain elevated HIV rates among black MSM. Continued emphasis on risk behaviors will have only limited impact on the disproportionate rates of HIV infection among black MSM. Future research should focus on the contribution of other factors, such as social networks, to explain racial disparities in HIV infection rates.

From the aCenters for Disease Control and Prevention, USA

bDepartment of Psychology, Georgia State University, Atlanta, Georgia, USA.

Received 18 February, 2007

Revised 7 June, 2007

Accepted 13 June, 2007

Correspondence to G.A. Millett, Centers for Disease Control and Prevention 1600 Clifton Road, Mail Stop E-37 Atlanta, GA 30333, USA. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.