Changes in Disparities in Estimated HIV Incidence Rates Among Black, Hispanic/Latino, and White Men Who Have Sex With Men (MSM) in the United States, 2010–2015

Abstract

Background: During 2008–2015, the estimated annual HIV incidence rate in the United States decreased for each transmission risk category, except for men who have sex with men (MSM). Racial/ethnic disparities exist, with higher incidence rates for Black and Hispanic/Latino MSM. Setting: This analysis examines changes, 2010–2015, in disparities of HIV incidence among Black, Hispanic/Latino and White MSM. Methods: We compared results from the rate ratio, rate difference, weighted and unweighted index of disparity, and population attributable proportion. We calculated incidence rates for MSM using HIV surveillance data and published estimates of the MSM population in the United States. We generated 95% confidence intervals for each measure and used the Z statistic and associated P values to assess statistical significance. Findings: Results from all but one measure, Black-to-White rate difference, indicate that racial/ethnic disparities increased during 2010–2015; not all results were statistically significant. There were statistically significant increases in the Hispanic/Latino-to-White MSM incidence rate ratio (29%, P < 0.05), weighted index of disparity with the rate for White MSM as the referent group (9%, P < 0.05), and the population attributable proportion index (10%, P < 0.05). If racial/ethnic disparities among MSM had been eliminated, a range of 55%–61% decrease in overall MSM HIV incidence would have been achieved during 2010–2015. Conclusions: A large reduction in overall annual HIV incidence among MSM can be achieved by eliminating racial/ethnic disparities among MSM. Removing social and structural causes of racial/ethnic disparities among MSM can be effective in reducing overall annual HIV incidence among MSM.

Racial/Ethnic Disparities in HIV Preexposure Prophylaxis Among Men Who Have Sex with Men — 23 Urban Areas, 2017

“…These findings highlight the need to address racial/ethnic disparities in PrEP awareness, discussions with health care providers, and, importantly, use among MSM. Black and Hispanic MSM currently experience substantially higher HIV incidence than do white MSM ( 2 ). Because PrEP effectively prevents sexual HIV transmission ( 3 ), racial/ethnic disparities in PrEP use might further increase disparities in HIV incidence ( 5 ).…”

“…In 2017, preliminary data show that gay, bisexual, and other men who have sex with men (MSM) accounted for 67% of new diagnoses of human immunodeficiency virus (HIV) infection, that MSM who inject drugs accounted for an additional 3%, and that African American/black (black) and Hispanic/Latino (Hispanic) MSM were disproportionately affected ( 1 ). During 2010–2015, racial/ethnic disparities in HIV incidence increased among MSM; in 2015, rates among black and Hispanic MSM were 10.5 and 4.9 times as high, respectively, as the rate among white MSM (compared with 9.2 and 3.8 times as high, respectively, in 2010) ( 2 ). Increased use of preexposure prophylaxis (PrEP), which reduces the risk for sexual acquisition of HIV infection by approximately 99% when taken daily as prescribed,* would help to reduce these disparities and support the Ending the HIV Epidemic: A Plan for America initiative † ( 3 ).…”

From Epidemiology to Action: The Case for Addressing Social Determinants of Health to End HIV in the Southern United States

“…SDH can explain the disproportionate HIV burden among some of the most at-risk populations. In 2015, African American MSM-who account for approximately 33% of all HIV diagnoses in the South [35] -had an HIV incidence rate that was 10.5 times that of white MSM [49]. Individual-level behaviors cannot explain this disparity because, as shown in a meta-analysis of 174 U.S. studies, African American (vs. white) MSM have lower odds of condomless sex, having multiple sex partners, and recent drug use, behaviors that most commonly promote infection [50].…”

Exploring Changes in Racial/Ethnic Disparities of HIV Diagnosis Rates Under the “Ending the HIV Epidemic: A Plan for America” Initiative

“…We used 4 relative measures of disparity: the rate ratio (the black:white rate ratio and the Hispanic/Latino:white rate ratio), 2 versions of the Index of Disparity, 2 versions of the population-attributable proportion (PAP), and the Gini coefficient. [12][13][14][15][16][17] The Index of Disparity, PAP, and Gini coefficient are composite measures that account for disparities across the 7 racial/ethnic groups that we examined, whereas the rate ratio accounts for disparities between 2 specified racial/ethnic groups. [12][13][14][15][16][17] We also applied 2 versions of the Index of Disparity to determine the absolute racial/ethnic disparity in HIV diagnosis rates: the absolute Index of Disparity and the weighted absolute Index of Disparity.…”

“…[12][13][14][15][16][17] The Index of Disparity, PAP, and Gini coefficient are composite measures that account for disparities across the 7 racial/ethnic groups that we examined, whereas the rate ratio accounts for disparities between 2 specified racial/ethnic groups. [12][13][14][15][16][17] We also applied 2 versions of the Index of Disparity to determine the absolute racial/ethnic disparity in HIV diagnosis rates: the absolute Index of Disparity and the weighted absolute Index of Disparity. [12][13][14][15][16][17] Disparity measures are detailed elsewhere.…”