Disparities in HIV Viral Load Suppression by Race/Ethnicity Among Men Who Have Sex with Men in the HIV Outpatient Study

Abstract

Maximizing the rates of virologic suppression (VS) among gay, bisexual, and other men who have sex with men (MSM) is essential to limiting HIV morbidity and sexual transmission of HIV in the United States. We analyzed data for MSM of non-Hispanic white (white), non-Hispanic black (black), or Hispanic/Latino race/ethnicity in the HIV Outpatient Study (HOPS) at nine U.S. HIV clinics. VS (HIV RNA <50 copies/ml) was measured closest to January 1, 2015. We modeled factors associated with VS among persons prescribed antiretroviral therapy (ART) for ≥6 months and assessed VS for a subset of participants with behavioral interview data. Among 1,303 MSM studied, 24% were black and 11% were Hispanic/Latino. Fewer black than white or Hispanic/Latino MSM had any documented ART use history (92% vs. 99% and 94%, respectively), and fewer had VS (72% vs. 91% and 81%), p < .001. In analyses of MSM prescribed ART, which adjusted for insurance type, duration of ART use, and CD4⁺ cell count, blacks had lower prevalence of VS than whites [adjusted prevalence ratio (PR) 0.87, confidence interval (95% CI) 0.81-0.93] and Hispanics/Latinos did not (PR 0.95, 95% CI 0.88-1.02). Among 331 MSM with interview data, 6% had no VS, but reported anal sex without a condom with an HIV-uninfected or unknown HIV serostatus male partner in the past 6 months. In this study of HIV-infected MSM, blacks had a significantly lower prevalence of VS than white men. Optimizing HIV care and prevention among all MSM will require addressing underlying risk factors and social determinants of health that contribute to racial/ethnic disparities in HIV outcomes.

Keywords: ART; MSM; disparities; epidemiology; prevention; viral load.

FIG. 1.

Selection of the study population and the subset of participants with ACASI survey data. ACASI, audio computer-assisted self interview; ART, antiretroviral therapy; MSM, men who have sex with men.

FIG. 2.

Percent of MSM by race/ethnicity with plasma viral load <50 copies/ml (viral suppression), 2014–2015 closest to January 1, 2015, the HIV Outpatient Study, USA, 2014–2015 (N = 1,303). VL, viral load.

FIG. 3.

Prevalence of sex acts without a condom among sexually active MSM ACASI participants comparing men with viral suppression (<50 copies/ml) with men with no viral suppression (≥50 copies/ml), the HIV Outpatient Study, USA, 2014–2015 (N = 331).