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)
Published
Abstract
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
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