Journal Article Annotations
2019, 1st Quarter
Annotations by John Grimaldi, MD; and Mary Ann Cohen MD, FAPM
Also of interest:
Type of study: This study used data from a longitudinal cohort study of multilevel HIV-risk factors among young men who have sex with men (YMSM) aged 16-29 in Chicago, IL, RADAR (N=1015).
Findings:Data from a longitudinal cohort study of multilevel HIV-risk factors among young men who have sex with men (YMSM) aged 16-29 in Chicago, IL, RADAR (N=1015), were used to understand individual, network and social drivers of racial/ethnic disparities in HIV acquisition among YMSM. Analyses of individual and social characteristics revealed that black YMSM had significantly higher HIV prevalence despite lower rates of sexual risk behaviors compared to white and Hispanic YMSM. There was no difference in pre-exposure prophylaxis (PrEP) use across all groups. Black YMSM were less likely than other groups to achieve viral suppression and more likely to report stigma, victimization, trauma and childhood sexual abuse. These social determinants along with the following network characteristics heighten HIV risk among black YMSM. Compared to other groups, black YMSM have significantly higher network homophily and density and lower transitivity. These measures reflect dynamics underlying disease spread. Homophily refers to the degree of same-race sexual relationships; density is the proportion of all possible sexual pairs in a network that are actual sexual pairs; transitivity refers to the degree of connectiveness within a network.
Strengths and limitations: This longitudinal study comprises a large cohort of racially and ethnically diverse MSM whose young age may amplify the effect of individual, biological and structural characteristics on HIV prevention and care. An existing rich data set is employed to advance a nuanced understanding of ways in which racial and ethnic differences in network characteristics may account for disparities in HIV acquisition. Although conducted in Chicago, the study reveals insights that may apply to the South where an even larger proportion of black YMSM are affected by HIV. Limitations include the use of a community rather than a population sample which may not generalize to the general population, the use of some self-reported data, and the inclusion of few HIV-negative white MSM in the sample.
Relevance:Racial and ethnic disparities in HIV incidence, prevention, and care persist despite significant advances in biomedical HIV prevention strategies. The urgent need to address inequalities is supported by CDC estimates of lifetime risk of acquiring HIV which are 1:2 for black MSM, 1:5 for Hispanic MSM and 1:11 for white MSM. Studies of individual factors related to HIV transmission suggest that HIV-risk behaviors don’t account for racial and ethnic disparities. By enhancing our understanding of social and network determinants, this study moves us closer to our goal of reducing disparities and stopping HIV transmission. For example, this study suggests the potential public health benefit of interventions that target stigma, trauma and victimization. Findings from studies of network and social determinants of HIV could be integrated with data from partner services programs and molecular surveillance to develop more sophisticated interventions to facilitate both access to testing, prevention and care as well as identification of influential members of sexual networks. Other relevant findings include higher rates of suicide attempts in black YMSM and lowest rates of PrEP use, network homophily and number of visits to a healthcare provider in Hispanics. This study suggests the need for mental health interventions for black YMSM and prevention interventions informed by findings for Hispanic YMSM.