1 / 14

Equal behaviors, unequal risks :

Equal behaviors, unequal risks : The role of partner transmission potential in racial HIV disparities among men who have sex with men (MSM) in the United States. Eli Rosenberg. Colleen Kelley, Brandon O'Hara, Paula Frew, John Peterson, Travis Sanchez, Carlos del Rio, Patrick Sullivan.

psyche
Download Presentation

Equal behaviors, unequal risks :

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Equal behaviors, unequal risks: The role of partner transmission potential in racial HIV disparities among men who have sex with men (MSM) in the United States Eli Rosenberg Colleen Kelley, Brandon O'Hara, Paula Frew, John Peterson, Travis Sanchez, Carlos del Rio, Patrick Sullivan Department of Epidemiology Emory University Rollins School of Public Health Atlanta, GA July 23, 2012 Emory University Center for AIDS Research

  2. HIV and MSM • HIV prevalence among MSM is high and MSM continue to bear the burden of HIV incidence in the US • Black MSM, particularly young black MSM, continue to be overrepresented among new infections • Reasons for racial disparity remain unclear • Unknown degree to which prevalence of HIV without viral suppression perpetuates incidence disparities • Theoretically, greater likelihood of encountering a partner who might transmit HIV translates into increased incidence

  3. Measures of transmission risk for disparities research • How do we measure an individual’s risk of having unprotected sex in a community? • Suggests a measure that incorporates the spectrum of HIV infection, diagnosis, linkage to care, treatment, suppression • Our toolkit of measures is limited for this task • HIV prevalence • Community viral load • Population viral load • Need for a broad and relevant public health measure

  4. A new measure: Transmission Potential Prevalence (TPP) • Proportion of individuals in whole population with a current VL sufficient to transmit HIV • Crosses prevalence with VL measures • VL cut-point unknown for MSM. Used conservative estimate of 400 copies/ml.

  5. What are the TPPs in the black and white MSM communities of Atlanta and how do they relate to HIV risk?

  6. Study Design • Prospective HIV/STI incidence cohort study of black and white MSM in Atlanta • Eligibility: > 18-39 years old, non-Hispanic black or white, had male sex in last 3 months, not in mutually monogamous relationship, reside in metro Atlanta • Recruitment: venue-time-space sampling • Baseline visit: • HIV testing: Rapid test, WB confirmatory, viral loads • Partnership-level behavioral questionnaire • 709 men (399 B, 310 W) enrolled from 7/2010 - 6/2012

  7. Demographics and outcomes More details: O’Hara et al TU PE-133

  8. Results: Viral load measures More details: Kelley et al MO PE-264

  9. Behavioral model • Translate TPP and partner selection patterns into probabilities that HIV-negative, black and white MSM might encounter a potentially transmitting partner • Race-specific, deterministic models • TPP represents partner pool • UAI racial mixing patterns • 3 groups: black, white, other • Racial exclusivity 70% • Among non-exclusive men, mixing with 3 groups • Monte Carlo simulation to estimate variability (x 100,000)

  10. Results: Behavioral model Probability of having ≥ 1 partner with HIV transmission potential 25 10 7 3 39% 18%

  11. Conclusions • Despite similar CVL and PVL, sizeable racial differences in TPP and associated exposure risk • Model results suggest limited ability of behavioral interventions alone to eliminate disparities • Communities with high TPP should be focus of new resources to prevent transmission • HIV surveillance systems can be adapted to include TPP to understand transmission risk in subgroups and make meaningful comparisons

  12. Limitations • Current VL does not reflect durable virologicsuppression • Model does not account for other determinants of transmission • UAI serosorting not included • Does not explain what originally gave rise to disparities

  13. Relevance • Our data support targeting resources to dramatically reduce TPP among black MSM by increasing testing, linkage, and retention in HIV care in order to reduce disparities in HIV incidence, supported by coordinated behavioral interventions to increase effectiveness of treatment.

  14. Thank you !! Investigators Recruiters Event staff Retention specialists Data team Our participants! Eli Rosenberg esrose2@emory.edu Supported by NIH #: • R01-MH085600 • R01-HD067111 • KL2-RR025009 • P30 AI050409 (Emory CFAR)

More Related