Using data from a multisite venue-based survey of male subjects aged 15 to 22 years, we 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). We further estimated associations of these factors with HIV infection and their influence on racial/ethnic disparities in HIV prevalence. 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. Understanding racial/ethnic disparities in HIV risk requires information beyond the traditional risk behavior and partnership type distinctions. Prevention programs should address risks in steady partnerships, target young men before sexual initiation with male partners, and tailor interventions to men of color and of lower socioeconomic status.
From the *County of Los Angeles, Department of Health Services, Los Angeles, CA; †UCLA School of Public Health, Los Angeles, CA; ‡UCLA School of Medicine, Los Angeles, CA; §Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD;|| The New York Blood Center, New York, NY; ¶Florida Department of Health, Tallahassee, FL; #Division of HIV/AIDS Prevention-Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; **San Francisco Department of Public Health, San Francisco, CA; ††University of Texas Southwestern Medical Center at Dallas, TX; ‡‡Public Health–Seattle and King County, Seattle, WA; and §§New York City Department of Health, New York, NY.
Received for publication June 12, 2003; accepted December 4, 2003.
Partial funding for this analysis was provided by a National Institutes of Health (NIH) predoctoral traineeship (T32 AI07481) (Dr. Harawa). W. E. Cunningham was supported by a grant from the NCMHD (NIH/1P20MD000148).
Reprints: Nina T. Harawa, Los Angeles County Department of Health Services, HIV Epidemiology Program, 600 South Commonwealth Boulevard, Suite 1920, Los Angeles, CA 90005–4001 (e-mail: email@example.com).