Charles B. Hicks, MD reviewing Goodreau SM et al. Lancet HIV 2017 Apr 18.

A modeling study suggests that many factors, known and unknown, contribute to the much higher rate of HIV among black versus white MSM.

In Atlanta, Georgia, the estimated HIV prevalence of 46% in black men who have sex with men (MSM) is 3.3-fold higher than in white MSM (13%). Using a dynamic simulation model incorporating race-specific prevention and risk-behavior data, network attributes, and care patterns, investigators sought to identify factors that could account for such a substantial race-based disparity in HIV prevalence.

The model used data from two published studies on HIV disparities between black and white MSM, and an initial simulation determined that race-assortative mixing patterns (in which sexual partners are racially alike) alone could not explain the observed population-level race disparities in HIV incidence among MSM. Low engagement in HIV care and low attainment of viral suppression in black MSM explained a substantial proportion of the observed difference in HIV prevalence, factors that relate in part to poverty and poor access to transportation. Biologic factors also explained a meaningful proportion of the disparity, particularly the frequency of the CCR5Δ32 coreceptor mutation, which confers reduced risk of HIV acquisition and is rare in persons of African descent. The model did not explain the full magnitude of the disparities reported, indicating that other important factors were not accounted for in the model, potentially including differences in rates of sexually transmitted infections and differences in reporting of behavioral factors because of stigma.

CITATION(S):

Goodreau SM et al. Sources of racial disparities in HIV prevalence in men who have sex in men in Atlanta, GA, USA: A modelling study. Lancet HIV 2017 Apr 18; [e-pub]. 

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