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High HIV Prevalence and Incidence Observed among African-American Men who have Sex with Men (MSM) in Baltimore: The Behavioral Surveillance Research (BESURE) Study
Frangiscos Sifakis*1, C Flynn2, R Montes De Oca1, M Hilton1, N Tomoyasu2, and D Celentano1
1Johns Hopkins Univ, Bloomberg Sch of Publ Hlth, Baltimore, MD, US and 2Maryland Dept of Hlth and Mental Hygiene, Baltimore, US
Background: We examined HIV prevalence, incidence, and
risk behaviors among MSM in Baltimore,
Maryland.
Methods: BESURE is part of the CDC-funded National HIV Behavioral Surveillance (NHBS)
effort. It is a cross-sectional, community-based study of MSM 18 years or older
who were actively recruited in public venues and reside in the Baltimore metropolitan
area. A questionnaire was administered and blood specimens drawn for HIV
testing between June 2004 and April 2005. HIV incidence was ascertained
using the Serologic Testing Algorithm for Recent HIV Seroconversion
(STARHS) assay.
Results: Of 1,013 men recruited, 891 (88.0%) had
complete survey and HIV testing data.
The study sample included 500 (56.1%) African American, 293 (32.9%)
white, 41 (4.6%) Hispanic, and 57 (6.4%) other/mixed
race/ethnicity participants. Overall HIV
prevalence was 32.3%, but varied by race/ethnicity: 45.6% (n=228) among African
Americans, 10.6% (n=31) among whites, 29.3% (n=12) among Hispanics,
and 29.8% (n=17) among other/mixed race/ethnicity. After adjusting for age,
education, sexual activity during last 12 months, sexual identity, prior HIV
testing, and ever injected drugs in multivariate logistic regression analysis,
African Americans (AOR=9.3; 95%CI:5.8,15.0), Hispanics (AOR=4.0; 95%CI:1.7,9.2),
or other/mixed race (AOR=5.2; 95%CI:2.4,11.2)
participants were significantly more likely to be HIV positive when compared to
white participants. Of 288 HIV positive specimens, 27 were recent
infections and the overall HIV incidence was 9.2 % per year (95% CI: 4.3, 17.4).
HIV incidence was 15.4% per year (95%CI:
8.7, 25.2) among African Americans, 3.2% per year (95%CI:
0.7, 9.1) among whites, 0.0% per year (95%CI:
0.0, 3.7) among Hispanics, and 10.2% per year (95%CI:
4.9, 18.7) among mixed/other race/ethnicity. Among the 228 HIV positive African American men, 83 (36.4%) reported
knowing they were HIV positive, 74 (32.5%) reported previously testing HIV
negative, and 71 (31.1%) reported never before receiving an HIV test.
Conclusions: HIV prevalence (32.3%) and incidence (9.2% per
year) are high among MSM in Baltimore
and of particular concern among African American MSM (45.6% and 15.4% per year,
respectively). Unrecognized infection among African American
MSM remains high (63.4%). HIV prevention
and education in Baltimore
must promote HIV testing and better address the needs of African American MSM.
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