Skip to main content

Advertisement

SpringerLink
Log in

Factors Associated with HIV Antiretroviral Therapy among Men Who Have Sex with Men in 20 US Cities, 2014

  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Purcell DW, Johnson CH, Lansky A, et al. Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates. Open AIDS J. 2012;6:98–107.

    Article  Google Scholar 

  2. Centers for Disease Control and Prevention. HIV surveillance report. Vol 29. Atlanta, GA: US Department of Health and Human Services, CDC; 2017. November 2018. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Accessed 13 July 2019

  3. Singh S, Song R, Satcher Johnson A, McCray E, Hall HI. HIV incidence, prevalence and undiagnosed infection in men who have sex with men, United States. Ann Intern Med. 2018; https://doi.org/10.7326/M17-2082.

    Article  Google Scholar 

  4. Office of National AIDS Policy. National HIV/AIDS strategy for the United States: updated to 2020. Washington, DC: Office of National AIDS Policy; 2015. https://obamawhitehouse.archives.gov/sites/default/files/docs/national_hiv_aids_strategy_update_2020.p. Accessed 13 July 2019

  5. Cohen MS, Chen YQ, McCauley M, et al. HPTN 052 Study Team. Prevention of HIV- 1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493–505. https://www.nejm.org/doi/10.1056/NEJMoa1105243?url_ver=Z39.88 2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.gov. Accessed 13 July 2019

  6. Lundgren JD, Babiker AG, Gordin F, et al. INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;373:795–807. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4569751/. Accessed 13 July 2019

  7. Cohen MS, Chen YQ, McCauley M, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med. 2016;375:830–9.

    Article  CAS  Google Scholar 

  8. Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316(2):171–81. https://jamanetwork.com/journals/jama/fullarticle/2533066. Accessed 13 July 2019

    Article  Google Scholar 

  9. Bavinton BR, Pinto AN, Phanuphak N, et al. Viral suppression and HIV transmission in serodiscordant male couples: an international, prospective, observational, cohort study. Lancet. 2018;5(8):e438–e447.

    Article  Google Scholar 

  10. Rodger AJ. Risk of HIV transmission through condomless sex in MSM couples with suppressive ART: The PARTNER2 Study extended results in gay men. Presented at the 22nd International AIDS Conference; July 23–27, 2018; Amsterdam, the Netherlands.

  11. Centers for Disease Control.HIV treatment as prevention; 2018. Retrieved from www.cdc.gov/hiv/risk/art/index.html. Accessed 13 July 2019

  12. Hoots BE, Finlayson TJ, Wejnert C, Paz-Bailey G. Updated data on linkage to human immunodeficiency virus care and antiretroviral treatment among men who have sex with men—20 Cities, United States. J Infect Dis. 2017;216(7):808–12. https://www.ncbi.nlm.nih.gov/pubmed/28368493. Accessed 13 July 2019

    Article  Google Scholar 

  13. Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2016. HIV Surveillance Supplemental Report 2018;23(No. 4). http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published June 2018.

  14. Finlayson TJ, Le B, Smith A, et al. HIV risk, prevention, and testing behaviors among men who have sex with men—National HIV Behavioral Surveillance System, 21 U.S. cities, United States, 2008. MMWR Morb Mortal Wkly Rep. 2011;60:1–34. https://www.cdc.gov/mmwr/preview/mmwrhtml/ss6014a1.htm. Accessed 13 July 2019

  15. MacKellar DA, Gallagher KM, Finlayson T, Sanchez T, Lansky A, Sullivan PS. Surveillance of HIV risk and prevention behaviors of men who have sex with men—a national application of venue-based, timespace sampling. Public Health Rep. 2007;122(Suppl 1):39–47. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1804106/. Accessed 13 July 2019

    Article  Google Scholar 

  16. Centers for Disease Control and Prevention. National HIV Behavioral Surveillance System Round 4: Model Surveillance Protocol. December 11, 2015. https://www.cdc.gov/hiv/pdf/statistics/systems/nhbs/nhbs_round4modelsurveillanceprotocol.pdf.

  17. Sionean C, Le BC, Hageman K. HIV risk, prevention, and testing behaviors among heterosexuals at increased risk for HIV infection— National HIV Behavioral Surveillance System, 21 U.S. Cities, 2010. MMWR Surveill Summ. 2014;63(SS14):1–39. https://www.cdc.gov/mmwr/preview/mmwrhtml/ss6314a1.htm. Accessed 13 July 2019

  18. DiNenno EA, Oster AM, Sionean C, Denning P, Lansky A. Piloting a system for behavioral surveillance among heterosexuals at increased risk of HIV in the United States. Open AIDS J. 2012;6(1):169–76.

    Article  Google Scholar 

  19. Williams D, Yu Y, Jackson JS, Anderson NB. Racial differences in physical and mental health: socio-economic status, stress, and discrimination. J Health Psychol. 1997;2(3):335–51.

    Article  CAS  Google Scholar 

  20. Herek G, Capitanio JP, Widaman KF. HIV-related stigma and knowledge in the United States: prevalence and trends, 1991–1999. Am J Public Health. 2002;92:371–7.

    Article  Google Scholar 

  21. Kalichman SC, Simbayi LC, Jooste S, et al. Development of a brief scale to measure AIDS-related stigma in South Africa. AIDS Behav. 2005;9(2):135–43.

    Article  Google Scholar 

  22. Iachan R, Finlayson T, Kyle T, Wejnert C, Paz-Bailey G. Weighting for venue-based sampling: the MSM3 study. Joint Statistical Meeting: August 3, 2013; Montreal, Canada.

  23. Karon J, Wejnert C. Statistical methods for the analysis of time— location sampling data. J Urban Health. 2012;89(3):565–86. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3368048/. Accessed 13 July 2019

    Article  Google Scholar 

  24. Vanable PA, Carey MP, Blair DC, Littlewood RA. Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS Behav. 2006;10(5):473–82. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2566551/. Accessed 13 July 2019

    Article  Google Scholar 

  25. Sweeney SM, Vanable PA. The association of HIV-related stigma to HIV medication adherence: a systematic review and synthesis of the literature. AIDS Behav. 2016;20:1–22. https://link.springer.com/article/10.1007%2Fs10461-015-1164-1. Accessed 13 July 2019

    Article  Google Scholar 

  26. Kinsler JJ, Wong MD, Sayles JN, Davis C, Cunningham WE. The effect of perceived stigma from a health care provider on access to care among low-income HIV-positive population. AIDS Patient Care STDs. 2007;21(8):584–92. https://www.liebertpub.com/doi/abs/10.1089/apc.2006.0202?url_ver=Z39.88- 2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed. Accessed 13 July 2019

  27. Sayles JN, Wong MD, Kinsler J, Martins D, Cunningham WE. The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS. J Gen Intern Med. 2009;24(10):1101–8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762503/. Accessed 13 July 2019

  28. Rice WS, Crockett KB, Mugavero MJ, et al. Association between internalized HIV- related stigma and HIV care visit adherence. J Acquir Immune Defic Syndr. 2017;76(5):482–7. https://insights.ovid.com/pubmed?pmid=28885270. Accessed 13 July 2019

    Article  Google Scholar 

  29. Balaji AB, Bowles KE, Hess KL, Smith JC, Paz-Bailey G. Association between enacted stigma and HIV-related risk behavior among MSM, National Behavioral Surveillance System, 2011. AIDS Behav. 2017;21:227–37. https://link.springer.com/article/10.1007/s10461-016-1599-z. Accessed 13 July 2019

  30. NCHS. Health insurance and access to care. 2017. https://www.cdc.gov/nchs/data/factsheets/factsheet_health_insurance_and_access_to_care.pdf/. Accessed 13 Jul 2019.

  31. Patel RR, Mena L, Nunn A, et al. Impact of insurance coverage on utilization of pre-exposure prophylaxis for HIV prevention. PLoS One. 2017;12(5):e0178737. https://doi.org/10.1371/journal.pone.0178737.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Prado G. Lightfoot m, Brown, CH. Macro-level approaches to HIV prevention among ethnic minority youth. Am Psychol. 2013;68(4J):286–99. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3771582/pdf/nihms492151.pdf. Accessed 13 July 2019

  33. CDC. HIV Treatment as prevention. https://www.cdc.gov/hiv/risk/art/index.html. Accessed 13 Jul 2019.

  34. Beane SN, Culyba RJ, DeMayo M, Armstrong W. Exploring the medical home in Ryan White HIV care settings: a pilot study. J Assoc Nurse AIDS C. 2014;25(3):191–202. https://doi.org/10.1016/j.jana.2013.10.007.

    Article  Google Scholar 

  35. Baugher AR, Beer L, Fagan JL, Mattson CL, Shouse RL. Discrimination in healthcare settings among adults with recent HIV diagnoses. AIDS Care. 2018:1–6. https://doi.org/10.1080/09540121.2018.1545988.

    Article  Google Scholar 

  36. Bradford JB, Coleman S, Cunningham W. HIV system navigation: an emerging model to improve HIV care access. AIDS Patient Care STDS. 2007;21(1):S49–58. https://www.liebertpub.com/doi/pdf/10.1089/apc.2007.9987. Accessed 13 July 2019

    Google Scholar 

Download references

Acknowledgements

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.

Funding

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.

Author information

Authors and Affiliations

  1. Centers for Disease Control and Prevention, 1600 Clifton Road, US8-2, Atlanta, GA, 30333, USA

    Renee Stein, Songli Xu, Mariette Marano, Adanze Eke, Teresa Finlayson, Gabriela Paz-Bailey & Cyprian Wejnert

  2. Public Health Analytic Consulting Services, Inc, Hillsborough, NC, USA

    Weston Williams

Authors
  1. Renee Stein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Songli Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Weston Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mariette Marano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adanze Eke
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Teresa Finlayson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gabriela Paz-Bailey
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Cyprian Wejnert
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the NHBS study group

Corresponding author

Correspondence to Renee Stein.

Ethics declarations

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.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stein, R., Xu, S., Williams, W. et al. Factors Associated with HIV Antiretroviral Therapy among Men Who Have Sex with Men in 20 US Cities, 2014. J Urban Health 96, 868–877 (2019). https://doi.org/10.1007/s11524-019-00386-w

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-019-00386-w

Keywords

Search

Navigation