Role of Preventive Healthcare in HIV Prevention among Young African American Men who have Sex with Men

Background: African American men who have sex with men (AAMSM) are at increased risk for HIV infection. Inadequate preventive care and patient/provider discomfort discussing sexual behavior may lead to missed opportunities for preventing HIV infection. To characterize the role of healthcare visits and provider communication in HIV prevention, a case-control study was conducted in the Jackson Metropolitan Area (JMA) of Mississippi, an area with recent increases in HIV diagnoses among AAMSM.

Methods: From February-April 2008, 29 HIV-infected AAMSM (cases) and 90 HIV-uninfected AAMSM (controls) were surveyed about risk behaviors for HIV transmission and healthcare utilization. Participants were aged 16-25 years and lived, or were diagnosed with HIV, in JMA during 2006-2008. Cases and controls were asked about behaviors in the year prior to diagnosis and the year prior to interview, respectively. Bivariate analyses were conducted using SAS.

Results: Cases were more likely than controls to report having older male partners (odds ratio [OR]=4.92; 95% confidence interval [CI]=2.01-12.06) and unprotected anal intercourse (OR=3.18; CI=1.3-7.77); they were less likely than controls to have health insurance (OR=0.37; CI=0.15-0.88), primary care providers (OR=0.12; CI=0.04-0.34), have received sexually transmitted disease prevention information from providers (OR=0.21; CI=0.5-0.82), or have discussed sexual behaviors with providers (OR=0.17; CI=0.06-0.54).

Discussion: Our data suggest that, among HIV-infected AAMSM, missed opportunities for HIV/STD education/prevention were likely. Promoting routine preventive care visits, increasing insurance coverage, increasing provider assessment of sexual risk factors through improved training, and fostering client trust for disclosure of risk behaviors are imperative for improved HIV prevention among AAMSM.