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Investigating a Sexual Network of Black Men Who Have Sex With Men: Implications for Transmission and Prevention of HIV Infection in the United States

Hurt, Christopher B. MD*; Beagle, Steve BS*; Leone, Peter A. MD*,†; Sugarbaker, Alyssa BS*; Pike, Emily BS*; Kuruc, JoAnn RN, MSN*; Foust, Evelyn M. CPM, MPH; Eron, Joseph J. Jr MD*; Cohen, Myron S. MD*; Hightow-Weidman, Lisa B. MD, MPH*

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 1st, 2012 - Volume 61 - Issue 4 - p 515–521
doi: 10.1097/QAI.0b013e31827076a4
Epidemiology and Prevention

Background: HIV infections increased 48% among young Black men who have sex with men (MSM) in the United States between 2006 and 2009. Incomplete understanding of this trend undermines prevention strategy development. We investigated a sexual network to characterize the risk environment in which young Black MSM acquire HIV.

Methods: Persons reported to the state after diagnosis of HIV or syphilis were included, along with sexual partners. We used network mapping alongside descriptive and bivariate statistics to characterize network connections. Generalized linear models assessed predictors of having untraceable sex partners.

Results: The network included 398 individuals and 419 sexual relationships. Three-quarters were Black (n = 299); 92% were MSM. Median age at first network appearance was 26 years and decreased over time (P < 0.001). HIV prevalence was at least 29% (n = 117); serostatus was unknown for 47% of the network, either because they were untraceable (n = 150) or refused HIV testing (n = 39). One in 5 network members diagnosed with HIV had a subsequent incident sexually transmitted infection. In multivariable models, one-time encounters increased the risk of having an untraceable partner (risk ratio = 4.51, 95% CI: 2.27 to 8.97), whereas being acutely HIV infected at diagnosis reduced it (risk ratio = 0.27, 95% CI: 0.08 to 0.89).

Conclusions: HIV prevalence in this sexual network of young Black MSM rivals that of sub-Saharan Africa, reflecting dramatically increased risk of acquiring HIV from the moment one entered the network. Prevention efforts for this population must consider the effect of sexual networks on HIV risk and find ways of leveraging network structure to reduce transmission.

*Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC

Communicable Disease Branch, North Carolina Department of Health and Human Services, Raleigh, NC.

Correspondence to: Christopher B. Hurt, MD, Division of Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd, CB#7030, Chapel Hill, NC 27599-7030 (e-mail: churt@med.unc.edu).

Supported by the National Center for Advancing Translational Sciences Grant 8KL2TR000084-05 (to C. B. Hurt); the National Institute of Mental Health Grant 1R01MH093275-01 (to L. B. Hightow-Weidman and E. Pike); the National Institute for Allergy and Infectious Diseases Grant 5P30AI050410-13 (to J. J. Eron) and Grant 5U01AI067854-01 (to S. Beagle, A. Sugarbaker, and J. Kuruc). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author contributions: Conceived and designed the study: C. B. Hurt, M. S. Cohen, L. B. Hightow-Weidman, J. J. Eron, Jr, P. A. Leone, S. Beagle, and A. Sugarbaker. Acquired and organized data: S. Beagle, A. Sugarbaker, E. Pike, E. M. Foust, P. A. Leone, J. Kuruc, and C. B. Hurt. Analyzed and interpreted data: C. B. Hurt, L. B. Hightow-Weidman, M. S. Cohen, and J. J. Eron, Jr. Wrote the first draft of the manuscript: C. B. Hurt, M. S. Cohen, and L. B. Hightow-Weidman. Critical review of the manuscript for important intellectual content: M. S. Cohen, J. J. Eron, Jr, L. B. Hightow-Weidman, E. M. Foust, P. A. Leone, S. Beagle, A. Sugarbaker, E. Pike, and J. Kuruc. ICMJE criteria for authorship read and met: C. B. Hurt, S. Beagle, P. A. Leone, A. Sugarbaker, E. Pike, J. Kuruc, E. M. Foust, J. J. Eron, Jr, M. S. Cohen, and L. B. Hightow-Weidman. Agree with manuscript results and conclusions: C. B. Hurt, S. Beagle, P. A. Leone, A. Sugarbaker, E. Pike, J. Kuruc, E. M. Foust, J. J. Eron, Jr, M. S. Cohen, and L. B. Hightow-Weidman.

Presented at the 19th Conference on Retroviruses and Opportunistic Infections, March 5–8, 2012, Seattle, WA (Abstract #1105).

The authors have no funding or conflicts of interest to disclose.

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Received August 13, 2012

Accepted August 22, 2012

© 2012 Lippincott Williams & Wilkins, Inc.