Factors Affecting Racial Disparities in Viral Suppression between Black and White MSM Open Access
Moreland, Sarah (Spring 2020)
Abstract
HIV disproportionately impacts men who have sex with men (MSM) in measures of incidence and prevalence. Despite efforts to reduce racial disparities in HIV incidence and prevalence between Black and White MSM, White MSM continue to have a significantly higher prevalence of viral suppression than their Black counterparts. A deeper understanding of the individual, social, and cultural factors contributing to or inhibiting viral suppression is required to improve HIV interventions.
A prospective cohort of 400 Black and white MSM living with HIV were enrolled through time-space venue sampling and various online recruitment methods. Participants completed behavioral surveys at baseline and at 3, 6, 12, 18, and 24-month follow-up visits. Laboratory measures were taken at baseline, 12, and 24 months. Bivariate and multivariate analyses were performed on baseline, 24-month, and longitudinal measures to explore factors contributing to the significant difference in viral suppression between black and white MSM.
Fifty-two percent of participants were black and 48% were white. The median age was 40 years old; most participants were living above the poverty line (71%) had some form of health insurance (71%) and had previously been engaged in HIV care (97%). Black MSM were significantly more likely to have less than a college degree (p=0.005), have measurable amounts of THC in their blood (p<0.0001), have missed antiretroviral therapy in the last 30 days (p<0.0001), and were less likely to be stably housed (p=0.0051), be taking HIV medications (p=0.024), and be engaged in care (p=0.0082). Disparities in health outcomes were attributable to age, substance use, social support and stigma, and housing quality.
Individual, social, and cultural factors contributing to racial disparities in viral suppression at different levels of the HIV care continuum were identified in this study. Understanding the unique needs of subgroups of MSM, including black and young MSM, at each stage will allow interventions to better target these barriers preventing MSM from achieving positive HIV health outcomes.
Table of Contents
Background ……………………………………………………………………………… 1
Methods …………………………….…………………………………………………… 5
Results ………………………………….……………………………………………… 11
Discussion ……………………………………………………………………………… 14
References ……………………………………………………………………………… 22
Tables ...………………………………………………………………...……………… 28
Table 1. Baseline characteristics of cohort of men who have sex with men ………...……... 28
Table 2. Factors associated with viral suppression among men who have sex with men …. 31
Table 3. Characteristics of male partnerships among men who have sex with men ………. 35
Table 4. Longitudinal Measures of Cohort of MSM …………………………...................... 36
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