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Determinants of HIV Incidence Disparities Among Young and Older Men Who Have Sex with Men in the United States

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Abstract

This study sought to determine why young men who have sex with men (MSM) have higher HIV incidence rates than older MSM in the United States. We developed hypotheses that may explain this disparity. Data came from peer-reviewed studies published during 1996–2016. We compared young and older MSM with respect to behavioral, clinical, psychosocial, and structural factors that promote HIV vulnerability. Compared with older MSM, young MSM were more likely to have HIV-discordant condomless receptive intercourse. Young MSM also were more likely to have “any” sexually transmitted infection and gonorrhea. Among HIV-positive MSM, young MSM were less likely to be virally suppressed, use antiretroviral therapy, and be aware of their infection. Moreover, young MSM were more likely than older MSM to experience depression, polysubstance use, low income, decreased health care access, and early ages of sexual expression. These factors likely converge to exacerbate age-associated HIV incidence disparities among MSM.

Resumen

Este estudio buscó determinar por qué los hombres jóvenes que tienen sexo con hombres (HSH) tienen tasas de incidencia de VIH más altas que los HSH mayores en los Estados Unidos. Desarrollamos hipótesis que pueden explicar esta disparidad. Los datos provienen de estudios revisados por pares publicados durante 1996–2016. Comparamos a HSH jóvenes con mayores con respecto a los factores conductuales o de comportamiento, clínicos, psicosociales y estructurales que promueven la vulnerabilidad al VIH. En comparación con los HSH mayores, los HSH jóvenes eran más propensos a tener relaciones sexuales VIH discordantes pasivas sin condón. Los HSH jóvenes también eran más propensos a tener “cualquier” infección de transmisión sexual y gonorrea. Entre los HSH VIH positivos, los HSH jóvenes tenían menos probabilidades de tener menos carga viral, usar terapia antirretroviral y estar al tanto de su infección. Además, los jóvenes HSH tenían más probabilidades que los HSH mayores de experimentar depresión, uso de varias sustancias, bajos ingresos, menor acceso a la atención médica y edades tempranas de expresión sexual. Es probable que estos factores converjan para exacerbar las disparidades en la incidencia del VIH entre los HSH.

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Acknowledgments

We are grateful to Katherine L. Tucker for assistance with the literature search. Jeanne Bertolli, PhD, MPH, John T. Brooks, MD, Wayne A. Duffus, MD, PhD, and Aidsa Rivera, MS provided helpful thoughts on earlier drafts of this article. This research was supported in part by an appointment to the Research Participation Program at the Centers for Disease Control and Prevention administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and the Centers for Disease Control and Prevention.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Authors and Affiliations

  1. Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA

    William L. Jeffries IV, Gabriela Paz-Bailey, Donna Hubbard McCree, Lamont Scales & Suzanne Whitmore

  2. Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA

    Kevin M. Greene

  3. Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA

    Richard Dunville

  4. Centers for Disease Control and Prevention, 1600 Clifton Road, MS E40, Atlanta, GA, 30333, USA

    William L. Jeffries IV

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  1. William L. Jeffries IV
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Correspondence to William L. Jeffries IV.

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The authors declare that they have no conflict of interest. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with human participants performed by any of the authors.

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Jeffries, W.L., Greene, K.M., Paz-Bailey, G. et al. Determinants of HIV Incidence Disparities Among Young and Older Men Who Have Sex with Men in the United States. AIDS Behav 22, 2199–2213 (2018). https://doi.org/10.1007/s10461-018-2088-3

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