Individual and Network Factors Associated With Racial Disparities in HIV Among Young Men Who Have Sex With Men: Results From the RADAR Cohort Study
Individual and Network Factors Associated With Racial Disparities in HIV Among Young Men Who Have Sex With Men: Results From the RADAR Cohort Study
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DOI：
10.1097/qai.0000000000001886
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发表时间：
2019-01-01
影响因子：
3.6
通讯作者：
Newcomb, Michael E.
中科院分区：
文献类型：
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作者：
Mustanski, Brian;Morgan, Ethan;Newcomb, Michael E.
背景：个体性风险行为不能解释观察到的HIV感染的种族差异。为了增加对差异的潜在驱动因素的理解，我们评估了个体，网络和社会determinations.Methods的差异：数据来自RADAR（N = 1015），一个纵向队列研究的多层次的艾滋病风险因素之间的年轻男性发生性行为的男性（YMSM）年龄在16-29岁的芝加哥，IL。数据收集包括生物标本;网络数据，包括关于社会、性和药物使用网络的详细信息;以及YMSM的社会心理特征。（24.8%）和西班牙裔YMSM（30.0%），黑人YMSM（33.9%）的艾滋病毒感染率和（32%; P < 0.001）和直肠性传播感染（26.5%; P = 0.011），在暴露前预防使用方面没有观察到差异。与所有其他YMSM相比，黑人YMSM报告了较低的性风险行为率和更多的终身HIV检测（P < 0.001）;然而，他们也显着不太可能实现病毒抑制（P = 0.01）。黑人YMSM报告大麻使用率最高（P = 0.03），以及更高水平的耻辱（P < 0.001），受害（P = 0.04），创伤（P < 0.001）和儿童性虐待（P < 0.001）。白色YMSM报告抑郁（P < 0.001）和饮酒（P < 0.001）的发生率较高。在网络分析中，网络特征之间存在显著差异，黑人YMSM具有最低的传递性（P = 0.002），最高的密度（P < 0.001）和最高的同质性（P < 0.001）。结论：黑人YMSM没有报告更高的HIV风险行为率，但社会和网络决定因素与增加的HIV风险一致。这些结果表明，网络干预措施和那些解决社会决定因素可能有助于减少差距。
Background: Individual sexual risk behaviors have failed to explain the observed racial disparity in HIV acquisition. To increase understanding of potential drivers in disparities, we assessed differences across individual, network, and social determinants.Methods: Data come from RADAR (N = 1015), a longitudinal cohort study of multilevel HIV-risk factors among young men who have sex with men (YMSM) aged 16-29 years in Chicago, IL. Data collection includes biological specimens; network data, including detailed information about social, sexual, and drug-use networks; and psychosocial characteristics of YMSM.Results: Compared to white YMSM (24.8%) and Hispanic YMSM (30.0%), black YMSM (33.9%) had a higher prevalence of both HIV (32%; P < 0.001) and rectal sexually transmitted infections (26.5%; P = 0.011) with no observed differences in pre-exposure prophylaxis use. Black YMSM reported lower rates of sexual risk behaviors and more lifetime HIV tests (P < 0.001) compared with all other YMSM; however, they were also significantly less likely to achieve viral suppression (P = 0.01). Black YMSM reported the highest rate of cannabis use (P = 0.03) as well as greater levels of stigma (P < 0.001), victimization (P = 0.04), trauma (P < 0.001), and childhood sexual abuse (P < 0.001). White YMSM reported higher rates of depression (P < 0.001) and alcohol use (P < 0.001). In network analyses, significant differences existed across network characteristics with black YMSM having the lowest transitivity (P = 0.002), the highest density (P < 0.001), and the highest homophily (P < 0.001).Conclusions: Black YMSM do not report higher rates of HIV-risk behaviors, but social and network determinants are aligned toward increased HIV risk. These results suggest that network interventions and those addressing social determinants may help reduce disparities.