- Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis
Gregorio Millett et al.
- A meta-analysis of 600,000 MSM to assess factors associated with disparities in HIV infection in black MSM in Canada, the UK, and the USA found that in every country, black MSM were no more likely than other MSM to engage in sero-discordant unprotected sex. Black MSM in Canada and the USA were less likely than other MSM to have a history of substance use.
- Despite being less risky, Black MSM in the UK and the USA were more likely to be HIV positive than were other MSM. This paradox is partly explained by the finding that HIV-positive black MSM in each country were less likely to start HIV treatment than men of other races and ethnicities. U.S. HIV-positive black MSM were also less likely to have health insurance, have a high CD4 count, adhere to anti-retroviral treatment, or be virally suppressed than were other US HIV-positive MSM. These low rates of successful treatment for black MSM are driving new HIV infections in black MSM networks and communities.
- The meta-analysis found that young black MSM in the U.S. were five times more likely to be HIV positive compared with other MSM despite engaging in similar risk behaviors. The data showed that high rates of HIV infection among U.S. young black MSM is due to an earlier sexual debut, a history of childhood sexual abuse, older age sex partners, and a low income.
- These results provide evidence that the greatest HIV-related disparities in US black MSM relative to other MSM are disparities in HIV clinical care access and use, structural issues (including low income, unemployment, incarceration, low education), and sex partner characteristics, and the smallest disparities were in sexual and substance-use risk behaviors.
- Interventions that support early initiation of antiretroviral therapy, adherence, and clinical visits for HIV positive black MSM might have a greater effect in the reduction of HIV infection rates than do those that focus on individual sexual or drug use risks.
- Physicians have a role in addressing racial disparities in HIV infection by providing regular HIV testing to and ART access for black MSM. Providers must diagnose and suppress the viral load of as many older MSM as possible to stem increasing rates of new infections in young black MSM. Repeat STI testing and treatment of STIs in black MSM should be a priority for providers in the USA and the UK.