Investigating increasing numbers of HIV cases in Mississippi: A multifaceted approach

Background: Epidemiologic investigations that rely on a single method may have substantial limitations in evaluating individual, network, and community dynamics of disease transmission. To investigate an HIV epidemic among young black men who have sex with men (YBMSM) aged 16–25 in Jackson, Mississippi, we used multiple methods.

Methods: During January–April 2008, we conducted (1) a chart review of 121 black men aged 13–31 with a recent diagnosis of HIV infection; (2) a rapid qualitative assessment (interviews with 25 community members); (3) a case-control study of 29 HIV-positive and 90 HIV-negative YBMSM; (4) a network analysis of 23 HIV-positive YBMSM; (5) an in-depth qualitative assessment of 7 HIV-positive and 9 HIV-negative YBMSM; and (6) a phylogenetic analysis of HIV strains from 500 persons in Mississippi with a recent diagnosis.

Results: Using multiple approaches allowed us to verify and supplement data (e.g., partner selection, travel, sexuality-related stigma) from separate sources. For example, during the rapid qualitative assessment, some community members stated that YBMSM often have older partners. The case-control study revealed that HIV-positive YBMSM were more likely than HIV-negative YBMSM to have older partners (p = 0.0003). The network analysis showed that HIV-positive YBMSM, in the year before HIV diagnosis, had male partners that were, on average, 1.6 years older. Finally, phylogenetic analysis will identify clusters of genetically related infections among persons of differing ages.

Discussion: Using diverse methods can provide corroborating or complementary information about community beliefs, risk factors for HIV infection, and networks associated with disease transmission.