Race and Age Disparities in HIV
Incidence and Prevalence Among MSM in
Atlanta, GA
Eli Rosenberg
Patrick Sullivan, Colleen Kelley, Travis
Sanchez, Nicole Luisi, Carlos del Rio,
Laura Salazar, Paula Frew, John Peterson
Center for AIDS Research
Emory University
Atlanta, GA
CROI 2014
March 4, 2014
Emory University
Center for AIDS
Research
Disclosures
Dr. Rosenberg has no financial relationships with
commercial entities to disclose.
HIV and MSM
• HIV prevalence among MSM is high and MSM continue to
bear the burden of new infections in the US and Atlanta, GA
• Black MSM (BMSM), particularly young BMSM, continue to
be overrepresented among new HIV infections
• Similar patterns for other sexually transmitted infections (STI)
• Reasons for these racial disparities remain unclear
• Prospective, racially comparative studies are needed
Study Design
• Prospective HIV/STI incidence cohort study: 2009-2014
▫ Sexually active black and white MSM in Atlanta
▫ Ages 18 - 39
Baseline
HIV/STI testing,
Questionnaire
Month 3
HIV/STI testing,
Questionnaire
Month 6
HIV/STI testing,
Questionnaire
Month 12
HIV/STI testing,
Questionnaire
▫ 803 men enrolled
▫ 30% HIV-positive (BMSM: 44%, WMSM: 13%)
Month 18
HIV/STI testing,
Questionnaire
▫ 562 HIV-negative MSM followed for 832 person-years
▫ 79% retention at 24-months
Month 24
HIV/STI testing,
Questionnaire
• Recruitment
▫ Venue-time-space sampling, Facebook
• Procedures
▫ Testing: HIV, Chlamydia, Gonorrhea, Syphilis
▫ Behavioral questionnaire
• Enrollment
Demographic characteristics of cohort
Age at enrollment
18 – 24 years
25 + years
Education
High school or less
Some college
College degree
Sexual Identity
Homosexual, Gay
Bisexual
Heterosexual, Other
Health insurance
Poverty
BMSM (n=260) WMSM (n=302) P-value
col %
col %
< .0001
50%
33%
50%
67%
< .0001
24%
11%
40%
33%
35%
56%
< .0001
76%
92%
20%
6%
4%
2%
54%
76%
< .0001
29%
13%
< .0001
STI Incidence
BMSM
Infections
WMSM
Incidence/
Incidence/
Infections
100 PY
100 PY
Rate Ratio
(95% CI)
Urethral Chlamydia
17
4.9
14
3.1
1.6 (0.7, 3.4)
Urethral Gonorrhea
8
2.3
1
0.2
10.3 (1.4, 458)
Rectal Chlamydia
31
10.2
21
5.4
1.9 (1.04, 3.4)
Rectal Gonorrhea
28
9.0
15
3.8
2.4 (1.2, 4.8)
Syphilis
22
6.2
0
0.0
Proportion HIV Infected
Log-Rank P = 0.0005
6.6 / 100 PY
24 infections
Cum. Inc. (2-yr): 11.3%
1.7 / 100 PY
8 infections
Cum. Inc. (2-yr): 3.6%
Proportion HIV Infected
Log-Rank P < 0.0001
12.1 / 100 PY
16 infections
Cum. Inc (2-yr): 16.6%
3.5 / 100 PY
8 infections
Cum. Inc. (2-yr): 6.0%
1.9 / 100 PY
7 infections
Cum. Inc. (2-yr): 4.5%
1.0 / 100 PY
1 infection
Cum. Inc. (2-yr): 1.6%
HIV incidence
Factor
Black participant
White participant
Social
Health Insurance
determinants No health Insurance
Individual risk UAI
behaviors
No UAI
Older partners (≥10 y)
Partner pool / No older partners
network
Black partners
No black partners
Incidence Rate Ratio
/100 PY
(95% CI)
6.6
1.7
2.6
6.3
5.3
1.1
8.6
3.1
8.6
1.9
3.8 (1.7, 9.9)
ref.
ref.
2.4 (1.2, 5.0)
4.8 (1.5, 24)
ref.
2.8 (1.2, 6.1)
ref.
4.5 (2.1, 10)
ref.
HIV incidence
Age-scaled Cox PH models
Black vs. White HR (95% CI):
Covariate
HRRace = 3.3 (1.4, 7.5)
Health Insurance
(UAI)
HRRace = 3.0 (1.3, 6.7)
UAI
(Older partners)
Older partners (≥10 y)
HRRace = 2.9 (1.3, 6.5)
Black partners
(no covariate adjustment)
2.6
HRRace = 2.6 (1.3, 6.5)
(Health Ins.)
HRRace = 1.6 (0.6, 4.2)
(Black partners)
HRRace = 1.5 (0.6, 3.9)
(Black P, Health Ins.)
HRRace = 1
Conclusions
• In Atlanta, MSM and BMSM face multiple
high-incidence epidemics of HIV/STI
▫ >1 in 10 YBMSM acquire HIV per year
STI-HIV Effect
Poster #1028
Thursday, P-W9
• Individual behavioral risk factors associated with HIV
incidence, but do not account for race disparity
• Partner pool/network and structural factors help to
explain HIV race disparity
Relevance
Sexual network factors and social determinants may
supersede individual characteristics and behaviors as
drivers of HIV disparities.
Thank You!
The InvolveMENt Team:
• Investigators
• Recruiters
• Event staff
• Retention specialists
• Data team
Eli Rosenberg
esrose2@emory.edu
• Our participants
Supported by NIH #:
• R01-MH085600 (PI: Sullivan) • P30 AI050409
(Emory CFAR, PI: Curran)
• R01-HD067111 (PI: Sullivan)