The system seems to still be failing bi and gay black men in keeping the HIV rate down despite their behavior.
Numerous studies have shown that black gay and bi men have fewer partners, are tested for HIV more often, and are less likely to have unsafe sex than their white counterparts.
They are also 16 times more likely to face an HIV infection than their peers.
A recent study published in the Journal of Acquired Immunodeficiency Syndromes seeks to uncover the cause for this odd correlation.
“We have known from prior studies that this paradox exists—black young MSM engage in fewer risk behaviors but have a much higher rate of HIV diagnosis,” said Brian Mustanski, the senior author of this Northwestern Medicine study.
“Our study illuminates how HIV disparities emerge from complex social and sexual networks and inequalities in access to medical care for those who are HIV positive.”
The study is the most comprehensive look at this disparity, studying 1,014 16 to 29-year-old men in the Chicago metropolitan area. It looked at their social networks, the stress, and other factors that contribute to their lives and livelihoods.
Black men who have sex with men were shown to have the lowest number of sexual partners and were more likely to be regularly tested for HIV, but also faces greater levels of stigma, trauma, victimization, and childhood sexual abuse.
Background: 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.
Methods: 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 in Chicago. Data collection includes biological specimens; network data, including detailed information about social, sexual, and drug-use networks; and psychosocial characteristics of YMSM.
Results: 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 STIs (26.5%; p=0.011) with no observed differences in PrEP use. Black YMSM reported lower rates of sexual risk behaviors and more lifetime HIV tests (p<0.001) compared to all other YMSM, however, 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).
Conclusion: Black YMSM do not report higher rates of HIV risk behaviors, but social and network determinants are aligned towards increased HIV risk. These results suggest that network interventions and those addressing social determinants may help reduce disparities.
They were also more likely to not have a close relationship with their sexual partners. They also were more likely to have a detectable HIV viral load if they were already HIV positive.
“Their social and sexual networks are more dense and interconnected, which from an infectious disease standpoint makes infections transmitted more efficiently through the group,” said Mustanski. “That, coupled with the higher HIV prevalence in the population, means any sexual act has a higher chance of HIV transmission.”
Among their other findings: black gay men were more likely to have hazardous marijuana use, and more likely to have experienced more stigma, trauma and childhood sexual abuse. White gay men were more likely to have alcohol problems.
The study suggests focusing on addressing social detriments — such as the stigma and trauma many reported — as one way to close the gap young gay and bisexual men are facing in HIV prevention.