HIV AIDS remains a major health crisis among African American men who have sex with men (AA MSM). In a recent large-scale HIV seroprevalence survey, prevalence rates were highest among AA MSM (28%), compared to 16% among MSM of all other ethnicities. This is a health disparity that has been replicated in many different studies since the start of the AIDS epidemic. Given the scale of the HIV epidemic among AA MSM, we cannot prevent the ongoing spread of HIV in the United States until we find ways to field effective HIV prevention programs for AA MSM. Combination prevention approaches to HIV/AIDS offer considerable promise to achieve this goal by addressing some of the high risk contexts that increase transmission risk among AA MSM. However, our ability to design effective combination prevention approaches to lower HIV transmission risk among AA MSM depends on achieving a clear epidemiological understanding of both barriers and facilitators to HIV testing, receiving reactive test results for men who are HIV positive and timel access to medical care if HIV positive. Unfortunately, our ability to explain HIV testing and health care access behaviors among AA MSM is currently limited due to the difficulties of recruiting sufficiently large samples of AA MSM who are delaying access to HIV prevention and care services. These shortcomings hamper our ability to draw effective conclusions about targeted prevention efforts for AA MSM, including most fundamentally an informed evidence base upon which combination prevention strategies must be built. Syndemics theory, which examines the effects and interactions among multiple psychosocial health conditions (i.e. substance abuse, depression, violence victimization) associated with increased risks within marginalized and vulnerable populations provides an important theoretical framework to examining these behaviors, especially since it encompasses both vulnerabilities and resiliencies in high risk populations. This application proposes to address this situation by collecting data from a large scale sample of AA MSM (N=6000) to: 1. Measure the prevalence and identify syndemic associations of uptake of HIV testing among AA MSM 2. Measure the prevalence and identify syndemic associations of unknown HIV seropositivity among AA MSM 3. Measure the prevalence and identify syndemic associations of timely access to care among HIV+ AA MSM By partnering with well-established community groups to recruit large samples of vulnerable men, we will be in a position to characterize the barriers and facilitators to the essential buildig blocks of combination prevention approaches and so provide crucial information for developing effective programs to lower HIV transmission among AA MSM.

Public Health Relevance

HIV AIDS is a major health crisis among African American men who have sex with men (AA MSM). Our ability to design effective combination prevention approaches to lower HIV transmission risk among AA MSM depends on achieving a clear understanding of barriers and facilitators to HIV testing, receiving reactive test results for men who are HIV positive and timely access to medical care if HIV positive. Unfortunately, our ability to explain HIV testing and health care access behaviors among AA MSM is limited due to the difficulties of recruiting sufficiently large samples of AA MSM who are delaying access to HIV prevention and care services. This application proposes to address this situation by collecting data from a large sample of AA MSM to measure the prevalence of uptake of HIV testing, of unknown HIV seropositivity and of timely access to care among HIV infected AA MSM. This study will allow us to characterize for the first time the barriers and facilitators to HIV preventon and care services among these highly vulnerable men and so provide crucial information for developing effective programs to lower HIV transmission among AA MSM.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR013865-02
Application #
8666822
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Hardy, Lynda R
Project Start
2013-06-01
Project End
2018-03-31
Budget Start
2014-04-01
Budget End
2015-03-31
Support Year
2
Fiscal Year
2014
Total Cost
$619,601
Indirect Cost
$173,643
Name
University of Pittsburgh
Department
Public Health & Prev Medicine
Type
Other Domestic Higher Education
DUNS #
004514360
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
Eaton, Lisa A; Driffin, Daniel D; Smith, Harlan et al. (2015) Black men who have sex with men, sexual risk-taking, and willingness to use rapid home HIV tests. Prev Sci 16:321-9