JMIR Publications

ABSTRACT

Background:

The US HIV epidemic is driven by infections in men who have sex with men (MSM) and characterized by profound disparities in HIV prevalence and outcomes for Black Americans. Black MSM living with HIV are reported to have worse care outcomes than other MSM, but the reasons for these health inequities are not clear. We planned a prospective observational cohort study to help understand the reasons for worse HIV care outcomes for Black versus white MSM in Atlanta.

Objective:

Identify individual, dyadic, network, neighborhood and structural factors that explain Black/white disparities in HIV viral suppression for MSM living with HIV in Atlanta.

Methods:

Four hundred MSM (200 Black, 200 white) living with HIV were enrolled in a prospective cohort study with in-person visits and viral suppression assessments at baseline, 12 and 24 months, additional surveys of care and risk behaviors at 3, 6, and 18 months, analysis of care received outside the study through public health reporting, and qualitative interviews for participants who experienced sentinel health events (e.g., loss of viral suppression) during the study. The study is based on Bronfenbrenner’s socioecological theoretical model.

Results:

Four hundred MSM were enrolled between MM YYYY and MM YYYY in Atlanta. Followup was completed in MM YYYY; final study retention was 80% at 12 months.

Conclusions:

Health disparities for Black MSM are hypothesized to be driven by structural racism and barriers to care. Observational studies are important to document and quantify the specific factors within the socioecological framework that account for disparities in viral suppression. In the meantime, it is also critical to push for steps to improve access to care, including Medicaid expansion in Southern states, including Georgia, which have not yet moved to expand Medicaid. Clinical Trial: None