WASHINGTON — Black men who have sex with men from a cross-section of countries in Africa were found to be 15 times more likely to have HIV than general populations and 8.5 times more likely to have HIV than general black populations, according to pooled analysis estimates presented here.
Gregorio A. Millett, MD, of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at CDC, said such disparities are greater in African and Caribbean countries that criminalize same-sex behaviors than in those countries that do not criminalize these behaviors.
The presentation contained data from two meta-analyses. One involved 106,148 black MSM and nearly 600,000 MSM of other races and ethnicities from nearly 200 studies. The other involved 129,976 black MSM in North America and the Caribbean.
“The disparities persisted in the US, where black MSM were 22 times more likely to be HIV positive than other black populations,” Millett said. “The disparities were present in the high-income countries we looked at, also. Black MSM were 72 times more likely to have HIV than the general population in the US, 73 times more likely than the general population in Canada and 111 times more likely than the general population in the United Kingdom.”
Millett said black MSM were engaging in comparable — if not safer — risk behaviors than other populations but still were more likely to be infected.
“This suggests that there are larger factors than individual behaviors that contribute to risk,” he said.
Millett said disparities exist at all levels of the so-called treatment cascade.
“Black MSM are more likely to have undiagnosed infections, more likely to be HIV positive than MSM of other races, less likely to use ART, less likely to have CD4 cell counts less than 200, less likely to adhere to ART and less likely to have HIV suppression,” he said. “Moreover, they are 50% less likely to have access to health insurance, more likely to have an income less than $20,000 and less likely to visit a health care provider.”
The researchers said most studies of black MSM mainly focus on outcomes linked to HIV behavioral risks rather than on prevalence, incidence or undiagnosed infection. However, despite the presence of these factors, black MSM in Africa face 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, according to the results. – by Rob Volansky
Millett GA. #TUSY0706. Presented at: XIX International AIDS Conference; July 22-27, 2012; Washington, D.C.
Millett GA. Lancet. 2012;doi:10.1016/S0140-6736(12)60722-3.
Dr. Millett reports no relevant financial disclosures.