Why HIV takes a heavy toll on black men in the U.S.

"Our findings show the substantial challenges that remain ahead in our efforts to reduce and eliminate racial disparities in HIV incidence among black and white MSM here in the US," says Eli Rosenberg. (Credit: iStockphoto)

Black men in the United States who have sex with other men have been disproportionately affected by HIV since the beginning of the epidemic.

This, despite the fact that they don’t engage in more risk-associated behaviors than white men, and are just as, if not more, consistent about condom use and HIV testing.


Despite efforts to reduce these disparities by optimizing treatment outcomes, they will likely persist for decades, researchers report.

A new study, published online in the Lancet HIV, assesses how existing disparities in HIV prevalence and in the HIV continuum of care explain differences in HIV incidence in men who have sex with men (MSM).

The HIV care continuum has emerged as an important way to measure HIV/AIDS care and identify gaps along the continuum of HIV services, including testing, diagnosis, treatment, and ultimately, viral suppression.

“Our findings show the substantial challenges that remain ahead in our efforts to reduce and eliminate racial disparities in HIV incidence among black and white MSM here in the US,” says Eli Rosenberg, assistant professor of epidemiology at Rollins School of Public Health at Emory University and lead author of the paper.

“There is an urgent need to improve our rates of HIV testing, linkage and retention in care, and prescription of and adherence to antiretroviral therapy for black men living with HIV.”

Gaps in care

Using data from the Centers for Disease Control and Prevention (CDC) on people with HIV from 2009 to 2010, the researchers analyzed separate HIV care continuums for black and white MSM, and estimated how many were infected but undiagnosed; diagnosed but not receiving antiretroviral therapy; and virally suppressed.

Additionally, multiple intervention scenarios were created to hypothesize the effect of care for black MSM if they achieved the same degree of HIV care as white MSM; had levels of 95 percent diagnosis; 95 percent retention in care; or both.

The analysis shows that health care outcomes were worse among black MSM with HIV than white MSM with HIV. White and black MSM have similar numbers of new HIV infections per year (9,710 among white MSM compared with 9,833 among black MSM), but the total black MSM population is smaller and the proportion of HIV prevalence is greater, resulting in greater disparities in HIV incidence between the two populations.

In 2010, 32 percent of all black MSM in the US were living with HIV, compared with only 8 percent of white MSM.

‘Change the course’

Disparities were also noted at all stages of the HIV care continuum—only 33 percent of HIV-positive black MSM were retained in care, compared with 51 percent of white MSM; and only 16 percent of black MSM were virally suppressed, compared with 34 percent of white MSM.

The modeling analysis found that optimizing HIV testing and retention in care will only have limited impact in reducing the disparities in rates of new HIV infections in the near-future.

Because a larger proportion of black MSM are living with HIV, the researchers suggest that if black MSM achieved the same degree of HIV care as white MSM, the racial gap in new infection rates would be reduced by 27 percent. If black MSM with HIV had 95 percent diagnosis, or 95 percent retention in care, or both, the reduction would be 27 percent, 25 percent, and 59 percent, respectively.

“We have an opportunity to change the course of the epidemic here in the US by implementing the steps laid out in the National HIV/AIDS Strategy by focusing on the populations at greatest risk and ensuring that all men who have sex with men, especially black MSM, have access to healthcare,” says Greg Millett, amfAR vice president and director of public policy, and one of the coauthors of the study.

“We must also scale up programs for medications that prevent HIV infection at reduced or no cost for uninfected black gay men, while continuing to invest in research toward a cure and a vaccine. Otherwise, these disparities in HIV incidence among MSM will persist.”

The National Institutes of Health provided fundings.

Source: Emory University