Understanding HIV disparities by examining trends and partnership characteristics in racial/ethnic and sexual minorities in the United States Open Access

Chapin Bardales, Johanna (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/db78tc04f?locale=en


Racial/ethnic and sexual minorities are disproportionately affected by HIV and AIDS in the United States. National HIV/AIDS strategies seek to reduce HIV disparities, yet limited research has evaluated HIV disparity measures over time. Among men who have sex with men (MSM), sexual networks of partnerships likely facilitate HIV transmission and may contribute to age and race disparities. In this dissertation, we evaluate historical trends in HIV-related racial/ethnic disparities and examine how partner-related factors may be driving age and race disparities for MSM.

In Aim 1, we evaluated trends in US racial/ethnic disparities of new AIDS diagnoses over a 30-year period. Black-White disparity increased at varying magnitudes from 1984 through 2001, narrowed from 2002-2005, then rose again from 2006-2013. Hispanic-White disparity increased from 1984-1997, then declined. For MSM, Black-White and Hispanic-White disparities increased from 2008-2013.

Aim 2 examined trends in partner counts and composition among MSM to assess how partner type may be changing in the context of increasing acceptance of same-sex partnerships. Overall, the total number of male sex partners in the past year increased, while the number of main partners remained stable. We observed a shift from MSM having ≥1 main partners and 0 casual partners to having ≥1 main partners and ≥2 casual partners.

In Aim 3, we simulated the effects of age and partner type on HIV transmission in a dynamic sexual network model of MSM. Approximately 60% of all HIV transmissions arose from casual and one-time partners combined, though main partners still accounted for 40%. This distribution by partner type did not differ by age.

In this dissertation, we found that HIV-related racial/ethnic disparities increased in recent years, particularly for MSM. Among MSM, the increases in casual partnerships and shift towards having both main and casual partnerships suggest that sexual partnering patterns conducive to HIV transmission, such as concurrency, may be increasing for MSM and possibly contributing to increases in HIV incidence or disparity trends. As casual partnerships accounted for most HIV transmissions across ages of MSM and casual partnering may be recently increasing, MSM with casual partnerships remain a high-leverage target for HIV prevention interventions.

Table of Contents


CHAPTER 1: Background and Significance                                                         1

1.1 HIV Prevalence and Incidence in the United States                                      1

1.2 HIV in Racial/Ethnic Minorities                                                                   1

1.3 HIV in Men Who Have Sex With Men (MSM)                                                4

1.4 Role of Partnerships in Understanding HIV Transmission in MSM                   12

1.5 Current Gaps in Knowledge and Objectives for Dissertation Studies              21

1.6 Specific Aims and Data Sources for Dissertation Studies                              26

1.7 Structure of this Dissertation                                                                     28


CHAPTER 2: Trends in racial/ethnic disparities in new AIDS diagnoses          43

in the United States, 1984-2013


CHAPTER 3: Trends in number and composition of sex partners among          70

men who have sex with men in the United States, National HIV Behavioral

Surveillance, 2008-2014


CHAPTER 4: Distribution of HIV transmissions by age, partner type, and       101

clinical factors among men who have sex with men in the United States


CHAPTER 5: Conclusions and future directions                                                  131


APPENDIX: Supplementary Technical Appendix for Chapter 4                         153


About this Dissertation

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
  • English
Research Field
Committee Chair / Thesis Advisor
Committee Members
Last modified

Primary PDF

Supplemental Files