Explaining the racial disparities in HIV prevalence and unrecognized infection among men who have sex with men (MSM) in Chicago

Background and Methods: The Chicago Department of Public Health, as part of the CDC National HIV Behavioral Surveillance system (NHBS), conducted a survey with 570 men who have sex with men (MSM) during 2008. The survey aimed to describe HIV prevalence, sex and drug behaviors and HIV prevention utilization among MSM in Chicago. Venue-based, time-space sampling was used to recruit MSM from Chicagoland venues where MSM congregate.

Results: 91 of 524 (17.4%) MSM tested HIV-positive at the time of the survey. HIV prevalence among Black MSM (30.1%) was nearly three times the rate of White (11.4%) and Hispanic MSM (12.0%). Despite this observed disparity in HIV prevalence, individual-level sex and drug use behaviors (numbers of sex partners, condom use, knowledge of partner status, etc.) did not differ significantly by race/ethnicity. 66% of Black MSM who tested positive at the time of the survey were unaware of their HIV infection, compared to 23% of White and 50% of Latino MSM. However, frequency of HIV testing in the prior 2 years did not significantly differ between groups.

Conclusions: HIV prevalence rates remain high across MSM racial/ethnic groups in Chicago. Continued focus on individual-level risk behaviors and routine HIV testing will only have a limited impact on reducing racial disparities in HIV prevalence. Incidence rates among MSM, the background prevalence of HIV among Black Chicagoans, and MSM sexual mixing patterns may be contributing factors to these disparities and need to be addressed by local health departments in their surveillance and prevention efforts.