Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Department of Psychiatry, Columbia University, New York, NY, USA.
J Int AIDS Soc. 2021 Apr;24(4):e25689. doi: 10.1002/jia2.25689.
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.
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.
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]).
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.
由于与结构性种族主义相关的因素，与白人男男性接触者（MSM）相比，感染艾滋病毒的与黑人男性发生性关系的男男性接触者（MSM）病毒抑制率较低。这些数据大部分来自临床队列，需要确定造成这些种族差异的可改变原因，以便对这些不平等现象进行干预。因此，我们研究了佐治亚州亚特兰大市一个基于社区的感染艾滋病毒的黑人和白人 MSM 队列中，与病毒抑制率相关的种族差异的因素。
我们对亚特兰大感染艾滋病毒的黑人和白人 MSM 进行了一项观察性队列研究。招募工作于 2016 年 6 月至 2017 年 6 月进行，男性在入组后 24 个月内进行随访；在入组后 12 个月和 24 个月时收集实验室和行为调查数据。与病毒抑制率的种族差异相关的解释因素包括社会人口统计学和心理社会变量。使用具有稳健误差方差的泊松回归模型来估计病毒抑制率的黑人/白人差异的患病率比（PR）。将使种族差异的 PR 降低≥5%的因素视为可显著减弱种族差异的因素，并将其纳入多变量模型。
总体而言，26%（104/398）的参与者在基线时未被病毒抑制。与白人 MSM（19%，36/192）相比，黑人 MSM（33%，69/206）的未被病毒抑制的比例明显更高（未调整的患病率比（PR）=1.6；95%CI：1.1 至 2.5）。通过控制 ART 覆盖率（降低 12%）、住房稳定性（降低 7%）、更高收入（降低 6%）和大麻使用（降低 6%），调整年龄后的黑/白 PR 降低了 12%。在多变量模型中，这些因素累计降低了种族差异的 PR 21%（调整后 PR=1.1 [95%CI：0.8 至 1.6]）。
与白人 MSM 相比，亚特兰大感染艾滋病毒的黑人 MSM 病毒抑制率较低。这种差异可以用许多因素来解释，其中许多因素应该成为结构性、政策和个人层面干预措施的目标，以减少种族差异。
