HIV risk, safe sex both up in gay black men
Black men who have sex with men are more likely to acquire HIV than other homosexual or bisexual men. But paradoxically, they are less likely to engage in a range of risky behaviors.
Black men who have sex with men are more likely to acquire HIV than other homosexual or bisexual men, researchers reported.
Globally, black men who have sex with men are 15 times more likely to be HIV-positive than general populations and 8.5 times more likely compared with blacks in general, according to Gregorio Millett, MPH, of the CDC, and colleagues.
But paradoxically, they are less likely to engage in a range of risky behaviors, Millett and colleagues reported online in The Lancet.
The findings come from a meta-analysis of 194 studies that analyzed racial factors associated with HIV risk or infection in the U.S., the U.K., and Canada. The analysis found a "clear and paradoxical pattern" of greater risk but less risky behavior, Millett and colleagues wrote.
The meta-analysis is associated with a series of review articles on HIV/AIDS among men who have sex with men that appeared online in the journal. The series includes a separate review, also by Millett and colleagues, that reviewed epidemics among black men outside of Africa who have sex with men.
That global disparity between black men and the rest of the population is reflected in the U.S., Millett and colleagues noted in their meta-analysis: Nearly 25% of new HIV infections in 2009 were among black men who have sex with men, although they represent less than 1% of the population.
And the CDC has reported that new HIV cases increased by 48% in young black men who had sex with men between 2006 and 2009.
But it remains unclear why such huge disparities arise, Millett and colleagues noted. To help fill the gaps, they undertook an analysis of seven Canadian studies, 13 studies from the U.K., and 174 American studies.
They attempted to find factors associated with HIV infection disparities in an overall sample of 106,000 black and 581,577 men who have sex with men in the three countries.
Importantly, Millett and colleagues found that, compared with other U.S. men who have sex with men, blacks have about twice the risk of facing structural barriers that increase HIV risk – such things as unemployment, low income, previous imprisonment, or lower education.
Despite that, they were more likely to report any preventive behavior against infection; the odds ratio was 1.39 (95% CI 1.23 to 1.57).
One implication of the findings, they argued, is that for black men who have sex with men, prevention programs that focus on behavioral risks may be less effective than working to increase early initiation of anti-retroviral therapy, as well as adherence to treatment, and clinical visits for those who are HIV-positive.
But that may not go far enough, commented Beryl Koblin, PhD, and colleagues at the New York Blood Center in New York City.
The analysis "provides some of the strongest evidence yet that neither sexual risk behavior nor drug and alcohol use can explain the over-representation" of black men who have sex with men among men infected with HIV in the U.S., Koblin and colleagues wrote in an accompanying comment article.
In addition to the changes suggested by Millett and colleagues, they urged "long-term changes" to address structural effects on the lives of black men who have sex with men, including such things as paid parental leave, "high-quality and free" infant-child care and preschool, and good public schools.
Millett and colleagues did not report any external support for either analysis and declared they had no conflicts.
Koblin and colleagues declared they had no conflicts.
By Michael Smith
Primary source: The Lancet Source reference: Millett GA, et al "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" Lancet 2012; DOI: 10.1016/S0140-6736(12)60899-X.
Additional source: The Lancet Source reference:Koblin BA, et al "Disparities in HIV/AIDS in black men who have sex with men" Lancet 2012; DOI: 10.1016/S0140-6736(12)61075-7.
Additional source: The Lancet Source reference:Millett GA, et al "Common roots: a contextual review of HIV epidemics in black men who have sex with men across the African diaspora" Lancet 2012; DOI:10.1016/S0140-6736(12)60722-3.
Source: MedPage Today