Millett GA, Flores SA, Peterson JL, Bakeman R. Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors

Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
AIDS (Impact Factor: 5.55). 11/2007; 21(15):2083-91. DOI: 10.1097/QAD.0b013e3282e9a64b
Source: PubMed


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.

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Available from: Gregorio Millett
    • "anal intercourse), and it centres behaviour over identity in the calculation of HIV risk. However, as research among Black MSM has demonstrated, social consequences of oppressed identities may be more significant drivers of HIV disparities than traditional risk behaviours (Millett, Flores, Peterson, & Bakeman, 2007;Peterson et al., 2014). Other scholars have eloquently described how the use of behavioural labels in public health discourse about sexual minorities may undermine self-determined identities, obscure social meanings, and tell us very little about actual sexual practices (Young & Meyer, 2005). "
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    ABSTRACT: Historically, HIV studies have conflated men who have sex with men (MSM) with transgender (trans) women, explicitly excluded trans individuals, or included sample sizes of trans people that are too small to reach meaningful conclusions. Despite the heavy burden of HIV among trans women, conflation of this population with MSM has limited the information available on the social and behavioural factors that increase HIV vulnerability among trans women and how these factors may differ from MSM. Using data sets from quantitative studies among MSM (n = 645) and trans women (n = 89), as well as qualitative in-depth interviews with 30 trans women in Baltimore, we explore what these data tell us about similarities and differences in HIV vulnerability between the two groups and where they leave gaps in our understanding. We conclude with implications for data collection and intervention development.
    No preview · Article · Jan 2016 · Global Public Health
    • "To date, relatively little research has been done to characterize marijuana use among BMSM and little to examine the relationship between disaggregated marijuana use, either in general or within the context of sex, and sexual behaviors that are associated with HIV serostatus. In this study, we find results consistent with those previously reported by Millet et al. (2007) in that drug use is not related to HIV serostatus. However, we did find that marijuana use both in general and in the context of sex are related to increased participation in risk behaviors; we also found a number of other interesting findings. "
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    ABSTRACT: Black men who have sex with men (BMSM) are highest risk for HIV seroconversion in the United States. Little attention has been paid to marijuana use among BMSM and potential for HIV risk. A sample of 202 BMSM was generated through respondent driven sampling. The relationship between differential marijuana use and both HIV risk behavior and social network factors were examined using weighted logistic regression. Of the BMSM in this sample 60.4 % use marijuana in general and 20.8 % use marijuana as sex-drug. General marijuana use was significantly associated with participation in group sex (AOR 3.50; 95 % CI 1.10-11.10) while marijuana use as a sex drug was significantly associated with both participation in condomless sex (AOR 2.86; 95% CI 1.07-7.67) and group sex (AOR 3.39; 95% CI 1.03-11.22). Respondents with a moderate or high perception of network members who use marijuana were more likely to use marijuana both in general and as a sex-drug. Network member marijuana use, while not associated with risk behaviors, is associated with individual marijuana use and individual marijuana use in the context of sex is associated with risk practices. Targeting interventions towards individuals and their respective networks that use marijuana as a sex drug may reduce HIV risk.
    No preview · Article · Sep 2015 · AIDS and Behavior
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    • "The Involvement study was developed on a theoretical platform of ecological theory; we conceptualized possible exposures at the individual, dyadic, and neighborhood levels [3]. We found, as others have [7] [19] [20], that individual-level risk behaviors such as UAI were associated with risk of HIV acquisition, but did not explain the disparities in HIV acquisition between black and white men. At the dyadic level, characteristics of the " partner pool " dthat is, the extent to which men reported partners from groups like older men and "

    Full-text · Dataset · Sep 2015
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