AIDS 2012The rate of new HIV cases among black men who have sex with men (MSM) in the United States is two times that among white MSM. Among black MSM under the age of 30, the rate is even higher—three times that of white MSM. These alarming data from HIV Prevention Trials Network study 061 (HPTN 061) were announced Monday, July 23, at the XIX International AIDS Conference (AIDS 2012) in Washington DC, and echo those of another analysis of nearly 200 studies reported during a symposium on Tuesday, July 24.

The HPTN 061 preliminary results were reported by Kenneth Mayer, MD, of Boston’s Fenway Health Center, and Beryl Koblin, of the New York Blood Center.

“There is an extreme health disparity in the U.S.” Mayer said. “Black men who have sex with men comprise less than 1 percent of the U.S. population but more than 20 percent of new HIV infections over the last few years.”

HPTN 061, a study of 1,553 black MSM conducted in Atlanta, Boston, Los Angeles, New York City, San Francisco and Washington, DC, between July 2009 and December 2011, was an attempt to investigate interventions that might help stem new infections.

The study recruited both HIV-positive and HIV-negative black men 18 or older who identified as male or male at birth and reported at least one incident of unprotected anal intercourse (UAI) with another man within the past six months.

A little over a third of the men were 30 or younger, and 2 percent identified as transgender. Almost half had some college education or more; 31 percent worked full or part time and 20 percent were full- or part-time students. Sixty percent had an annual income less than $20,000.

The length of participation in the study averaged a year and most participants visited a study center three times. During each visit, they participated in interviews, were offered testing for HIV and other sexually transmitted infections, and were given the opportunity to work with a peer health navigator who could assist them in getting connected to resources available in their community, such as medical care and social services.

At the start of the study, 174 men reported a previous diagnosis of HIV. Of those who said they had never been tested or had tested negative, 165 (12 percent) tested positive during their baseline visit. Of the 1,168 black MSM who were HIV negative at the start of the study, 1,009 agreed to be tested at least once during their follow-up visits.

Twenty six new infections were documented in the study, Koblin reported, which meant the incidence rate was 2.8 percent—50 percent higher than has been seen in white MSM studies. Among those between 18 and 30 years of age, the rate was an astonishing 5.9 percent—three times higher than the usual rate in white MSM studies—on account of the fact that 20 of the 26 new infections were documented among individuals in this age bracket.

The incidence was 4.3 percent among the study participants who identified as gay or bisexual, compared with 1.5 percent among the black MSM who identified as “other.”

The incidence was 3.8 percent among black MSM who reported having sex exclusively with men and 1.7 percent among those who reported having sex with both men and women. And compared with an incidence of 1 percent among those who hadn’t reported unprotected receptive anal intercourse, the incidence was nearly 5 percent among those who did.

Mayer’s report shed light on some of the risk factors associated with HIV infection at the start of the study. His analysis was limited to those who entered the study with HIV and those who tested positive during their baseline visit; his data did not reflect those who tested positive for the virus while participating in the study. Both groups of individuals who were living with HIV at the start of the study were compared with those who began the study without HIV infection.

Previous and new HIV cases tended to be older (43 and 41 versus 39 years, respectively) than those who were HIV negative upon starting the study. People starting the study with HIV were also more likely to be unemployed, less likely to be in stable housing, more likely to have an income below $50,000, more likely to be transgender and more likely to identify as gay (as opposed to simply “MSM”).

“The men in both HIV-positive groups reported slightly fewer partners, but were more likely to have had UAI as the receptive partner [bottom],” Mayer said. He also commented that the highest numbers of new (baseline visit) HIV diagnoses were found in Harlem, Atlanta and Washington, DC, with fewer found in the Boston site of the study.

“These data suggest that structural, behavioral and biological factors—particularly poverty, unemployment, local environment, UAI, being older and having STIs—is each independently associated with undiagnosed HIV infection among black MSM,” Mayer said.

Both Mayer and Koblin commented that culturally-tailored interventions encouraging repeated HIV/STI testing, engagement in care and innovative prevention strategies addressing current risks are urgently need to decrease further spread of HIV among black MSM.

While these presentations did not specifically address the HPTN 061 findings on incarceration, Mayer did say that 60 percent of the men in the study had a history of incarceration. “The work we’ve done at the sites reveals that many of these incarcerations were from punitive drug laws and other kinds of discriminatory laws,” he said. “You see a cycle where people may lose social agency by being incarcerated—having difficulties finding jobs and being constrained to a life of poverty."