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. 2014 Dec;1(3):e112-e118.
doi: 10.1016/S2352-3018(14)00011-3.

Understanding the HIV disparities between black and white men who have sex with men in the USA using the HIV care continuum: a modeling study

Eli S Rosenberg  1 , Gregorio A Millett  1 , Patrick S Sullivan  1 , Carlos Del Rio  1 , James W Curran  1
Affiliations

Understanding the HIV disparities between black and white men who have sex with men in the USA using the HIV care continuum: a modeling study

Eli S Rosenberg et al. Lancet HIV. 2014 Dec.

Abstract

Background: 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.

Methods: Using available US Centers for Disease Control and Prevention (CDC) estimates, we constructed HIV care continua for black and white MSM for 2009-2010. These estimates were used as parameters in a deterministic model to yield estimated race-specific transmissions, transmission rates, incidence rates, and rate-ratios (RR). We examined the impact of changes in the care continuum for black MSM on transmission and incidence rates.

Findings: Marked disparities were found throughout the care continuum: ultimately, 16% of black and 34% of white MSM achieved viral suppression. Based on these care continua, 9,833 and 9,710 new HIV transmissions were estimated annually respectively from HIV-positive black and white MSM (transmission RR=1·36 and incidence RR=7·92). In a model where black and white MSM have identical care outcomes, transmission RR=1·00 and incidence RR=5·80. Scenarios of 95% diagnosis, 95% retention, and concurrent 95% diagnosis and 95% retention respectively yield transmission RR=1·00, 1·02, 0·56, and incidence RR=5·81, 5·93, 3·28.

Interpretation: Disparities in HIV transmission rates may be reduced by improving the HIV care continuum outcomes, but existing racial disparities in HIV prevalence will likely continue to drive higher incidence among black MSM for decades to come.

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Figures

Figure 1
Figure 1. Estimated HIV care continuum for black and white MSM in the United States, 2009/2010
Bold numbers above bars represent the estimated total MSM of each race attaining steps of care, white percentages within bars represents the estimated percentage of MSM of each race attaining steps of care, and black percentages within arrows represent the percentage of MSM of each race percent attaining a given step of care, conditional on attaining the previous step.
Figure 2
Figure 2. Illustration of estimated HIV transmission and incidence, using the observed HIV care continuum
White and black MSM have similar numbers of new HIV infections, but black MSM have a smaller total population and greater proportion of prevalent HIV-positive men, resulting in incidence disparities. All representations of area in the boxes are proportionally scaled to the corresponding group sizes. This illustration assumes a scenario of 100% racial concordance in HIV serodiscordant relationships; 5 alternative scenarios are described in the Appendix, Tables 2-3.
See this image and copyright information in PMC

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