Understanding the Human Immunodeficiency Virus (HIV) 'Riskscapes' of Black men who have sex with men (BMSM) in the Southeastern United States (U.S.)

Background: BMSM are disproportionately affected by HIV, especially in the Southeastern U.S. Reports suggest that individual risk behaviors do not fully explain the burden of HIV among BMSM.  Multi-level determinants, including social, physical andmental health factors, create environmental 'riskscapes' that may place Southern BMSM at increased risk, butarenot completely understood.

Methods: We will recruit between 800-1,000 BMSM intwo Southeastern U.S. cities. Participants will complete validated questionnaires, including depression, discrimination and religiosity/spirituality scales, and a residential history, and undergo HIV and STI (sexually transmitted infections) testing, including syphilis and genital and extra-genital gonorrhea and chlamydia screening. A comprehensive linkage to care protocol has been developed.

Results: To date, 115 BMSM aged 18 to 58 years have been enrolled; 68% identified as gay or homosexual and 4% as transgender. Approximately 33% have elevated depressive symptoms (Center for Epidemiologic Studies of Depression score ≥ 16), 20% report experiences of discrimination on a day-to-day basis, and the majority (62%) report moderate-to-high levels of religiosity/spirituality. Nearly 20% were previously diagnosed with HIV and 2% were newly diagnosed. STI prevalence estimates range from 2.1% (urethral gonorrhea) to 19% (rectal Chlamydia). Participants with reactive HIVand/or positive STI tests have been linked to care and treatment.

Conclusions: The HIV and STI diagnoses suggest unprotected sex among the men in our study.  Examining these data in relation to multi-level determinants may increase our understanding of non-sex behavior factors that may contribute to excess HIV risk in BMSM in the southeast and better inform HIVpolicy and prevention efforts.