Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: A prospective observational cohort study

Patrick S. Sullivan, Eli S. Rosenberg, Travis H. Sanchez, Colleen F. Kelley, Nicole Luisi, Hannah L. Cooper, Ralph DiClemente, Gina M. Wingood, Paula M. Frew, Laura F. Salazar, Carlos del Rio, Mark J. Mulligan, John L. Peterson

Research output: Contribution to journalArticle

Abstract

Purpose: To describe factors associated with racial disparities in HIV (human immunodeficiency virus) incidence among men who have sex with men (MSM) in the United States. Methods: In a longitudinal cohort of black and white HIV-negative MSM in Atlanta, HIV incidence rates were compared by race. Incidence hazard ratios (HRs) between black and white MSM were estimated with an age-scaled Cox proportional hazards model. A change-in-estimate approach was used to understand mediating time-independent and -dependent factors that accounted for the elevated HR. Results: Thirty-two incident HIV infections occurred among 260 black and 302 white MSM during 843 person-years (PY) of follow-up. HIV incidence was higher among black MSM (6.5/100 PY; 95% confidence interval [CI]: 4.2-9.7) than white MSM (1.7/100 PY; CI: 0.7-3.3) and highest among young (18-24years) black MSM (10.9/100 PY; CI: 6.2-17.6). The unadjusted hazard of HIV infection for black MSM was 2.9 (CI: 1.3-6.4) times that of white MSM; adjustment for health insurance status and partner race explained effectively all of the racial disparity. Conclusions: Relative to white MSM in Atlanta, black MSM, particularly young black MSM, experienced higher HIV incidence that was not attributable to individual risk behaviors. In a setting where partner pool risk is a driver of disparities, it is also important to maximize care and treatment for HIV-positive MSM.

Original languageEnglish (US)
Pages (from-to)445-454
Number of pages10
JournalAnnals of Epidemiology
Volume25
Issue number6
DOIs
StatePublished - Jun 1 2015

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Observational Studies
Cohort Studies
HIV
Incidence
Confidence Intervals
Virus Diseases
Insurance Coverage
hydroquinone
Health Insurance
Risk-Taking
Proportional Hazards Models
Health Status

Keywords

  • Cohort studies
  • HIV incidence
  • Men who have sex with men
  • Racial disparities

ASJC Scopus subject areas

  • Epidemiology

Cite this

Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA : A prospective observational cohort study. / Sullivan, Patrick S.; Rosenberg, Eli S.; Sanchez, Travis H.; Kelley, Colleen F.; Luisi, Nicole; Cooper, Hannah L.; DiClemente, Ralph; Wingood, Gina M.; Frew, Paula M.; Salazar, Laura F.; del Rio, Carlos; Mulligan, Mark J.; Peterson, John L.

In: Annals of Epidemiology, Vol. 25, No. 6, 01.06.2015, p. 445-454.

Research output: Contribution to journalArticle

Sullivan, PS, Rosenberg, ES, Sanchez, TH, Kelley, CF, Luisi, N, Cooper, HL, DiClemente, R, Wingood, GM, Frew, PM, Salazar, LF, del Rio, C, Mulligan, MJ & Peterson, JL 2015, 'Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: A prospective observational cohort study', Annals of Epidemiology, vol. 25, no. 6, pp. 445-454. https://doi.org/10.1016/j.annepidem.2015.03.006
Sullivan, Patrick S. ; Rosenberg, Eli S. ; Sanchez, Travis H. ; Kelley, Colleen F. ; Luisi, Nicole ; Cooper, Hannah L. ; DiClemente, Ralph ; Wingood, Gina M. ; Frew, Paula M. ; Salazar, Laura F. ; del Rio, Carlos ; Mulligan, Mark J. ; Peterson, John L. / Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA : A prospective observational cohort study. In: Annals of Epidemiology. 2015 ; Vol. 25, No. 6. pp. 445-454.
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abstract = "Purpose: To describe factors associated with racial disparities in HIV (human immunodeficiency virus) incidence among men who have sex with men (MSM) in the United States. Methods: In a longitudinal cohort of black and white HIV-negative MSM in Atlanta, HIV incidence rates were compared by race. Incidence hazard ratios (HRs) between black and white MSM were estimated with an age-scaled Cox proportional hazards model. A change-in-estimate approach was used to understand mediating time-independent and -dependent factors that accounted for the elevated HR. Results: Thirty-two incident HIV infections occurred among 260 black and 302 white MSM during 843 person-years (PY) of follow-up. HIV incidence was higher among black MSM (6.5/100 PY; 95{\%} confidence interval [CI]: 4.2-9.7) than white MSM (1.7/100 PY; CI: 0.7-3.3) and highest among young (18-24years) black MSM (10.9/100 PY; CI: 6.2-17.6). The unadjusted hazard of HIV infection for black MSM was 2.9 (CI: 1.3-6.4) times that of white MSM; adjustment for health insurance status and partner race explained effectively all of the racial disparity. Conclusions: Relative to white MSM in Atlanta, black MSM, particularly young black MSM, experienced higher HIV incidence that was not attributable to individual risk behaviors. In a setting where partner pool risk is a driver of disparities, it is also important to maximize care and treatment for HIV-positive MSM.",
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T2 - A prospective observational cohort study

AU - Sullivan, Patrick S.

AU - Rosenberg, Eli S.

AU - Sanchez, Travis H.

AU - Kelley, Colleen F.

AU - Luisi, Nicole

AU - Cooper, Hannah L.

AU - DiClemente, Ralph

AU - Wingood, Gina M.

AU - Frew, Paula M.

AU - Salazar, Laura F.

AU - del Rio, Carlos

AU - Mulligan, Mark J.

AU - Peterson, John L.

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N2 - Purpose: To describe factors associated with racial disparities in HIV (human immunodeficiency virus) incidence among men who have sex with men (MSM) in the United States. Methods: In a longitudinal cohort of black and white HIV-negative MSM in Atlanta, HIV incidence rates were compared by race. Incidence hazard ratios (HRs) between black and white MSM were estimated with an age-scaled Cox proportional hazards model. A change-in-estimate approach was used to understand mediating time-independent and -dependent factors that accounted for the elevated HR. Results: Thirty-two incident HIV infections occurred among 260 black and 302 white MSM during 843 person-years (PY) of follow-up. HIV incidence was higher among black MSM (6.5/100 PY; 95% confidence interval [CI]: 4.2-9.7) than white MSM (1.7/100 PY; CI: 0.7-3.3) and highest among young (18-24years) black MSM (10.9/100 PY; CI: 6.2-17.6). The unadjusted hazard of HIV infection for black MSM was 2.9 (CI: 1.3-6.4) times that of white MSM; adjustment for health insurance status and partner race explained effectively all of the racial disparity. Conclusions: Relative to white MSM in Atlanta, black MSM, particularly young black MSM, experienced higher HIV incidence that was not attributable to individual risk behaviors. In a setting where partner pool risk is a driver of disparities, it is also important to maximize care and treatment for HIV-positive MSM.

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