Individual sexual risk behaviors have failed to explain the observed racial disparity in HIV acquisition. To increase understanding of potential drivers in disparities, we assessed differences across individual, network, and social determinants.
Data come from RADAR (N = 1015), a longitudinal cohort study of multilevel HIV-risk factors among young men who have sex with men (YMSM) aged 16–29 years in Chicago, IL. Data collection includes biological specimens; network data, including detailed information about social, sexual, and drug-use networks; and psychosocial characteristics of YMSM.
Compared to white YMSM (24.8%) and Hispanic YMSM (30.0%), black YMSM (33.9%) had a higher prevalence of both HIV (32%; P < 0.001) and rectal sexually transmitted infections (26.5%; P = 0.011) with no observed differences in pre-exposure prophylaxis use. Black YMSM reported lower rates of sexual risk behaviors and more lifetime HIV tests (P < 0.001) compared with all other YMSM; however, they were also significantly less likely to achieve viral suppression (P = 0.01). Black YMSM reported the highest rate of cannabis use (P = 0.03) as well as greater levels of stigma (P < 0.001), victimization (P = 0.04), trauma (P < 0.001), and childhood sexual abuse (P < 0.001). White YMSM reported higher rates of depression (P < 0.001) and alcohol use (P < 0.001). In network analyses, significant differences existed across network characteristics with black YMSM having the lowest transitivity (P = 0.002), the highest density (P < 0.001), and the highest homophily (P < 0.001).
Black YMSM do not report higher rates of HIV-risk behaviors, but social and network determinants are aligned toward increased HIV risk. These results suggest that network interventions and those addressing social determinants may help reduce disparities.
*Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL;
†Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; and
‡Department of Medicine, Division of Infectious Diseases and HIV Translational Research Center, Northwestern University Feinberg School of Medicine, Chicago, IL.
Correspondence to: Brian Mustanski, PhD, Northwestern Institute of Sexual and Gender Minority Health and Wellbeing, 625 N Michigan Avenue Suite 1400, Chicago, IL 60611 (e-mail: firstname.lastname@example.org).
Supported by grants from the National Institute on Drug Abuse at the National Institutes of Health (U01DA036939; PI: B.M.; K08DA037825; PI: M.B.).
Presented in part at the Conference on Retroviruses and Opportunistic Infections (CROI); March 5, 2018; Boston, MA.
The authors have no funding or conflicts of interest to disclose.
Protection of human subjects: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health. The sponsor had no involvement in the conduct of the research or the preparation of the article.
Received July 23, 2018
Accepted September 27, 2018