Background: Men who have sex with men (MSM) continue to be overrepresented for new HIV infections compared with non-MSM. This disparity becomes even more alarming when considering racial groups. We describe the race-specific effects in HIV prevalence among MSM relative to non-MSM and explore the causes of disagreement among estimates.
Methods: We used data from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative longitudinal survey conducted in the US Bayesian learning corrected for potential misclassification of MSM status and adjusted for residual confounding, hypothesized to explain the MSM racial disparity in HIV. We articulated the structure and strength of the latent confounders that would make race-specific risk gradients equivalent.
Results: Compared with non-MSM, the adjusted prevalence odds ratio (POR) and 95% credible interval for black MSM having self-reported HIV infection was 5.8 (2.0, 16), while the POR for white MSM was 12 (4.2, 31). For all MSM, the POR for HIV infection was 9.3 (3.6, 23) with black men having 2.6 times the odds of prevalent infection compared with white men.
Conclusions: The observed race-specific associations in MSM are likely not due to misclassification alone, but represent a constellation of factors that differ between racial groups. We recommend specific risk factors in surveys needed to further identify the behavioral characteristics that lead to the observed differences when the estimates are stratified by race.
From the aDepartment of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA; and bDepartment of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA.
Editor’s Note: A commentary on this article appears on p. 221.
Submitted 10 December 2015; accepted 19 October 2016.
Financially supported by DHHS Office of Minority Health (BAAMHS study).
This paper was selected for the Tyroler Student Prize Paper Award for the 2016 Epidemiology Congress of the Americas.
The authors report no conflicts of interest.
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Correspondence: Neal D. Goldstein, Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Nesbitt Hall, 3215 Market St., Philadelphia, PA 19104. E-mail: email@example.com.