Social Context and Human Immunodeficiency Virus (HIV) Risk for Black Men who Have Sex with Men (BMSM) in the Southeastern United States (U.S.), 2014

Background: BMSM are disproportionately affected by HIV, especially in the southeastern U.S. Factors beyond individual-level risk behaviors that may explain variations in MSM populations, including policy barriers, are underexplored.  We examined several factors that may be associated with increased HIV risk for BMSM living in the southeast. 

Methods: We enrolled BMSM in two southeastern cities. Participants completed electronic surveys regarding demographics, social factors, and behaviors and were screened for HIV and other sexually transmitted infections (STI). We report adjusted odds ratios (AOR) and 95% confidence intervals (CI) for the association between being HIV-positive and social, behavioral and clinical variables.

Results:To date, 328 BMSM have been enrolled: median age= 26 years; 69% identified as gay, 26% as bisexual.  HIV prevalence was 41% (n=134), with 37% (n=50) being newly diagnosed at enrollment or within 12 months before enrollment. Among all participants, 240 (73%) reported being circumcised, 125 (38%) had history of incarceration, and 180 (55%) had no healthcare coverage (previous 12 months).  Being HIV-positive was more likely among BMSM who were living at or below poverty (AOR 2.24, 95% CI 1.06-4.87) or who had a history of syphilis (AOR 3.26; 95% CI 1.41-7.58), and was less likely among younger BMSM (18-24 years) versus BMSM ≥ 35 years (AOR 0.12, 95% CI 0.05-0.27) and bisexual men versus gay men (AOR 0.19; 95% CI 0.08-0.45).

Conclusions: These findings suggest that several factors contribute to HIV risk for BMSM in the southeast. HIV interventions and policies that address poverty, healthcare coverage and strengthen routine HIV/STI screenings are warranted.