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Mistaken Assumptions and Missed Opportunities: Correlates of Undiagnosed HIV Infection Among Black and Latino Men Who Have Sex With Men

Millett, Gregorio A MPH*; Ding, Helen MD, MS, MSPH†; Marks, Gary PhD*; Jeffries, William L IV PhD, MPH‡; Bingham, Trista MPH, PhD§; Lauby, Jennifer PhD‖; Murrill, Christopher PhD, MPH¶; Flores, Stephen PhD*; Stueve, Ann PhD, MPH#

JAIDS Journal of Acquired Immune Deficiency Syndromes: 1 September 2011 - Volume 58 - Issue 1 - pp 64-71
doi: 10.1097/QAI.0b013e31822542ad
Epidemiology and Prevention

Objective: To identify demographic, behavioral, and psychological variables associated with being HIV positive unaware among black and Latino men who have sex with men (MSM).

Methods: Participants recruited in 3 cities completed a computer-assisted interview and were tested for HIV infection (OraSure Technologies, Bethlehem, PA). HIV-positive unaware MSM were compared with MSM who tested HIV negative in bivariate and multivariate analyses.

Results: Of 1208 MSM (597 black and 611 Latino), 11% were HIV-positive unaware (18% black; 5% Latino). In multivariate analysis of the Latino MSM, being HIV-positive unaware was associated with nongay identity, high perceived risk of currently being HIV positive, and belief that sex with other Latino men reduces HIV transmission risk. Among black MSM, being HIV-positive unaware was associated with gay identity, moderately higher income, having health insurance, sexuality disclosure to a current health care provider, fewer than 3 lifetime HIV tests, high perceived risk of testing HIV positive, and belief that sex with other black men reduces HIV transmission risk.

Conclusions: HIV prevention efforts should address misperceptions among those black and Latino MSM who believe that assortative (ie, intraracial) sexual mixing reduces risk of HIV infection. Our findings also revealed missed opportunities to diagnose black MSM with HIV infection who were already engaged in care and had disclosed their sexuality to their health care provider. Clinicians should offer HIV testing to all MSM, particularly black MSM, who disclose engaging in recent sex with other men to facilitate earlier diagnosis of HIV infection and reduce transmission risk to sexual partners.

From the *Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA; †Centers for Disease Control and Prevention, Immunization Service Division, Atlanta, GA; ‡Epidemic Intelligence Service, Division of Applied Sciences, Centers for Disease Control and Prevention, Atlanta GA; §Seroepidemiology Unit, HIV Epidemiology Program, Los Angeles County Department of Public Health, Los Angeles, CA; ‖Public Health Management Corporation, Philadelphia, PA; ¶Global AIDS Program, Centers for Disease Control and Prevention, Atlanta, GA; and #Health and Human Development Programs, Education Development Center, Boston, MA.

Received for publication March 26, 2011; accepted May 18, 2011.

Supported by fund through a co-operative agreement from the US Centers for Disease Control and Prevention.

Presented at CROI, March 2, 2011, Boston, MA (Abstract # 131LB).

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

The authors have no conflicts of interest to disclose.

Correspondence to: Gregorio A. Millett, MPH, Centers for Disease Control and Prevention, 395 E Street, SW, Suite 9100, MS-06, Washington, DC 20201 (e-mail: gmillett@cdc.gov).

© 2011 Lippincott Williams & Wilkins, Inc.