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APHA Scientific Session and Event Listing

Recorded presentation

Maria Madison, ScD¹, Darrell Wheeler, PhD², Geetha Beauchamp, MS³, and Deborah Donnell, PhD³. (1) Abt Associates Clinical Trials, Abt Associates Inc., 181 Spring St., Lexington, MA 02421, (2) Hunter College School of Social Work, CUNY, 129 E. 79th Street, New York, NY 10026, 212.452.7491, dwheeler@hunter.cuny.edu, (3) Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N. LE-400, Seattle, WA 98109

Background: Even though African Americans represent only 13% of the U.S. population, we account for approximately 50% of the estimated new HIV cases diagnosed annually, and 51% of the AIDS mortality. The greatest proportion of HIV/AIDS cases occurred among African American men who have sex with men, AAMSM (22%; heterosexual AA men = 10.8% and AA women = 20%). From 1999 to 2003, the EXPLORE trial was conducted to test a behavioral intervention in preventing acquisition of HIV infection among MSM in the United States. The study enrolled and followed 4,295 MSM (including 281 AAMSM) over an average of 4.5 years. The behavioral intervention did not contribute to a significant reduction in the acquisition of HIV infection among AAMSM. This paper investigates why AAMSM joined this clinical trial, and whether ‘social capital' and ‘networking' were factors in the differential rates of HIV acquisition between white and AAMSM. As well, this paper attempts to determine other predictors of HIV seroconversion between white (WMSM) and AAMSM within EXPLORE. Methods: First we performed subgroup analysis of 'reasons for joining the trial' as well as 'social capital' and 'networking' variables (using GEE; longitudinal analysis controlling for study arm and site). We performed univariate analysis of social capital and network variables as predictors (longitudinal) of serconversion for AAMSM. We also investigated the relationship between community network variables on depression. Results/Conclusions: MSM joined the trial for altruistic reasons as well as for personal benefit. The primary reason for joining, however, was “to avoid risky behavior”. There was no ethnic difference in reasons for joining the trial. AAMSM were more likely to call an MSM help line than WMSM (OR 1.8, 95% CI 1.23-2.52, p=0.002). AAMSM who called the help line were 1.6 times as likely to be HIV positive vs. those who don't call the help line. GEE analysis showed that AAMSM were 1.13 times as likely to be depressed as WMSM. Also, GEE analysis of the community networks shows that those who call the help line are 1.1 times as likely to be depressed as those who don't call the help line.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• List social network variables that contribute to opening discourse around HIV transmission among AAMSM;
• Describe reasons why AAMSM enter into clinical trials;
• Assess predictors of HIV seroconversion among AAMSM;
• Identify HIV risk factors among AAMSM;
• Recognize the potential role of depression in HIV acquisition, particularly among AAMSM;
• Articulate why an increased and urgent response is necessary to reduce the burden of HIV/AIDS among African-Americans – and identify key steps toward abating the epidemic among African Americans

Keywords: HIV Risk Behavior, African American

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation