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Structural Determinants of Black MSM HIV Testing Coverage (2011-2016).

Barbara Tempalski1, Stephanie Beane2, Hannah L F Cooper2

  • 1Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA. tempalski@ndri.org.

AIDS and Behavior
|March 4, 2020
PubMed
Summary

Black men who have sex with men (BMSM) face the highest burden of HIV/AIDS in the US. Structural factors like community resources and organized support influence HIV testing coverage among BMSM, highlighting the need for targeted prevention strategies.

Keywords:
Black MSMHIV testingPlace researchStructural determinantsTheory of community actionUS Metropolitan Statistical Areas

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Area of Science:

  • Public Health
  • Epidemiology
  • Social Determinants of Health

Background:

  • Black men who have sex with men (BMSM) disproportionately bear the burden of HIV/AIDS in the US.
  • The federal 'Ending the Epidemic' initiative underscores the need for expanded HIV prevention and treatment access.
  • Understanding structural factors influencing HIV testing is crucial for reducing disparities.

Purpose of the Study:

  • To examine structural factors associated with HIV testing coverage among BMSM across US Metropolitan Statistical Areas (MSAs) from 2011-2016.
  • To analyze the relationship between community-level variables and BMSM HIV testing patterns.
  • To inform targeted HIV prevention strategies for BMSM.

Main Methods:

  • Multilevel modeling was used to analyze MSA-specific annual measures of BMSM HIV testing coverage.
  • Variables were assessed based on the Theory of Community Action (need, resource availability, institutional opposition, organized support).
  • Covariates included rates of BMSM living with HIV, employment, heterosexual testing rates, health expenditures, organizational presence, and drug arrest rates.

Main Results:

  • Positive associations were found between BMSM HIV testing coverage and rates of BMSM living with HIV, Black employment, Black heterosexual testing, health expenditures, ACT UP presence, and syringe services.
  • Hard drug arrest rates were inversely associated with BMSM HIV testing coverage.
  • Need, resource availability, organized support, and institutional opposition significantly influenced place-based HIV testing coverage for BMSM.

Conclusions:

  • Structural factors are significant determinants of place-based variations in BMSM HIV testing coverage.
  • Addressing HIV disparities among BMSM requires innovative prevention approaches and a deeper understanding of these structural influences.
  • Targeted interventions are needed to improve HIV testing patterns and reduce risk behaviors in high-need areas for BMSM.