Examining inequities in rates of undiagnosed HIV and rectal STIs in a large nationwide cohort study of sexual minority men

H. Jonathon Rendina; Ali Talan; K. Marie Sizemore; Nicola F. Tavella; Brian Salfas; Ore Shalhav; Drew Westmoreland; Brian Mustanski; Carlos E. Rodríguez-Díaz

doi:10.1136/sextrans-2021-055047

Examining inequities in rates of undiagnosed HIV and rectal STIs in a large nationwide cohort study of sexual minority men

H. Jonathon Rendina, Ali Talan, K. Marie Sizemore, Nicola F. Tavella, Brian Salfas, Ore Shalhav, Drew Westmoreland, Brian Mustanski, Carlos E. Rodríguez-Díaz

Research output: Contribution to journal › Article › peer-review

Abstract

Objective Sexual minority men (SMM) of colour are disproportionately impacted by HIV and bacterial STIs (bSTIs). To better understand within-group heterogeneity and differential risk factors by race and ethnicity, we sought to examine rates of undiagnosed HIV and rectal bSTI at the intersection of racial and ethnic identity with other sociodemographic factors. Methods We examined data from 8105 SMM conducting home-based self-testing at enrolment in a nationwide cohort study collected from November 2017 to August 2018. We conducted analyses stratified by racial and ethnic groups to examine within-group (ie, subgroup) unadjusted rates of HIV and rectal bSTI infection across a range of characteristics. Results Rates of undiagnosed HIV were highest among Black (4.3%, n=39) and Latino (2.4%, n=38) SMM, with lower rates among those identified as multiracial (1.6%, n=15), white (1.3%, n=56) and other races (1.3%, n=6). Across the stratified analyses of HIV infection, 15 significant associations emerged showing that age, region, insurance type, sexual positioning and incarceration history had differential impacts across racial and ethnic groups. In particular, private and public insurance were protective against HIV for white but not Black and Latino SMM, and incarceration was associated with substantially higher rates of HIV infection for Black and Latino SMM relative to white SMM. We found significant co-occurrence of HIV and bSTI rates for participants who identified as Latino (OR=7.5, 95% CI 2.12 to 26.54), white (OR=3.19, 95% CI 1.14 to 8.98) and multiracial (OR=5.5, 95% CI 1.08 to 27.90), but not those who identified as Black (OR=0.82, 95% CI 0.10 to 6.56) or other races (OR=3.56 95% CI 0.31 to 40.80). Conclusions Stratified analyses showed differential rates of HIV infection at the intersection of racial and ethnic groups with other characteristics, particularly insurance status and incarceration history, pointing to structural inequities rather than individual behaviours underlying disproportionately high rates of HIV for Black and Latino SMM.

Original language	American English
Pages (from-to)	269-276
Number of pages	8
Journal	Sexually Transmitted Infections
Volume	98
Issue number	4
DOIs	https://doi.org/10.1136/sextrans-2021-055047
State	Published - Jun 1 2022
Externally published	Yes

ASJC Scopus subject areas

Dermatology
Infectious Diseases

Keywords

Bacterial infections
Epidemiology
HIV
HIV seroprevalence

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10.1136/sextrans-2021-055047

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Jonathon Rendina, H., Talan, A., Marie Sizemore, K., Tavella, N. F., Salfas, B., Shalhav, O., Westmoreland, D., Mustanski, B., & Rodríguez-Díaz, C. E. (2022). Examining inequities in rates of undiagnosed HIV and rectal STIs in a large nationwide cohort study of sexual minority men. Sexually Transmitted Infections, 98(4), 269-276. https://doi.org/10.1136/sextrans-2021-055047

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title = "Examining inequities in rates of undiagnosed HIV and rectal STIs in a large nationwide cohort study of sexual minority men",

abstract = "Objective Sexual minority men (SMM) of colour are disproportionately impacted by HIV and bacterial STIs (bSTIs). To better understand within-group heterogeneity and differential risk factors by race and ethnicity, we sought to examine rates of undiagnosed HIV and rectal bSTI at the intersection of racial and ethnic identity with other sociodemographic factors. Methods We examined data from 8105 SMM conducting home-based self-testing at enrolment in a nationwide cohort study collected from November 2017 to August 2018. We conducted analyses stratified by racial and ethnic groups to examine within-group (ie, subgroup) unadjusted rates of HIV and rectal bSTI infection across a range of characteristics. Results Rates of undiagnosed HIV were highest among Black (4.3\%, n=39) and Latino (2.4\%, n=38) SMM, with lower rates among those identified as multiracial (1.6\%, n=15), white (1.3\%, n=56) and other races (1.3\%, n=6). Across the stratified analyses of HIV infection, 15 significant associations emerged showing that age, region, insurance type, sexual positioning and incarceration history had differential impacts across racial and ethnic groups. In particular, private and public insurance were protective against HIV for white but not Black and Latino SMM, and incarceration was associated with substantially higher rates of HIV infection for Black and Latino SMM relative to white SMM. We found significant co-occurrence of HIV and bSTI rates for participants who identified as Latino (OR=7.5, 95\% CI 2.12 to 26.54), white (OR=3.19, 95\% CI 1.14 to 8.98) and multiracial (OR=5.5, 95\% CI 1.08 to 27.90), but not those who identified as Black (OR=0.82, 95\% CI 0.10 to 6.56) or other races (OR=3.56 95\% CI 0.31 to 40.80). Conclusions Stratified analyses showed differential rates of HIV infection at the intersection of racial and ethnic groups with other characteristics, particularly insurance status and incarceration history, pointing to structural inequities rather than individual behaviours underlying disproportionately high rates of HIV for Black and Latino SMM.",

keywords = "Bacterial infections, Epidemiology, HIV, HIV seroprevalence",

author = "\{Jonathon Rendina\}, H. and Ali Talan and \{Marie Sizemore\}, K. and Tavella, \{Nicola F.\} and Brian Salfas and Ore Shalhav and Drew Westmoreland and Brian Mustanski and Rodr{\'i}guez-D{\'i}az, \{Carlos E.\}",

note = "Publisher Copyright: {\textcopyright} 2022 Author(s) (or their employer(s)). Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2022",

month = jun,

day = "1",

doi = "10.1136/sextrans-2021-055047",

language = "American English",

volume = "98",

pages = "269--276",

journal = "Sexually Transmitted Infections",

issn = "1368-4973",

publisher = "BMJ Publishing Group",

number = "4",

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Jonathon Rendina, H, Talan, A, Marie Sizemore, K, Tavella, NF, Salfas, B, Shalhav, O, Westmoreland, D, Mustanski, B & Rodríguez-Díaz, CE 2022, 'Examining inequities in rates of undiagnosed HIV and rectal STIs in a large nationwide cohort study of sexual minority men', Sexually Transmitted Infections, vol. 98, no. 4, pp. 269-276. https://doi.org/10.1136/sextrans-2021-055047

TY - JOUR

T1 - Examining inequities in rates of undiagnosed HIV and rectal STIs in a large nationwide cohort study of sexual minority men

AU - Jonathon Rendina, H.

AU - Talan, Ali

AU - Marie Sizemore, K.

AU - Tavella, Nicola F.

AU - Salfas, Brian

AU - Shalhav, Ore

AU - Westmoreland, Drew

AU - Mustanski, Brian

AU - Rodríguez-Díaz, Carlos E.

PY - 2022/6/1

Y1 - 2022/6/1

N2 - Objective Sexual minority men (SMM) of colour are disproportionately impacted by HIV and bacterial STIs (bSTIs). To better understand within-group heterogeneity and differential risk factors by race and ethnicity, we sought to examine rates of undiagnosed HIV and rectal bSTI at the intersection of racial and ethnic identity with other sociodemographic factors. Methods We examined data from 8105 SMM conducting home-based self-testing at enrolment in a nationwide cohort study collected from November 2017 to August 2018. We conducted analyses stratified by racial and ethnic groups to examine within-group (ie, subgroup) unadjusted rates of HIV and rectal bSTI infection across a range of characteristics. Results Rates of undiagnosed HIV were highest among Black (4.3%, n=39) and Latino (2.4%, n=38) SMM, with lower rates among those identified as multiracial (1.6%, n=15), white (1.3%, n=56) and other races (1.3%, n=6). Across the stratified analyses of HIV infection, 15 significant associations emerged showing that age, region, insurance type, sexual positioning and incarceration history had differential impacts across racial and ethnic groups. In particular, private and public insurance were protective against HIV for white but not Black and Latino SMM, and incarceration was associated with substantially higher rates of HIV infection for Black and Latino SMM relative to white SMM. We found significant co-occurrence of HIV and bSTI rates for participants who identified as Latino (OR=7.5, 95% CI 2.12 to 26.54), white (OR=3.19, 95% CI 1.14 to 8.98) and multiracial (OR=5.5, 95% CI 1.08 to 27.90), but not those who identified as Black (OR=0.82, 95% CI 0.10 to 6.56) or other races (OR=3.56 95% CI 0.31 to 40.80). Conclusions Stratified analyses showed differential rates of HIV infection at the intersection of racial and ethnic groups with other characteristics, particularly insurance status and incarceration history, pointing to structural inequities rather than individual behaviours underlying disproportionately high rates of HIV for Black and Latino SMM.

AB - Objective Sexual minority men (SMM) of colour are disproportionately impacted by HIV and bacterial STIs (bSTIs). To better understand within-group heterogeneity and differential risk factors by race and ethnicity, we sought to examine rates of undiagnosed HIV and rectal bSTI at the intersection of racial and ethnic identity with other sociodemographic factors. Methods We examined data from 8105 SMM conducting home-based self-testing at enrolment in a nationwide cohort study collected from November 2017 to August 2018. We conducted analyses stratified by racial and ethnic groups to examine within-group (ie, subgroup) unadjusted rates of HIV and rectal bSTI infection across a range of characteristics. Results Rates of undiagnosed HIV were highest among Black (4.3%, n=39) and Latino (2.4%, n=38) SMM, with lower rates among those identified as multiracial (1.6%, n=15), white (1.3%, n=56) and other races (1.3%, n=6). Across the stratified analyses of HIV infection, 15 significant associations emerged showing that age, region, insurance type, sexual positioning and incarceration history had differential impacts across racial and ethnic groups. In particular, private and public insurance were protective against HIV for white but not Black and Latino SMM, and incarceration was associated with substantially higher rates of HIV infection for Black and Latino SMM relative to white SMM. We found significant co-occurrence of HIV and bSTI rates for participants who identified as Latino (OR=7.5, 95% CI 2.12 to 26.54), white (OR=3.19, 95% CI 1.14 to 8.98) and multiracial (OR=5.5, 95% CI 1.08 to 27.90), but not those who identified as Black (OR=0.82, 95% CI 0.10 to 6.56) or other races (OR=3.56 95% CI 0.31 to 40.80). Conclusions Stratified analyses showed differential rates of HIV infection at the intersection of racial and ethnic groups with other characteristics, particularly insurance status and incarceration history, pointing to structural inequities rather than individual behaviours underlying disproportionately high rates of HIV for Black and Latino SMM.

KW - Bacterial infections

KW - Epidemiology

KW - HIV

KW - HIV seroprevalence

UR - https://www.scopus.com/pages/publications/85109005050

UR - https://www.scopus.com/inward/citedby.url?scp=85109005050&partnerID=8YFLogxK

U2 - 10.1136/sextrans-2021-055047

DO - 10.1136/sextrans-2021-055047

M3 - Article

C2 - 34193532

SN - 1368-4973

VL - 98

SP - 269

EP - 276

JO - Sexually Transmitted Infections

JF - Sexually Transmitted Infections

IS - 4

ER -

Examining inequities in rates of undiagnosed HIV and rectal STIs in a large nationwide cohort study of sexual minority men

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