Gregorio Millett

Gregorio Millett
The Foundation For Aids Research, amfAR

MPH

About

99
Publications
37,626
Reads
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7,612
Citations
Citations since 2017
44 Research Items
4444 Citations
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Introduction
Vice President and Director of Public Policy at amfAR. Former CDC senior scientist and Obama White House staffer in the Office of National AIDS Policy. One of the principal authors of President Obama's original National HIV/AIDS Strategy. Interested in the intersection between epidemiology and policy to address health disparities.
Additional affiliations
June 2009 - January 2011
The White House
Position
  • Senior Policy Advisor
January 2001 - December 2012
Education
September 1993 - June 1995
University of North Carolina at Chapel Hill
Field of study
  • Health Behavior

Publications

Publications (99)
Article
Full-text available
Randomized controlled trials and meta-analyses have demonstrated that male circumcision reduces men's risk of contracting human immunodeficiency virus (HIV) infection during heterosexual intercourse. Less is known about whether male circumcision provides protection against HIV infection among men who have sex with men (MSM). To quantitatively summa...
Article
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...
Article
Full-text available
Purpose Given incomplete data reporting by race, we used data on COVID-19 cases and deaths in US counties to describe racial disparities in COVID-19 disease and death and associated determinants. Methods Using publicly available data (accessed April 13, 2020), predictors of COVID-19 cases and deaths were compared between disproportionately (>13%)...
Article
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Emerging epidemiological data suggest that white Americans have a lower risk of acquiring COVID-19. Although many studies have pointed to the role of systemic racism in COVID-19 racial/ethnic disparities, few studies have examined the contribution of racial segregation. Residential segregation is associated with differing health outcomes by race/et...
Article
Full-text available
Introduction: The U.S. Ending the HIV Epidemic (EHE) Initiative was launched nationally in February 2019. With a target of ending the HIV epidemic by 2030, EHE initially scales up effective HIV prevention and care in 57 localities that comprise the greatest proportion of annual HIV diagnoses in the United States (US). However, the EHE effort has be...
Article
Background: Few assessments of associations between structural-level factors and HIV among gay men and other men who have sex with men (MSM) have been conducted, especially in sub-Saharan Africa. Our objective was to examine HIV testing history, HIV status, and stigmas among MSM living in ten countries with heterogeneous legal environments. Metho...
Article
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Background COVID-19 has rapidly emerged as a global public health threat with infections recorded in nearly every country. Responses to COVID-19 have varied in intensity and breadth, but generally have included domestic and international travel limitations, closure of non-essential businesses, and repurposing of health services. While these interve...
Article
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Background The COVID-19 pandemic caused by SARS-CoV-2 has highlighted consistent inequities in incidence, disease severity, and mortality across racial and ethnic minority populations in the United States (US) and beyond. While similar patterns have been observed with previous viral respiratory pathogens, to date, no systematic review has comprehen...
Article
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Introduction: The United States President's Emergency Plan for AIDS Relief (PEPFAR) is a large bilateral funder of the global HIV response whose policy decisions on key populations (KPs) programming determine the shape of the key populations' response in many countries. Understanding the size and relative share of PEPFAR funds going to KPs and the...
Article
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Background HIV services, like many medical services, have been disrupted by the COVID-19 pandemic. However, there are limited data on the impacts of the COVID-19 pandemic on HIV treatment engagement outcomes among transgender (trans) and nonbinary people. This study addresses a pressing knowledge gap and is important in its global scope, its use of...
Article
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Introduction Due to factors associated with structural racism, Black men who have sex with men (MSM) living with HIV are less likely to be virally suppressed compared to white MSM. Most of these data come from clinical cohorts and modifiable reasons for these racial disparities need to be defined in order to intervene on these inequities. Therefore...
Article
With more than 1·2 million people living with HIV in the USA, a complex epidemic across the large and diverse country, and a fragmented health-care system marked by widening health disparities, the US HIV epidemic requires sustained scientific and public health attention. The epidemic has been stubbornly persistent; high incidence densities have be...
Preprint
Full-text available
Background COVID-19 has rapidly emerged as a global public health threat with infections recorded in nearly every country. Responses to COVID-19 have varied in intensity and breadth, but generally have included domestic and international travel limitations, closure of non-essential businesses, and repurposing of health services. While these interve...
Article
Full-text available
Purpose: Experienced homophobia-negative treatment and perceptions that gay, bisexual, and other men who have sex with men (MSM) encounter because of their sexual orientations-may promote HIV infection among MSM. We conducted a rapid review and meta-analysis to examine experienced homophobia in relation to HIV infection risk. Methods: We searched...
Preprint
Full-text available
Background: The COVID-19 pandemic caused by SARS-CoV-2 has highlighted consistent inequities in the risk of infection, severity of disease, or mortality across racial and ethnic minority populations in the United States and beyond. Although novel, SARS-CoV-2 shares commonalities in transmission dynamics with other viral respiratory pathogens where...
Article
San Francisco was the first city in the USA to develop a Getting to Zero HIV elimination strategy. The cause of decreased HIV incidence has been attributed to the use of biomedical prevention methods, such as pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP). These strategies have benefitted White men who have sex with men (MSM), w...
Article
The 2017 expanded Mexico City Policy prohibits non-US-based nongovernmental organizations from receiving US global health assistance if they either perform or refer for abortion services. We study the effects of the expanded policy on implementing partners of US-funded HIV programming by the President's Emergency Plan for AIDS Relief (PEPFAR) via a...
Article
Full-text available
Objectives Ascertain COVID-19 transmission dynamics among Latino communities nationally. Methods We compared predictors of COVID-19 cases and deaths between disproportionally Latino counties (>17.8% Latino population) and all other counties through May 11, 2020. Adjusted Rate Ratios were estimated using COVID-19 cases and deaths via zero-inflated...
Article
Background: The US HIV epidemic is driven by infections in men who have sex with men (MSM) and characterized by profound disparities in HIV prevalence and outcomes for Black Americans. Black MSM living with HIV are reported to have worse care outcomes than other MSM, but the reasons for these health inequities are not clear. We planned a prospecti...
Preprint
BACKGROUND The US HIV epidemic is driven by infections in men who have sex with men and characterized by profound disparities in HIV prevalence and outcomes for Black Americans. Black men who have sex with men living with HIV are reported to have worse care outcomes than other men who have sex with men, but the reasons for these health inequities a...
Preprint
Full-text available
Purpose Given incomplete data reporting by race, we used data on COVID-19 cases and deaths in US counties to describe racial disparities in COVID-19 disease and death and associated determinants. Methods Using publicly available data (accessed April 13, 2020), predictors of COVID-19 cases and deaths were compared between disproportionately (>13%) b...
Article
Full-text available
Black communities in the United States are bearing the brunt of the COVID-19 pandemic and the underlying conditions that exacerbate its negative consequences. Syndemic theory provides a useful framework for understanding how such interacting epidemics to develop under conditions of health and social disparity. Multiple historical and present-day fa...
Article
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Importance Nonmedical prescription opioid use is a pressing public health issue in the United States. Transgender youth, including adolescent girls and young women who were assigned male at birth and currently identify as women, female, transgender women, or another diverse gender identity along the transfeminine gender spectrum, are more likely th...
Article
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Background There has been a heightened emphasis on prioritizing data to inform evidence-based HIV responses, including data focused on both defining the content and scale of HIV programs in response to evidence-based need. Consequently, population size estimation (PSE) studies for key populations have become increasingly common to define the necess...
Article
Internet-based recruitment can be effective in reaching large numbers of geographically diverse individuals. Geosocial sexual networking apps on smartphones have emerged as the modal way in which men who have sex with men (MSM) meet sex partners, and as venues for sexual health research. We report on the performance of three types of ads—text-only,...
Article
In 2019, the HIV pandemic is growing and soon over 40 million people will be living with HIV. Effective population-based approaches to decrease HIV incidence are as relevant as ever given modest reductions observed over the past decade. Treatment as prevention is often heralded as the path to improve HIV outcomes and to reduce HIV incidence. Althou...
Article
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Background Gay, bisexual, and other men who have sex with men continue to bear a large burden of the HIV epidemic in the United States and are among the only populations with increasing incidence in recent years. Objective The Together 5000 (T5K) Study aimed to enroll a US-based, racially diverse sample of HIV-negative men, transmen, and transwome...
Article
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Background UNAIDS estimates global HIV investment needs in low- and middle-income countries (LMICs) at $26 billion per year in 2020. Yet international financing for HIV programs has stagnated amidst despite the increasing number of people requiring and accessing treatment. Despite increased efficiencies in HIV service delivery, evaluating programs...
Article
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Background: The previously-named Mexico City Policy (MCP) - which prohibited non U.S.-based non-governmental organizations (NGOs) from receiving U.S. family planning (FP) funding if they advocated, provided, counseled, or referred clients for abortions, even with non-U.S. funds - was reinstated and expanded in 2017. For the first time, the expande...
Article
Objectives: To assess the impact of the expansion of Medicaid eligibility in the United States on the opioid epidemic, as measured through increased access to opioid analgesic medications and medication-assisted treatment. Methods: Using Medicaid enrollment and reimbursement data from 2011 to 2016 in all states, we evaluated prescribing patterns...
Article
We conducted a randomized controlled trial of a six-session behavioral intervention designed to reduce frequency of condomless sex and numbers of sex partners among recently incarcerated, bisexual Black men. One hundred participants were assigned to the small-group intervention, Men in Life Environments (MILE), and 112 were assigned to the control...
Article
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Background: Gay, bisexual, and other cisgender men who have sex with men (GBMSM) are disproportionately affected by the HIV pandemic. Traditionally, GBMSM have been deemed less relevant in HIV epidemics in low- and middle-income settings where HIV epidemics are more generalized. This is due (in part) to how important population size estimates rega...
Article
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Black men who have sex with men and women (MSMW) are among the populations at highest risk for HIV infection. We describe the evaluation of Project RISE, a six-session individual-level intervention developed for black MSMW using an ecosystems approach. A randomized controlled trial was used to test the effect of the intervention on sexual risk outc...
Article
Full-text available
Black men who have sex with men and women (BMSMW) are at increased HIV risk, but few efficacious interventions meet their unique needs. Three HIV prevention interventions were evaluated with a common protocol. Baseline data were pooled to describe sexual behavior involving transmission risk with male, female, and male-to-female transgender partners...
Article
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Objective: The global fight against HIV/AIDS in Africa has long been a focus of US foreign policy, but this could change if the federal budget for 2018 proposed by the US Office of Management and Budget is adopted. We aim to inform public and Congressional debate around this issue by evaluating the historical and potential future impact of US inve...
Article
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Background National Strategic Plans (NSPs) for HIV have become foundational documents that frame responses to HIV. Both Global Fund and PEPFAR require coordination with NSPs as a component of their operations. Despite the role of NSPs in country planning, no rigorous assessment of NSP targets and performance outcomes exists. We performed a quantita...
Article
Background: In the USA, men who have sex men (MSM) are at high risk for HIV, and black MSM have a substantially higher prevalence of infection than white MSM. We created a simulation model to assess the strength of existing hypotheses and data that account for these disparities. Methods: We built a dynamic, stochastic, agent-based network model...
Article
Providing clean needles through syringe services programs (SSPs) prevents the spread of disease among people who inject drugs (PWID). The recent HIV outbreak in Scott County, Indiana was a wakeup call with particular significance because modeling suggests that Scott County is but one of many counties in the United States highly vulnerable to an HIV...
Article
Full-text available
Purpose: Respondent-driven sampling (RDS) was used to recruit four samples of Black and Latino men who have sex with men (MSM) in three metropolitan areas to measure HIV prevalence and sexual and drug use behaviors. We compared demographic and behavioral risk characteristics of participants across sites, assessed the extent to which the RDS statis...
Article
Black/white disparities in HIV incidence and prevalence among men who have sex with men (MSM) in the United States remain largely unexplained. We examined the impact on HIV prevalence and incidence of interventions that decrease disparities in HIV care. Deciding which interventions have most impact on reducing disparities is critical. Using availab...
Article
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To examine associations of homophobia, racism, and resiliency with differences in prevalent HIV infection in black and white MSM. The Involve[ment]t study is a cohort of black and white MSM aged 18-39 years in Atlanta, GA designed to evaluate individual, dyadic, and community level factors that might explain racial disparities in HIV prevalence. Pa...
Article
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Objectives: We report lessons derived from implementation of the Social Network Strategy (SNS) into existing HIV counseling, testing, and referral services targeting 18- to 64-year-old Black gay, bisexual, and other men who have sex with men (MSM). Methods: The SNS procedures used in this study were adapted from a Centers for Disease Control and...
Article
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Little research has been conducted to examine whether correlates of sexual risk vary by nativity among Latino men who have sex with men (MSM). We used cross sectional data collected from 870 Latino MSM recruited with respondent-driven sampling techniques. For each sub-sample (US-born and foreign-born), we assessed the association between each of th...
Article
Epidemics of HIV in MSM continue to expand in most low, middle and upper income countries in 2013 and rates of new infection have been consistently high among young MSM. Current prevention and treatment strategies are insufficient for this next wave of HIV spread. We conducted a series of comprehensive reviews of HIV prevalence and incidence, risks...
Article
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Black men who have sex with men (MSM) are disproportionately burdened by HIV/AIDS. Despite this burden there has been a shortage of research on HIV interventions for black MSM. This article provides a comprehensive review of the literature on interventions for black MSM to identify effective HIV prevention intervention strategies for black MSM. We...
Article
Full-text available
Gay, bisexual, and other men who have sex with men (MSM) have been disproportionately affected by HIV and AIDS since the beginning of the epidemic in the United States and in many other parts of the world. The HIV epidemic is inextricably tied to other health problems that disproportionately affect gay, bisexual, and other MSM including psychologic...
Article
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In 2006, Millett published a seminal literature review that examined 12 hypotheses to explain the high rates of HIV among black MSM. This paper augments Millett's article by reviewing the recent literature on behavioral, biomedical, structural, social contextual, psychosocial, and social network factors that affect HIV rates among black MSM. We sea...
Article
This reprinted article originally appeared in Cultural Diversity and Ethnic Minority Psychology, 2009, Vol. 15, No. 3, 215–222. (The following abstract of the original article appeared in record 2009-10166-002.) Latino gay men report experiences of racial discrimination within and outside the gay community. This study focused on correlates of racis...
Article
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 homo...
Article
Full-text available
The President's Emergency Plan for AIDS Relief (PEPFAR), which began in 2003, initially responded to the global AIDS epidemic by applying lessons learned in treating the disease in the United States to addressing the emergency abroad. As the program expanded, it evolved to support interventions increasingly tailored to local needs in countries rece...
Article
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We investigated whether the experience of homophobic events increases the odds of engaging in unprotected anal intercourse (UAI) among black men who have sex with men (MSM) and whether social integration level buffered the association. Participants (N = 1,154) reported homophobic events experienced in the past 12 months. Social integration measures...
Conference Paper
In the United States, gay and bisexual men, particularly men who are also racial or ethnicity minorities, shoulder a disproportionate burden of sexually transmitted diseases (STDs) including HIV. Recent CDC HIV surveillance reports found no differences in risk behavior among men who have sex with men who seroconverted. Similar data arise from studi...
Article
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We examined the impact of social discrimination and financial hardship on unprotected anal intercourse with a male sex partner of serodiscordant or unknown HIV status in the past 3 months among 1081 Latino and 1154 Black men who have sex with men (MSM; n = 2235) residing in Los Angeles County, California; New York, New York; and Philadelphia, Penns...
Article
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Gender role conflict may influence condom use among black MSM. We examined relationships between the Gender Role Conflict Scale (GRCS), social/demographic variables and condom use among 456 black MSM. Higher total GRCS scores did not predict unprotected insertive anal intercourse (UIAI) or unprotected receptive anal intercourse (URAI) with men, but...
Article
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We examined the hypothesis that black and Latino men who have sex with men (MSM) who have supportive social relationships with other people are less likely to have unrecognized HIV infection compared with MSM of color who report lower levels of social support. We interviewed 1286 black and Latino MSM without known HIV infection in three metropolita...
Article
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The authors examine whether young black and Latino men who have sex with men (MSM) who have older sex partners are more likely than those who do not have older sex partners to have unrecognised HIV infection. The authors examine whether the association stems from (1) increased sexual risk behaviour with male partners of any age, (2) heightened risk...
Article
To identify demographic, behavioral, and psychological variables associated with being HIV positive unaware among black and Latino men who have sex with men (MSM). Participants recruited in 3 cities completed a computer-assisted interview and were tested for HIV infection (OraSure Technologies, Bethlehem, PA). HIV-positive unaware MSM were compared...
Article
Full-text available
Using cross-sectional data collected from 1081 Latino men who have sex with men (MSM) recruited with respondent-driven sampling (RDS) techniques from Los Angeles and New York, we examined the extent to which Latino MSM reported exposure to social discrimination (i.e., experienced both homophobia and racism, homophobia only, racism only, or neither...
Article
We evaluated several hypotheses for disparities in HIV infection between black and white MSM in the United States, including incarceration, partner HIV status, circumcision, sexual networks, and duration of infectiousness. The 2008 National HIV Behavioral Surveillance System (NHBS), a cross-sectional survey conducted in 21 US cities. MSM were inter...
Article
Human immunodeficiency virus (HIV) disproportionately affects black women. Nearly two-thirds of all female HIV cases reported to the CDC are black, and HIV is the leading cause of death among black women aged 25 to 34 years. The greatest HIV transmission risk among black women is sexual intercourse with a man, although the role of bisexual men is n...
Article
Full-text available
In July 2010, the Obama Administration released a National HIV/AIDS Strategy for the United States to refocus national attention on responding to the domestic HIV epidemic. The goals of the strategy are to reduce HIV incidence; to increase access to care and optimize health outcomes among people living with HIV; and to reduce HIV-related disparitie...
Conference Paper
Issues: Men who have sex with men (MSM) represent almost half of the greater than one million people living with HIV in the US. African American MSM are the most disproportionately impacted subgroup. Improving knowledge of HIV status by increasing HIV testing in areas and among populations with the highest rates of HIV is an important HIV intervent...