Racial differences in the association between transportation mode and HIV viral suppression among men who have sex with men in Atlanta, Georgia Open Access

Wien, Simone (Spring 2021)

Permanent URL: https://etd.library.emory.edu/concern/etds/3n204048g?locale=en


There is a well-documented disparity in HIV outcomes among Black men who have sex with men (Black MSM) compared to MSM overall. While transportation has been cited as a barrier to HIV care, and that Black MSM face persistent disparities in HIV outcomes, no transportation estimates or associations have been studied for Black MSM. The purpose of this study is to assess the relationship between mode of transportation and HIV viral suppression among Black and white MSM living with HIV in Atlanta, Georgia.

This cross-sectional analysis consisted of Black and white MSM living with HIV. Participants were classified as either using “independent” or “dependent” transportation based on survey results. Viral load was obtained via testing. Participants were excluded if they did not have an HIV provider or listed one outside of Georgia. Logistic regression was performed to assess the association between independent transportation and viral suppression.

Our sample included 170 Black and 175 white MSM. More Black MSM had a detectable viral load (25% vs. 15%) and took a dependent mode of transportation (37% vs. 18%) compared to white MSM. We found a weak positive association between independent transportation mode and viral suppression for Black MSM (cOR 1.18, 95% CI 0.50, 2.24), and a stronger positive association for white MSM (cOR 3.61, 95% CI 1.45, 8.97). For white MSM this association remained but was weaker after controlling for recent HIV diagnosis and income (aOR 2.54, 95% CI 0.85, 7.59).

Our results highlight racial differences in viral suppression and transportation mode used for MSM living with HIV. One explanation for the weaker association for Black MSM this is that barriers to HIV care are greater for Black MSM than white MSM. Limitations include restricting the analysis to participants who had an HIV provider in Georgia, which limits generalizability to MSM currently engaged in care. Interventions to improve viral suppression for Black MSM must address fundamental causes of health inequalities and include more than transportation services. Future studies examining racial and ethnic differences in transportation and viral suppression should explore how this relationship changes in areas with more public transportation infrastructure.

Table of Contents

Introduction 8

Methods 11

Recruitment 11

Inclusion, exclusion criteria 11

Variable collection 12

Results 15

Descriptive statistics 15

Measures of association for HIV viral suppression 16

Discussion 17

Key findings 17

Limitations 18

Interpretation of findings 20

Generalizability 21

Conclusion 21

Figures and Tables 23

Figure 1. Analytic Study Sample 23

Table 1. Demographic Characteristics of MSM enrolled in EngageMENt Study, 2017 24

Table 2. Clinical Outcomes and Transportation to HIV Provider among MSM enrolled in EngageMENt Study, 2017 26

Table 3A. Odds Ratios for HIV Viral Suppression by Mode of Transportation to HIV Provider, Black MSM enrolled in EngageMENt Study, 2017 28

Table 3B. Odds Ratios for HIV Viral Suppression by Mode of Transportation to HIV Provider, White MSM enrolled in EngageMENt Study, 2017 28

References 29

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