Department of Anthropology, University of Washington, Seattle, WA, USA.
Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.
Lancet HIV. 2017 Jul;4(7):e311-e320. doi: 10.1016/S2352-3018(17)30067-X. Epub 2017 Apr 18.
BACKGROUND: In the USA, men who have sex men (MSM) are at high risk for HIV, and black MSM have a substantially higher prevalence of infection than white MSM. We created a simulation model to assess the strength of existing hypotheses and data that account for these disparities. METHODS: We built a dynamic, stochastic, agent-based network model of black and white MSM aged 18-39 years in Atlanta, GA, USA, that incorporated race-specific individual and dyadic-level prevention and risk behaviours, network attributes, and care patterns. We estimated parameters from two Atlanta-based studies in this population (n=1117), supplemented by other published work. We modelled the ability for racial assortativity to generate or sustain disparities in the prevalence of HIV infection, alone or in conjunction with scenarios of observed racial patterns in behavioural, care, and susceptibility parameters. FINDINGS: Race-assortative mixing alone could not sustain a pre-existing disparity in prevalence of HIV between black and white MSM. Differences in care cascade, stigma-related behaviours, and CCR5 genotype each contributed substantially to the disparity (explaining 10·0%, 12·7%, and 19·1% of the disparity, respectively), but nearly half (44·5%) could not be explained by the factors investigated. A scenario assessing race-specific reporting differences in risk behaviour was the only one to yield a prevalence in black MSM (44·1%) similar to that observed (43·4%). INTERPRETATION: Racial assortativity is an inadequate explanation for observed disparities. Work to close the gap in the care cascade by race is imperative, as are efforts to increase serodiscussion and strengthen relationships among black MSM particularly. Further work is urgently needed to identify other sources of, and pathways for, this disparity, to integrate concomitant epidemics into models, and to understand reasons for racial differences in behavioural reporting. FUNDING: The Eunice Kennedy Shriver National Institute of Child Health and Development, the National Institute of Allergy and Infectious Diseases, the National Institute of Minority Health and Health Disparities, and the National Institute of Mental Health.
背景：在美国，男男性行为者（MSM）感染艾滋病毒的风险很高，而黑人 MSM 的感染率明显高于白人 MSM。我们创建了一个模拟模型，以评估现有假设和数据的强度，这些假设和数据解释了这些差异。
方法：我们构建了一个针对年龄在 18-39 岁之间的美国佐治亚州亚特兰大市的黑人和白人 MSM 的动态、随机、基于代理的网络模型，该模型纳入了特定于种族的个体和对偶层面的预防和风险行为、网络属性以及护理模式。我们从该人群中的两项基于亚特兰大的研究（n=1117）中估计参数，并辅以其他已发表的研究。我们单独或结合行为、护理和易感性参数中观察到的种族模式，对种族聚集性生成或维持 HIV 感染流行率差异的能力进行建模。
结果：仅种族聚集性混合本身并不能维持黑人和白人 MSM 之间已有的 HIV 流行率差异。护理级联、与耻辱感相关的行为和 CCR5 基因型的差异都对差异做出了重大贡献（分别解释了差异的 10.0%、12.7%和 19.1%），但近一半（44.5%）的差异无法用调查的因素来解释。评估风险行为种族特异性报告差异的情景是唯一一种导致黑人群体 HIV 流行率（44.1%）与观察到的流行率（43.4%）相似的情景。
解释：种族聚集性是观察到的差异的一个不充分的解释。通过种族缩小护理级联差距的工作势在必行，尤其是加强黑人群体之间的性传播疾病讨论和关系。迫切需要进一步研究，以确定这种差异的其他来源和途径，将并发的传染病纳入模型，并了解行为报告中种族差异的原因。
资助：美国国立儿童健康与人类发展研究所、美国国立过敏和传染病研究所、美国国家少数民族健康和健康差异研究所以及美国国立心理健康研究所。
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