Factors Associated with HIV Antiretroviral Therapy among Men Who Have Sex with Men in 20 US Cities, 2014
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Reducing HIV among men who have sex with men (MSM) is a national goal, and early diagnosis, timely linkage to HIV medical care, and ongoing care and treatment are critical for improving health outcomes for MSM with HIV and preventing transmission to others. We assessed demographic, social, and economic factors associated with HIV antiretroviral treatment among HIV-infected MSM. Data are from the National HIV Behavioral Surveillance (NHBS) collected in 2014 among MSM. We estimated prevalence ratios and 95% confidence intervals using average marginal predictions from logistic regression. Overall, 89% of HIV-positive MSM reported currently taking antiretroviral therapy (ART). After controlling for other variables, we found that higher perceived community stigma and not having health insurance were significant risk factors for not taking ART. We also found that high socioeconomic status (SES) was associated with taking ART. Race/ethnicity was not significantly associated with taking ART in either the unadjusted or adjusted analyses. Findings suggest that to increase ART use for MSM with HIV, we need to move beyond individual-level approaches and move towards the development, dissemination, and evaluation of structural and policy interventions that respond to these important social and economic factors.
KeywordsMSM National HIV Behavioral Surveillance Antiretroviral Therapy Stigma Health Insurance SES Race/ethnicity
The authors would like to thank all NHBS participants in 2014, as well as members of the NHBS Study Group: Atlanta, GA: Pascale Wortley, Jeff Todd, Kimi Sato; Baltimore, MD: Colin Flynn, Danielle German; Boston, MA: Dawn Fukuda, Rose Doherty, Chris Wittke; Chicago, IL: Nikhil Prachand, Nanette Benbow, Antonio D. Jimenez; Dallas, TX: Jonathon Poe, Shane Sheu, Alicia Novoa; Denver, CO: Alia Al-Tayyib, Melanie Mattson; Detroit, MI: Vivian Griffin, Emily Higgins, Kathryn Macomber; Houston, TX: Salma Khuwaja, Hafeez Rehman, Paige Padgett; Los Angeles, CA: Ekow Kwa Sey, Yingbo Ma; Miami, FL: Marlene LaLota, John-Mark Schacht, David Forrest; Nassau-Suffolk, NY: Bridget Anderson, Amber Sinclair, Lou Smith; New Orleans, LA: William T. Robinson, Narquis Barak, Meagan C. Zarwell; New York City, NY: Alan Neaigus, Kathleen H. Reilly; Newark, NJ: Barbara Bolden, Afework Wogayehu, Henry Godette; Philadelphia, PA: Kathleen A. Brady, Mark Shpaner, Jennifer Shinefeld; San Diego, CA: Lissa Bayang, Veronica Tovar-Moore; San Francisco, CA: H. Fisher Raymond, Theresa Ick; San Juan, PR: Sandra Miranda De León, Yadira Rolón-Colón; Seattle, WA: Tom Jaenicke, Hanne Thiede, Richard Burt; Washington, DC: Jenevieve Opoku, Irene Kuo; CDC: Winston Abara, Alexandra Balaji, Dita Broz, Laura Cooley, Melissa Cribbin, Paul Denning, Teresa Finlayson, Kathy Hageman, Kristen Hess, Brooke Hoots, Wade Ivy, Rashunda Lewis, Stacey Mason, Gabriela Paz-Bailey, Kathryn Salo, Catlainn Sionean, Amanda Smith, Justin Smith, Michael Spiller, Cyprian Wejnert, Mingjing Xia.
Financial suppport for NHBS was provided by the US Centers for Disease Control and Prevention (CDC) through a cooperative agreement with state and local health departments.
Compliance with Ethical Standards
Statement about Research Involving Human Participants and Informed Consent
NHBS activities were approved by local institutional review boards for each of the 20 MSAs. The project underwent a CDC review and approval process and was determined to be research in which CDC was not directly engaged and, therefore, did not require review by CDC IRB. All participants were explicitly assured during the recruitment process of the anonymous nature of the survey and the HIV testing. All participants provided oral informed consent to participate in the interview and be tested for HIV. Oral consent was documented electronically on the survey instrument by interviewers for all participants and on hard copy as required by local IRBs. Data collection was anonymous, so written consent was not possible and participant’s names or other personal identifiers were not linked to any NHBS instruments. All consent procedures, including oral consent, were approved by local IRBs.
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