Stuck in the Middle: Longitudinal HIV-Related Health Disparities Among Men Who Have Sex With Men and Women

Friedman, M. Reuel PhD, MPH*,†; Stall, Ron PhD, MPH†,‡; Silvestre, Anthony J. PhD*,†; Mustanski, Brian PhD§; Shoptaw, Steve PhD; Surkan, Pamela J. ScD; Rinaldo, Charles R. PhD*; Plankey, Michael W. PhD#

JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0000000000000143
Epidemiology and Prevention
Abstract

Introduction: Men who have sex with men and women (MSMW) have been shown in cross-sectional studies to suffer HIV-related health disparities above and beyond those found among men who have sex with men only (MSMO). We conducted a secondary data analysis over a 7-year time frame of participants in the Multicenter AIDS Cohort Study, a long-standing prospective cohort study, to examine whether MSMW had persistently higher rates of depression symptoms, polydrug use, and (among HIV-positive men who have sex with men) HIV viral load levels compared with MSMO.

Methods: Men were behaviorally defined as bisexual if they reported sexual activity with at least 1 male and 1 female partner between study waves 38 and 50. We used generalized mixed modeling with repeated measures to test differences in CES-D score, polydrug use, and viral load between sexually active MSMO (n = 1514) and MSMW (n = 111), adjusting for age, income, race/ethnicity, and recent seroconversion.

Results: MSMW were significantly more likely than MSMO to have higher CES-D scores, polydrug use, and viral load levels (all P < 0.01). Outcome trajectories did not differ significantly over time between these groups. Black and Hispanic HIV-positive MSMW had higher viral load levels relative to white HIV-positive MSMW (P < 0.01).

Discussion: Compared with MSMO, MSMW in the Multicenter AIDS Cohort Study suffer from profound and persistent HIV-related health disparities across biological, behavioral, and psychosocial domains. Further qualitative and quantitative research contextualizing the pathways underlying these disparities is recommended for intervention development targeting MSMW at risk for HIV acquisition and transmission.

Author Information

*Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA;

Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA;

Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA;

§Department of Medical Social Sciences, Northwestern University, Chicago, IL;

Department of Family Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA;

Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; and

#Department of Medicine, Georgetown University Medical Center, Washington, DC.

Correspondence to: M. Reuel Friedman, PhD, MPH, Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, PO Box 7319, Pittsburgh, PA, 15213. (e-mail: mrf9@pitt.edu).

Data collected by the Multicenter AIDS Cohort Study were supported by National Institutes of Health grants, National Institute of Allergy and Infectious Diseases, with additional supplemental funding from the National Cancer Institute; and the National Heart, Lung, and Blood Institute: UO1-AI-35042, UL1-RR025005, UO1-AI-35043, UO1-AI-35039, UO1-AI-35040, and UO1-AI-35041.

The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

Some data herein were previously presented in altered format in the lead author's doctoral dissertation, “HIV among men who have sex with men and women (MSMW): Prevalence estimates, acquisition and transmission risks, and implications for interventions” (unpublished dissertation, University of Pittsburgh, 2012).

The authors have no conflicts of interest to disclose.

Received March 10, 2014

Accepted March 10, 2014

© 2014 by Lippincott Williams & Wilkins