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Racial disparities observed with HIV transmission potential of MSM
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Among men who have sex with men, the risk of encountering a partner with HIV transmission potential is higher among black men than white men, data from a recent study suggest.
Presenting at the XIX International AIDS conference, Eli Rosenberg, a PhD student at Emory University Rollins School of Public Health, said although black MSM report similar or lesser levels of risk behaviors compared with white MSM, the prevalence of HIV is significantly higher among black MSM.
“In order to properly understand this, we need to shift our focus from standards set at the community level to standards that consider the individual perspective, specifically an individual’s risk of having unprotected sex,” Rosenberg said during his presentation. “In order for them to be at risk, they must encounter somebody who is HIV positive who has a level of unsuppressed infection that would permit transmission.”
According to Rosenberg, a new measure, dubbed the transmission potential prevalence (TPP), represents the proportion of those in the population with a viral load sufficient for the transmission of HIV. This includes those who have a viral load of more than 400 copies/mL. Rosenberg and colleagues sought out to determine the TPP among the black and white communities of Atlanta.
They used data from an HIV incidence cohort study of sexually active MSM aged 18 to 40 years in Atlanta. All participants underwent HIV testing at baseline, and if they were HIV positive, they underwent viral load testing. All participants took a partnership level behavior questionnaire. As of June, there were 790 men enrolled.
Although black men reported fewer partners than average, the HIV prevalence was substantially higher: 42% compared with 14% among white men. When looking at all of the participants in the community, 25% of black men were both HIV positive and had a viral load of more than 400 copies/mL vs. 8% of white participants.
They used this TPP data and partner selection patterns to calculate the probability that an HIV-negative black or white man might encounter a potentially transmitting partner for unprotected anal intercourse. For both black and white MSM, the average number of partners was two. However, among black MSM, there was a 39% chance that at least one partner has HIV transmission potential vs. 18% of white MSM. To reach a 50% risk, black MSM must have three partners and white MSM must have seven partners.
“Despite the fact that we see similar community and population viral loads, there are still substantial racial differences in the transmission potential prevalence and the associated exposure risk for HIV-negative men living in this community,” Rosenberg said. “We recommend that HIV surveillance systems be adapted through the incorporation of viral measures to be able to measure TPP and understand transmission risks.”
References:
Rosenberg E. #MOAC0101. Presented at: XIX International AIDS Conference; July 22-27, 2012; Washington, D.C.
Disclosures:
Mr. Rosenberg reports no relevant financial disclosures.