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Cited by 62HIV/AIDS Research and InterventionsHIV, Drug Use, Sexual RiskHIV Research and Treatment

Understanding disparities in viral suppression among Black MSM living with HIV in Atlanta Georgia

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Sullivan, Patrick S, Knox, Justin, Jones, Jeb, Taussig, Jennifer, Valentine Graves, Mariah, Millett, Greg, Luisi, Nicole, Hall, Eric +5 more·2021·Journal of the International AIDS Society
DOI 10.1002/jia2.25689PMC PMC8022103
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Abstract

Introduction: Due to factors associated with structural racism, Black men who have sex with men (MSM) living with HIV are less likely to be virally suppressed compared to white MSM. Most of these data come from clinical cohorts and modifiable reasons for these racial disparities need to be defined in order to intervene on these inequities. Therefore, we examined factors associated with racial disparities in baseline viral suppression in a community‐based cohort of Black and white MSM living with HIV in Atlanta, GA. Methods: We conducted an observational cohort of Black and white MSM living with HIV infection in Atlanta. Enrolment occurred from June 2016 to June 2017 and men were followed for 24 months; laboratory and behavioural survey data were collected at 12 and 24 months after enrolment. Explanatory factors for racial disparities in viral suppression included sociodemographics and psychosocial variables. Poisson regression models with robust error variance were used to estimate prevalence ratios (PR) for Black/white differences in viral suppression. Factors that diminished the PR for race by ≥5% were considered to meaningfully attenuate the racial disparity and were included in a multivariable model. Results: Overall, 26% (104/398) of participants were not virally suppressed at baseline. Lack of viral suppression was significantly more prevalent among Black MSM (33%; 69/206) than white MSM (19%; 36/192) (crude Prevalence Ratio (PR) = 1.6; 95% CI: 1.1 to 2.5). The age‐adjusted Black/white PR was diminished by controlling for: ART coverage (12% decrease), housing stability (7%), higher income (6%) and marijuana use (6%). In a multivariable model, these factors cumulatively mitigated the PR for race by 21% (adjusted PR = 1.1 [95% CI: 0.8 to 1.6]). Conclusions: Relative to white MSM, Black MSM living with HIV in Atlanta were less likely to be virally suppressed. This disparity was explained by several factors, many of which should be targeted for structural, policy and individual‐level interventions to reduce racial disparities.

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Authors
Sullivan, P. S., Knox, J., Jones, J., Taussig, J., Valentine Graves, M., Millett, G., Luisi, N., Hall, E., Sanchez, T. H., Del Rio, C., Kelley, C., Rosenberg, E. S., & Guest, J. L.
Affiliations
  • Emory University (US)
  • Columbia University (US)
  • Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA USA
  • American Foundation for AIDS Research Washington DC USA
  • Department of Medicine School of Medicine Emory University Atlanta GA USA
  • University at Albany, State University of New York (US)
Corresponding author
Sullivan, Patrick S
ORCID
Venue
Journal of the International AIDS Society
Publisher
Wiley
Published
2021-04
Volume
24
Issue
4
Pages
e25689-e25689
ISSN
1758-2652 (ISSN-L)
DOI
10.1002/jia2.25689
PMC
PMC8022103
OpenAlex
W3148142698
Cited by
62
References
9
Citations by year
2026: 4 · 2025: 15 · 2024: 13 · 2023: 10 · 2022: 6 · 2021: 6 · 2017: 2
FWCI
2.77
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the International AIDS Society (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
National Institute of Allergy and Infectious Diseases (P30AI050409, R01AI112723, T32DA031099)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
  • Life Sciences › Immunology and Microbiology › Virology › HIV Research and Treatment
Keywords
HIV, Black men who have sex with men, racial disparities, viral suppression, structural racism, antiretroviral therapy coverage, housing stability, income, cannabis use, Atlanta, community-based cohort
MeSH terms
Adolescent, Adult, Black or African American, Georgia, Humans, Male, Middle Aged, Residence Characteristics, Cohort Studies, HIV Infections, Homosexuality, Male, Viral Load, Black People, White People, Health Status Disparities, Healthcare Disparities, Young Adult

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