[show abstract][hide abstract] ABSTRACT: We did a meta-analysis to assess factors associated with disparities in HIV infection in black men who have sex with men (MSM) in Canada, the UK, and the USA.
We searched Embase, Medline, Google Scholar, and online conference proceedings from Jan 1, 1981, to Dec 31, 2011, for racial comparative studies with quantitative outcomes associated with HIV risk or HIV infection. Key words and Medical Subject Headings (US National Library of Medicine) relevant to race were cross-referenced with citations pertinent to homosexuality in Canada, the UK, and the USA. Data were aggregated across studies for every outcome of interest to estimate overall effect sizes, which were converted into summary ORs for 106,148 black MSM relative to 581,577 other MSM.
We analysed seven studies from Canada, 13 from the UK, and 174 from the USA. In every country, black MSM were as likely to engage similarly in serodiscordant unprotected sex as other MSM. Black MSM in Canada and the USA were less likely than other MSM to have a history of substance use (odds ratio, OR, 0·53, 95% CI 0·38-0·75, for Canada and 0·67, 0·50-0·92, for the USA). Black MSM in the UK (1·86, 1·58-2·18) and the USA (3·00, 2·06-4·40) were more likely to be HIV positive than were other MSM, but HIV-positive black MSM in each country were less likely (22% in the UK and 60% in the USA) to initiate combination antiretroviral therapy (cART) than other HIV-positive MSM. US HIV-positive black MSM were also less likely to have health insurance, have a high CD4 count, adhere to cART, or be virally suppressed than were other US HIV-positive MSM. Notably, despite a two-fold greater odds of having any structural barrier that increases HIV risk (eg, unemployment, low income, previous incarceration, or less education) compared with other US MSM, US black MSM were more likely to report any preventive behaviour against HIV infection (1·39, 1·23-1·57). For outcomes associated with HIV infection, disparities were greatest for US black MSM versus other MSM for structural barriers, sex partner demographics (eg, age, race), and HIV care outcomes, whereas disparities were least for sexual risk outcomes.
Similar racial disparities in HIV and sexually transmitted infections and cART initiation are seen in MSM in the UK and the USA. Elimination of disparities in HIV infection in black MSM cannot be accomplished without addressing structural barriers or differences in HIV clinical care access and outcomes.
The Lancet 07/2012; 380(9839):341-8. · 39.06 Impact Factor
[show abstract][hide abstract] ABSTRACT: Pooled estimates from across the African diaspora show that black men who have sex with men (MSM) are 15 times more likely to be HIV positive compared with general populations and 8·5 times more likely compared with black populations. Disparities in the prevalence of HIV infection are greater in African and Caribbean countries that criminalise homosexual activity than in those that do not criminalise such behaviour. With the exception of US and African epidemiological studies, most studies of black MSM mainly focus on outcomes associated with HIV behavioural risk rather than on prevalence, incidence, or undiagnosed infection. Nevertheless, black MSM across the African diaspora share common experiences such as discrimination, cultural norms valuing masculinity, concerns about confidentiality during HIV testing or treatment, low access to HIV drugs, threats of violence or incarceration, and few targeted HIV prevention resources.
The Lancet 07/2012; 380(9839):411-23. · 39.06 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study sought to identify the magnitude of HIV risk in a diverse sample of Men who use the Internet to seek Sex with Men
(MISM), and test if specific subpopulations are at sufficiently increased risk to warrant tailored interventions. A sample
of 2,716 American MISM, stratified by race/ethnicity, completed an Internet survey of online and offline sex seeking behavior
during the last 3months. Across most demographics, a minority of MISM reported unprotected anal intercourse with male partners
(UAIMP). Across all demographics, risk of UAIMP substantially increased with partners met online. Other predictors of increased
online partner risk include being 30–39years old, having children, not living in the Northeast, and low income. HIV-positive
men and African Americans reported increased online and offline partner risk. To address higher risk of UAIMP, online HIV
interventions should prioritize the needs of MISM, especially HIV-positive men, with content focused on online-mediated liaisons.
AIDS and Behavior 04/2012; 13(3):488-498. · 3.49 Impact Factor
[show abstract][hide abstract] ABSTRACT: The association between HIV treatment optimism--beliefs about susceptibility to transmit HIV, motivation to use condoms, and severity of HIV--and sexual risk behavior was examined among HIV-positive African American men who have sex with men (MSM). Participants were 174 men recruited in four major metropolitan areas of the United States to participate in a weekend HIV risk reduction intervention. Baseline results revealed that beliefs in less susceptibility to transmit HIV and less motivation to use condoms were significantly associated with more unprotected anal intercourse among serodiscordant casual partners. Less motivation to use condoms also predicted more unprotected insertive and receptive anal sex and was more important than susceptibility beliefs in predicting these behaviors. Suggestions are offered of ways to better inform HIV-positive African American MSM about their misperceptions about HIV treatment and how their level of optimism about HIV treatment may diminish or encourage condom use.
AIDS education and prevention: official publication of the International Society for AIDS Education 04/2012; 24(2):91-101. · 1.51 Impact Factor
[show abstract][hide abstract] ABSTRACT: Various metrics for HIV burden and treatment success [e.g. HIV prevalence, community viral load (CVL), population viral load (PVL), percent of HIV-positive persons with undetectable viral load] have important public health limitations for understanding disparities.
Using data from an ongoing HIV incidence cohort of black and white men who have sex with men (MSM), we propose a new metric to measure the prevalence of those at risk of transmitting HIV and illustrate its value. MSM with plasma VL>400 copies/mL were defined as having 'transmission risk'. We calculated HIV prevalence, CVL, PVL, percent of HIV-positive with undetectable viral loads, and prevalence of plasma VL>400 copies/ml (%VL400) for black and white MSM. We used Monte Carlo simulation incorporating data on sexual mixing by race to estimate exposure of black and white HIV-negative MSM to a partner with transmission risk via unprotected anal intercourse (UAI). Of 709 MSM recruited, 42% (168/399) black and 14% (44/310) white MSM tested HIV-positive (p<.0001). No significant differences were seen in CVL, PVL, or percent of HIV positive with undetectable viral loads. The %VL400 was 25% (98/393) for black vs. 8% (25/310) for white MSM (p<.0001). Black MSM with 2 UAI partners were estimated to have 40% probability (95% CI: 35%, 45%) of having ≥1 UAI partner with transmission risk vs. 20% for white MSM (CI: 15%, 24%).
Despite similarities in other metrics, black MSM in our cohort are three times as likely as white MSM to have HIV transmission risk. With comparable risk behaviors, HIV-negative black MSM have a substantially higher likelihood of encountering a UAI partner at risk of transmitting HIV. Our results support increasing HIV testing, linkage to care, and antiretroviral treatment of HIV-positive MSM to reduce prevalence of those with transmission risk, particularly for black MSM.
PLoS ONE 01/2012; 7(12):e53284. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Sexual prejudice and antigay anger were examined as mediators of the associations between traditional male gender norms, religious fundamentalism, and aggression toward gay men and lesbians. Participants were 201 self-identified heterosexual men recruited from the community to complete computer-administered measures of adherence to traditional male gender norms (i.e., status, toughness, antifemininity), religious fundamentalism, sexual prejudice, and frequency of aggression toward gay men and lesbians. Additionally, participants completed a structured interview designed to assess anger in response to a vignette depicting a male-male intimate relationship (i.e., partners saying "I love you," holding hands, kissing). Results showed that sexual prejudice and antigay anger partially mediated the effect of antifemininity on aggression and fully mediated the effect of religious fundamentalism on aggression. Sexual prejudice alone fully mediated the effect of status on aggression and neither sexual prejudice nor antigay anger mediated the effect of toughness on aggression. Further, results suggested that religious fundamentalism is a multifaceted construct of which some aspects increase risk for aggression toward gay men and lesbians, whereas other aspects decrease this risk. These data provide multivariate evidence from a nonprobability, community-based sample that extreme internalization of dominant cultural values can set the stage for violence toward marginalized groups. Implications for intervention programming and future research are reviewed.
Psychology of Men & Masculinity 10/2011; 12(4):383-400. · 2.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study was designed to examine the extent to which masculine gender-role stress, sexual prejudice, and antigay anger collectively facilitate antigay aggression. Participants were 135 heterosexual men who completed a structured interview assessing masculine gender-role stress, sexual prejudice, anger in response to a vignette depicting a non-erotic male–male intimate relationship (i.e., partners holding hands, kissing), and past perpetration of antigay aggression. The results indicate that the association between masculine gender-role stress and antigay aggression is partially mediated by antigay anger among sexually prejudiced men. These findings contribute to theoretical understanding of antigay aggression. Implications for future research and intervention are discussed.
Journal of Applied Social Psychology 05/2011; 41(5):1237 - 1257. · 0.83 Impact Factor
[show abstract][hide abstract] ABSTRACT: OBJECTIVE: Sexual prejudice and masculine gender role stress were examined as mediators of the associations between adherence to different male gender norms and aggression toward sexual minorities. This study also sought to extend past research to a community sample and employ multiple methods to assess aggression. METHOD: Participants were 199 heterosexual men between the ages of 18-30 who were recruited from a large southeastern United States city. Participants completed measures of adherence to male gender role norms, sexual prejudice, masculine gender role stress, and aggression toward sexual minorities. RESULTS: Associations between adherence to the status and antifemininity norms and aggression toward sexual minorities were mediated by sexual prejudice, but not masculine gender role stress. The portion of unique association between adherence to the antifemininity norm and aggression toward sexual minorities was about three times larger than the portion mediated by sexual prejudice and masculine gender role stress. CONCLUSIONS: Findings provide the first multivariate evidence from a community-based sample for determinants of aggression toward sexual minorities motivated by gender role enforcement. These data support intervention programming and preventative intervention studies aimed at reducing sexual prejudice and facilitating less stereotypic attitudes about the male gender role, particularly surrounding the antifemininity norm.
[show abstract][hide abstract] ABSTRACT: This study examines mediation of the association between social norms and unsafe sexual behavior. Self-report data were collected from 675 HIV-infected men enrolled in a study exploring interventions for HIV risk behavior. Unsafe sex included any unprotected anal sex with HIV-negative or HIV status unknown partners in the last three months. Norms for condom use indirectly influenced unsafe sex through condom self-efficacy and/or safer sex intentions. Additionally, sexual behavior discontrol influenced unsafe sex regardless of other individual or social factors. Our results suggest that interventions consider the combined effects of condom self-efficacy, safer sex intentions and sexual behavior control.
Journal of Health Psychology 10/2009; 14(6):761-70. · 1.22 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of the present study was to examine racial differences in women's attitudes toward lesbians and gay men and to offer an understanding of these differences. Participants were 224 18-30 year old heterosexual African American (64%) and White (36%) female undergraduates from a large urban university in the southeastern United States. Participants completed measures of social demographics, sexual orientation, and sexual prejudice. Results showed that African American, relative to White, women endorsed more negative attitudes toward lesbians and gay men. Also, unlike White women, African American women reported more negative attitudes toward gay men than lesbians. Implications are discussed regarding differences in cultural contexts that exist between African American and White women.
Sex Roles 07/2009; 61(9-10):599-606. · 1.47 Impact Factor
[show abstract][hide abstract] ABSTRACT: The HIV/AIDS epidemic has exacted a devastating toll upon Black men who have sex with men (MSM) in the United States, and there is a tremendous need to escalate HIV-prevention efforts for this population. The social context in which Black MSM experience the impact of racism and heterosexism strongly affects their risk for HIV infection; thus, HIV-prevention research focused on Black MSM should focus on contextual and structural factors. There is a pronounced lack of community-level HIV-intervention research for Black MSM, but effective preliminary strategies involve adapting existing effective models and tailoring them to the needs of Black MSM. Future research should develop new, innovative approaches, especially structural interventions, that are specifically targeted toward HIV prevention among Black MSM.
American Journal of Public Health 05/2009; 99(6):976-80. · 3.93 Impact Factor
[show abstract][hide abstract] ABSTRACT: We addressed gaps in current HIV prevention research by examining the differences between 2 groups of young men: men who have sex with men only (MSM/O) and men who have sex with men and women (MSM/W). We examined patterns and correlates of sexual risk, and considered how race/ethnicity may affect these relationships.
Cross-sectional self-report data were collected from a racially diverse sample of 10,295 young MSM from 1999 to 2002. The sample comprised data from 13 urban locations across the US.
MSM/W reported less unprotected anal intercourse (UAI) than MSM/O, despite reporting less exposure to HIV prevention interventions, lower social support, and less awareness of antiretroviral therapies. African American men were more likely to be MSM/W and less likely to report UAI. Ever getting an HIV test was associated with less UAI only among African American participants (MSM/W or MSM/O) in racial/ethnic group-specific analyses.
HIV prevention interventions for MSM should address differences between MSM/W and MSM/O. An important component of HIV prevention efforts designed for African American MSM/W and MSM/O should be HIV testing.
[show abstract][hide abstract] ABSTRACT: The present study examined whether sexual prejudice and masculine gender role stress mediate the effect of male gender role beliefs on anger in response to gay men. Participants were 135 exclusively heterosexual men who completed a structured interview designed to assess endorsement of 3 male gender norms (status, toughness, and antifemininity), sexual prejudice, masculine gender role stress, and anger in response to a vignette depicting a nonerotic male-male intimate relationship (i.e., partners saying "I love you," holding hands, kissing). Results revealed that sexual prejudice fully mediated the association between status and anger (and partially mediated the association between antifemininity and anger) in response to gay men. Moreover, results indicated that masculine gender role stress partially mediated the effect of antifemininity on anger in response to gay men. Overall, these findings suggest that male gender role norms, particularly the antifemininity norm, are strongly associated with anger in response to gay men and that sexual prejudice and masculine gender role stress are important mediators of these associations. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Psychology of Men & Masculinity 06/2008; 9(3):167-178. · 2.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of this study was to examine the role of anger in response to gay men within three theoretical models of antigay aggression. Participants were 135 exclusively heterosexual men who completed a structured interview designed to assess sexual prejudice, anger in response to a vignette depicting a nonerotic male-male intimate relationship (i.e. partners saying "I love you", holding hands, kissing), and past perpetration of antigay aggression. Among identified antigay assailants, motivations for one earlier assault (i.e. sexual prejudice, peer dynamics, thrill seeking) were also assessed. Results indicated that anger fully mediated the relationship between sexual prejudice and antigay aggression, partially mediated the effect of peer dynamics on antigay aggression, and did not account for the relationship between thrill seeking and antigay aggression. These findings indicate that anger in response to gay men facilitates antigay aggression among some, but not all, antigay perpetrators.
[show abstract][hide abstract] ABSTRACT: To identify factors that contribute to the racial disparity in HIV prevalence between black and white men who have sex with men (MSM) in the United States.
A comprehensive literature search of electronic databases, online bibliographies, and publication reference lists yielded 53 quantitative studies of MSM published between 1980 and 2006 that stratified HIV risk behaviors by race. Meta-analyses were performed to compare HIV risks between black and white MSM across studies.
Compared with white MSM, black MSM reported less overall substance use [odds ratio (OR), 0.71; 95% confidence interval (CI), 0.53-0.97], fewer sex partners (OR, 0.64; 95% CI, 0.45-0.92), less gay identity (OR, 0.29; 95% CI, 0.17-0.48), and less disclosure of same sex behavior (OR, 0.42; 95% CI, 0.30-0.60). HIV-positive black MSM were less likely than HIV-positive white MSM to report taking antiretroviral medications (OR, 0.43; 95% CI, 0.30-0.61). Sexually transmitted diseases were significantly greater among black MSM than white MSM (OR, 1.64; 95% CI, 1.07-2.53). There were no statistically significant differences by race in reported unprotected anal intercourse, commercial sex work, sex with a known HIV-positive partner, or HIV testing history.
Behavioral risk factors for HIV infection do not explain elevated HIV rates among black MSM. Continued emphasis on risk behaviors will have only limited impact on the disproportionate rates of HIV infection among black MSM. Future research should focus on the contribution of other factors, such as social networks, to explain racial disparities in HIV infection rates.
AIDS 11/2007; 21(15):2083-91. · 6.41 Impact Factor
[show abstract][hide abstract] ABSTRACT: Surveillance findings consistently indicate that black men who have sex with men (MSM) experience a disproportionate burden of HIV/AIDS compared with white MSM. This study tested the hypothesis that black MSM engage in greater levels of HIV risk behaviors than white MSM and sought to determine if self-reported HIV serostatus moderated any of the observed differences.
A cross-sectional study of MSM was conducted by recruiting men from gay-identified venues in a large metropolitan area of the southern United States. Data were collected by face-to-face interview.
The hypothesis was only supported for one measure of HIV risk behavior: The average number of main (steady) sex partners in the past year was significantly greater among black men (P < 0.0001). However, black and white MSM did not significantly differ in unprotected sex with serodiscordant partners. Racial differences in sexual risk behavior were found only for HIV-negative men and indicated greater protective behavior for black men.
These findings suggest that fewer black MSM, compared with white MSM, engage in HIV sexual risk behaviors but only among HIV-negative men. Identifying the epidemiologic dynamics driving HIV infection among black MSM that go beyond individual-level risk behaviors may be warranted.
Sex Transm Dis 10/2007; 34(10):744-8. · 2.59 Impact Factor
[show abstract][hide abstract] ABSTRACT: We examined the association between perceptions about condom use among one's peers, beliefs about new HIV treatments, and HIV sexual risk behaviour among 849 young African-American men who have sex with men (MSM). Participants were randomly recruited from and anonymously interviewed in community venues in Atlanta, Georgia, USA, in cross-sectional samples between 1999 and 2002. Data analyses indicated that 30% of the sample reported unprotected anal intercourse in the past three months; stronger peer condom norms predicted less-frequent risky sexual behaviour. However, the belief in less threat of HIV because of HIV treatments was not associated with either risky sexual behaviour or peer norms, and peer norms did not mediate the association between HIV treatment beliefs and unprotected anal intercourse. These findings suggest that changing peer norms for condom use may reduce HIV risky sex in African-American MSM, regardless of their beliefs about HIV drug treatments.
International Journal of STD & AIDS 03/2007; 18(2):105-8. · 1.00 Impact Factor
[show abstract][hide abstract] ABSTRACT: HIV rates are disproportionately higher for Black men who have sex with men (MSM) than for other MSM. We reviewed the literature to examine 12 hypotheses that might explain this disparity. We found that high rates of HIV infection for Black MSM were partly attributable to a high prevalence of sexually transmitted diseases that facilitate HIV transmission and to undetected or late diagnosis of HIV infection; they were not attributable to a higher frequency of risky sexual behavior, nongay identity, or sexual nondisclosure, or to reported use of alcohol or illicit substances. Evidence was insufficient to evaluate the remaining hypotheses.Future studies must address these hypotheses to provide additional explanations for the greater prevalence of HIV infection among Black MSM.
American Journal of Public Health 07/2006; 96(6):1007-19. · 3.93 Impact Factor