Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, USA.
PLoS One. 2013 Jul 26;8(7):e70413. doi: 10.1371/journal.pone.0070413. Print 2013.
Black men who have sex with men (MSM) in the United States (US) are affected by HIV at disproportionate rates compared to MSM of other race/ethnicities. Current HIV incidence estimates in this group are needed to appropriately target prevention efforts.
From July 2009 to October 2010, Black MSM reporting unprotected anal intercourse with a man in the past six months were enrolled and followed for one year in six US cities for a feasibility study of a multi-component intervention to reduce HIV infection. HIV incidence based on HIV seroconversion was calculated as number of events/100 person-years. Multivariate proportional hazards modeling with time-dependent covariates was used to identify correlates of HIV acquisition.
Of 1,553 Black MSM enrolled, 1,164 were HIV-uninfected at baseline and included in follow-up. Overall annual HIV incidence was 3.0% (95% confidence interval (CI): 2.0, 4.4%) and 5.9% among men ≤30 years old (95% CI: 3.6, 9.1%). Men ≤30 years old reported significantly higher levels of sexual risk and were more likely to have a sexually transmitted infection diagnosed during follow-up. Younger men also were more likely to not have a usual place for health care, not have visited a health care provider recently, and to have unmet health care needs. In multivariate analysis, age ≤30 years (hazard ratio (HR): 3.4; 95% CI: 1.4, 8.3) and unprotected receptive anal intercourse with HIV-positive or unknown status partners (HR: 4.1; 95% CI: 1.9, 9.1) were significantly associated with HIV acquisition.
In the largest cohort of prospectively-followed Black MSM in the US, HIV incidence was high, particularly among young men. Targeted, tailored and culturally appropriate HIV prevention strategies incorporating behavioral, social and biomedical based interventions are urgently needed to lower these rates.
与其他种族/族裔的男男性接触者（MSM）相比，美国的黑人 MSM 感染 HIV 的比例不成比例。需要当前的 HIV 发病率估计数，以便有针对性地开展预防工作。
2009 年 7 月至 2010 年 10 月，在六个美国城市中招募了报告过去六个月内与男性发生无保护肛交的黑人 MSM，并对其进行了为期一年的随访，以评估一项降低 HIV 感染的多组分干预措施的可行性研究。基于 HIV 血清转换的 HIV 发病率计算为每 100 人年的事件数。使用具有时间依赖性协变量的多变量比例风险模型来确定 HIV 获得的相关因素。
在招募的 1553 名黑人 MSM 中，有 1164 名在基线时 HIV 未感染并纳入随访。总体每年 HIV 发病率为 3.0%（95%置信区间（CI）：2.0，4.4%），而≤30 岁的男性为 5.9%（95%CI：3.6，9.1%）。≤30 岁的男性报告的性风险水平明显更高，并且在随访期间更有可能被诊断出患有性传播感染。年轻男性也更有可能没有常规的医疗保健场所，最近没有去看医疗保健提供者，并且有未满足的医疗保健需求。在多变量分析中，年龄≤30 岁（风险比（HR）：3.4；95%CI：1.4，8.3）和与 HIV 阳性或未知状态的伴侣进行无保护的接受性肛交（HR：4.1；95%CI：1.9，9.1）与 HIV 获得显著相关。
在美国规模最大的前瞻性随访黑人 MSM 队列中，HIV 发病率很高，尤其是在年轻男性中。迫切需要针对这些人群的、有针对性的、量身定制的、具有文化适应性的 HIV 预防策略，结合行为、社会和基于生物医学的干预措施，以降低这些比率。
