HIV Rates in Young Black Gay Men Strikingly Higher Despite Fewer Risk Behaviors

Northwestern University investigators exploring the racial disparity of HIV acquisition found that young black men who have sex with men are 16 times more likely to be infected with HIV than young white gay men.

Perhaps what’s more noteworthy is that young black gay men reported lower rates of sexual risk behaviors, fewer sexual partners, and more lifetime HIV tests, according to the results of a study published in the Journal of Acquired Immune Deficiency Syndromes.

"We have known from prior studies that this paradox exists—black young men who have sex with men engage in fewer risk behaviors but have a much higher rate of HIV diagnosis," senior study author Brian Mustanski, PhD, a professor of medical social sciences at Northwestern University Feinberg School of Medicine and director of the Northwestern Institute for Sexual and Gender Minority Health and Wellbeing, said in a statement. "Our study illuminates how HIV disparities emerge from complex social and sexual networks and inequalities in access to medical care for those who are HIV positive."

The longitudinal cohort study included data from 1015 gay men between the ages of 16 and 29 who live in Chicago, and also factored in psychosocial characteristics, as well as information about social, sexual, and drug use behaviors.

According to the data, young black gay men had a higher prevalence of HIV (32%) and rectal sexually tansmitted infections (26.5%), but the lowest number of sexual partners, more frequent HIV tests, and experienced greater levels of stigma, victimization, and trauma, childhood sexual abuse.

"Overall, young black MSM do not report higher rates of HIV risk behaviors like condomless sex," study coauthor Ethan Morgan, PhD, said in a statement. "But aspects of their social networks align with increased HIV risk. By learning more about young black MSM's social networks, we can better understand what drives such persistent racial disparities in HIV—and close that gap."

US Centers for Disease Control and Prevention reported that gay and bisexual men accounted for 67% of all HIV diagnoses in 2016. Of those, African Americans comprised 38%, followed by Hispanic/Latino men (29%), and whites (28%). The population of HIV-positive black gay men also tends to be younger—75% were between the ages of 13 and 34 in 2016.

Dr. Mustanski and his team believe their results suggest that “network interventions and those addressing social determinants may help reduce the disparity” their study showed.

"Their social and sexual networks are more dense and interconnected, which from an infectious disease standpoint makes infections transmitted more efficiently through the group," Dr. Mustanski said in the statement. "That, coupled with the higher HIV prevalence in the population, means any sexual act has a higher chance of HIV transmission."