Background: There is a large and disproportionate burden of HIV in black men who have sex with men (MSM) which is not adequately explained by racial/ethnic differences in risk behaviors. However, social factors may account for this disparity in HIV infection. We examine the extent to which both individual risk behaviors and social factors reduce the effect of black race and may account for the disparity in HIV infection of black MSM.
Methods: In a cross-sectional study in New York City in 2011, MSM were venue sampled, interviewed, and HIV tested. Variables associated (P < 0.10) both with black race and testing HIV positive were analyzed using multivariate logistic regression.
Results: Of 416 participants who were HIV tested and did not self-report being positive, 19.5% were black, 41.1% were Hispanic, 30.5% were white, and 8.9% were of other race/ethnicity. Overall, 8.7% tested positive (24.7% of blacks, 7.6% of Hispanics, 1.0% of whites, and 5.4% of other). The effect of black race versus non–black race/ethnicity with testing HIV positive declined by 49.2%, (crude odds ratio, 6.5 [95% confidence interval, 3.2–13.3] vs. adjusted odds ratio, 3.3 [95% confidence interval, 1.5–7.5]), after adjustment for having a black last sex partner, not having tested for HIV in the past 12 months, Brooklyn residency, and having an annual income less than US$20,000.
Conclusions: Greater HIV infection risk of black MSM may result from social factors and less frequent HIV testing than from differences in risk behaviors. To reduce the disparity in HIV infection of black MSM, multilevel interventions that both ameliorate social risk factors and increase the frequency of HIV testing are needed.
Greater HIV infection of black men in New York City who have sex with men was associated with social factors and less frequent HIV testing but not with risk behaviors.
From the *HIV Epidemiology Program, New York City Department of Health and Mental Hygiene, New York, NY; †Department of Epidemiology, University of Washington, Seattle, WA; ‡Department of Anthropology, John Jay College of Criminal Justice, New York, NY; and §College of Nursing, New York University, New York, NY
Acknowledgments: The authors acknowledge Gabriela Paz-Bailey, Dita Broz, and Isa Miles of the Centers for Disease Control and Prevention for their contributions to the National HIV Behavioral Surveillance study design, the New York City National HIV Behavioral Surveillance field staff for all their efforts, and the participants who gave their consent to be in the study.
Source of support: This research was funded by a cooperative agreement between the New York City Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention (FOA: PS11-001, Grant No. 1U1BPS003246-01). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of The Centers for Disease Control and Prevention.
Conflict of interest: None declared.
Correspondence: Alan Neaigus, PhD, 42-09 28th St, CN: 22-108, Long Island City, NY 11101. E-mail: firstname.lastname@example.org.
Received for publication December 18, 2013, and accepted April 10, 2014.