Background:  Approximately half of the sexually transmitted HIV infections in the US stem from individuals who are unaware of their HIV infection. A higher proportion of black and Latino men who have sex with men (MSM) are HIV⁺ and unaware in the US compared to white MSM, but few studies have identified variables associated with unrecognized HIV infection among MSM in these communities.

Methods:  Over 2200 black and Latino MSM were recruited via chain-referral sampling from three high HIV prevalence metropolitan areas in the US from 2005 to 2006. A computer-assisted interview and a rapid oral fluid HIV antibody test (OraSure Technologies, Bethlehem, PA) were administered to participants. MSM who tested HIV⁺ and were unaware of their status were compared to MSM who tested HIV^– on demographic, psychological, and behavioral variables.

Results:  Of 1214 MSM (600 black and 614 Latino), 12% were HIV⁺ unaware. Black MSM were more likely than Latino MSM to be HIV⁺ unaware (18% vs 5%, respectively; p <0.001).  In multivariable analysis among Latino MSM, being HIV⁺ unaware was associated with non-gay identity, low perceived risk of currently being HIV⁺ or testing HIV⁺ during one’s lifetime, and belief that sex with other Latino men reduces HIV transmission risk. Among black MSM, being HIV⁺ unaware was associated with gay identity, moderately higher income, having health insurance, sexuality disclosure to a current healthcare provider, <3 lifetime HIV tests, low perceived risk of testing HIV⁺, amyl nitrite use during last unprotected sex, and belief that sex with other black men reduces HIV transmission risk.

Conclusions:  Our findings revealed missed opportunities to diagnose men who were HIV⁺ unaware. Even HIV⁺ unaware black MSM who revealed their sexuality to their current healthcare provider failed to be diagnosed with HIV infection. Existing HIV prevention efforts must increase uptake of HIV testing by black MSM and encourage health professionals to offer testing to self-disclosing homosexually active men. Our data also revealed that low perceived susceptibility of HIV infection and assortative sexual mixing beliefs were each associated with unrecognized HIV infection among black and Latino MSM. HIV prevention efforts targeting black and Latino MSM must address perceived risk of HIV infection and imprecise sexual risk reduction beliefs about intra-racial partnerships.