AIDS and Behavior

, Volume 20, Issue 1, pp 7–16 | Cite as

Running Backwards: Consequences of Current HIV Incidence Rates for the Next Generation of Black MSM in the United States

  • Derrick D. MatthewsEmail author
  • A. L. Herrick
  • Robert W. S. Coulter
  • M. Reuel Friedman
  • Thomas C. Mills
  • Lisa A. Eaton
  • Patrick A. Wilson
  • Ron D. Stall
  • The POWER Study Team
Original Paper


Black men who have sex with men (MSM) in the United States are disproportionately impacted by HIV. To better understand this public health problem, we reviewed the literature to calculate an estimate of HIV incidence among Black MSM. We used this rate to model HIV prevalence over time within a simulated cohort, which we subsequently compared to prevalence from community-based samples. We searched all databases accessible through PubMed, and Conference on Retroviruses and Opportunistic Infections abstracts for HIV incidence estimates among Black MSM. Summary HIV incidence rates and 95 % confidence intervals (CIs) were calculated using random effects models. Using the average incidence rate, we modeled HIV prevalence within a simulated cohort of Black MSM (who were all HIV-negative at the start) from ages 18 through 40. Based on five incidence rates totaling 2898 Black MSM, the weighted mean incidence was 4.16 % per year (95 % CI 2.76–5.56). Using this annual incidence rate, our model predicted that 39.94 % of Black MSM within the simulated cohort would be HIV-positive by age 30, and 60.73 % by 40. Projections were similar to HIV prevalence found in community-based samples of Black MSM. High HIV prevalence will persist across the life-course among Black MSM, unless effective prevention and treatment efforts are increased to substantially reduce HIV transmission among this underserved and marginalized population.


HIV/AIDS Black MSM Epidemiology Prevention HIV incidence HIV prevalence 



This study was partially supported by the National Institute for Nursing Research (R01NR013865), the National Institute for Mental Health (T32MH094174; R01MH094230), and the National Institute on Drug Abuse (F31DA037647). We thank Dr. Eli Rosenberg for his comments on an earlier version of this draft, the Center for Black Equity for partnering with us to implement POWER, and the hundreds of study participants who volunteered their time to contribute to this research. This article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


  1. 1.
    Centers for Disease Control and Prevention. HIV among African American gay and bisexual men. 2014.
  2. 2.
    Millett GA, Peterson JL, Flores SA, Hart TA, Wilson PA, Rourke SB, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. Lancet. 2012;380(9839):341–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Department of Health and Human Services. HIV/AIDS care continuum. 2013.
  4. 4.
    Rodger A, Bruun T, Cambiano V, Vernazza P, Estrada V, Lunzen JV, et al. HIV Transmission risk through condomless sex if HIV + partner on suppressive ART: PARTNER Study. In: Conference on Retroviruses and Opportunistic Infections. Boston; 2014.Google Scholar
  5. 5.
    Stall R, Duran L, Wisniewski SR, Friedman MS, Marshal MP, McFarland W, et al. Running in place: implications of HIV incidence estimates among urban men who have sex with men in the United States and other industrialized countries. AIDS Behav. 2009;13(4):615–29.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Prejean J, Song R, Hernandez A, Ziebell R, Green T, Walker F, et al. Estimated HIV incidence in the United States, 2006–2009. PLoS One. 2011;6(8):e17502.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Borenstein M, Hedges L, Higgins J, Rothstein H. Introduction to meta-analysis. Chichester: Wiley; 2011.Google Scholar
  8. 8.
    Centers for Disease Control and Prevention. Prevalence and awareness of HIV infection among men who have sex with men—21 cities, United States, 2008. MMWR Morb Mortal Wkly Rep. 2010;59(37):1201–7.Google Scholar
  9. 9.
    Finlayson TJ, Le B, Smith A, Bowles K, Cribbin M, Miles I, 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(SS14):1–34.Google Scholar
  10. 10.
    Kalton G. Sampling considerations in research on HIV risk and illness. In: Ostrow D, Kessler R, editors. Methodological issues in AIDS behavioral research. New York: Plenum; 1993. p. 53–74.Google Scholar
  11. 11.
    Pathela P, Braunstein SL, Blank S, Schillinger JA. HIV incidence among men with and without sexually transmitted rectal infections: estimates from matching against an HIV case registry. Clin Infect Dis. 2013;57(8):1203–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Centers for Disease Control and Prevention. HIV incidence among young men who have sex with men–seven US cities, 1994-2000. MMWR Morb Mortal Wkly Rep. 2001;50(21):440–4.Google Scholar
  13. 13.
    Wejnert C, Le B, Rose CE, Oster AM, Smith AJ, Zhu J. HIV infection and awareness among men who have sex with men–20 Cities, United States, 2008 and 2011. PLoS ONE. 2013;8(10):e76878.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    World Health Organization. Data on the size of the HIV/AIDS epidemic: Prevalence of HIV among adults aged 15 to 49. Data by country. 2013.
  15. 15.
    Hightow LB, MacDonald PD, Pilcher CD, Kaplan AH, Foust E, Nguyen TQ, et al. The unexpected movement of the HIV epidemic in the Southeastern United States: transmission among college students. J Acquir Immune Defic Syndr. 2005;38(5):531–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Koblin BA, Mayer KH, Eshleman SH, Wang L, Mannheimer S, del Rio C, et al. Correlates of HIV acquisition in a cohort of Black men who have sex with men in the United States: HIV prevention trials network (HPTN) 061. PLoS ONE. 2013;8(7):e70413.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr. 2005;39(4):446–53.PubMedCrossRefGoogle Scholar
  18. 18.
    Marks G, Millett GA, Bingham T, Lauby J, Murrill CS, Stueve A. Prevalence and protective value of serosorting and strategic positioning among Black and Latino men who have sex with men. Sex Transm Dis. 2010;37(5):325–7.PubMedGoogle Scholar
  19. 19.
    Mustanski B, Birkett M, Kuhns LM, Latkin CA, Muth SQ. The role of geographic and network factors in racial disparities in HIV among young men who have sex with men: an egocentric network study. AIDS Behav. 2014;19(6):1037–47.CrossRefGoogle Scholar
  20. 20.
    Rosenthal R. The file drawer problem and tolerance for null results. Psychol Bull. 1979;86(3):638–41.CrossRefGoogle Scholar
  21. 21.
    White House Office of National AIDS Policy. National HIV/AIDS strategy for the United States. Washington, D.C.; 2010.Google Scholar
  22. 22.
    The Fenway Institute. More HIV prevention funding should be shifted to gay men, Fenway says. 2013.
  23. 23.
    Smith DK, Herbst JH, Rose CE. Estimating HIV protective effects of method adherence with combinations of preexposure prophylaxis and condom use among African American men who have sex with men. Sex Transm Dis. 2015;42(2):88–92.PubMedCrossRefGoogle Scholar
  24. 24.
    May MT, Gompels M, Delpech V, Porter K, Orkin C, Kegg S, et al. Impact on life expectancy of HIV-1 positive individuals of CD4 + cell count and viral load response to antiretroviral therapy. AIDS. 2014;28(8):1193–202.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Hall HI, Holtgrave DR, Tang T, Rhodes P. HIV transmission in the United States: considerations of viral load, risk behavior, and health disparities. AIDS Behav. 2013;17(5):1632–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Rosenberg E, Millett G, Sullivan P, Del Rio C, Curran J. Understanding the HIV disparities between black and white men who have sex with men in the USA using the HIV care continuum: a modelling study. Lancet HIV. 2014;1(3):e112–8.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    National Alliance of State & Territorial AIDS Directors. ADAP alert: after five years, adap waiting lists have been eliminated; unmet need and funding uncertainties require continued commitment. Washington, DC. 2013.
  28. 28.
    Gallup. In U.S., uninsured rate lowest since 2008: uninsured rate declines most among blacks and lower-income Americans. 2014.
  29. 29.
    Levy ME, Wilton L, Phillips G II, Glick SN, Kuo I, Brewer RA, et al. Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States. AIDS Behav. 2014;18(5):972–96.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Arnold EA, Rebchook GM, Kegeles SM. ‘Triply cursed’: racism, homophobia and HIV-related stigma are barriers to regular HIV testing, treatment adherence and disclosure among young Black gay men. Cult Health Sex. 2014;16(6):710–22.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Department of Justice. Best practices guide to reform hiv-specific criminal laws to align with scientifically-supported factors. Washington, D.C.; 2014.Google Scholar
  32. 32.
    Herrick AL, Lim SH, Wei C, Smith H, Guadamuz T, Friedman MS, et al. Resilience as an untapped resource in behavioral intervention design for gay men. AIDS Behav. 2011;15(Suppl 1):S25–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Smith DK, Toledo L, Smith DJ, Adams MA, Rothenberg R. Attitudes and program preferences of African-American urban young adults about pre-exposure prophylaxis (PrEP). AIDS Educ Prev. 2012;24(5):408–21.PubMedCrossRefGoogle Scholar
  34. 34.
    Cohen S, Vittinghoff E, Anderson P, Doblecki-Lewis S, Bacon O, Chege W, et al., editors. Implementation of PrEPin STD and community health clinics in the US: high uptake and drug concentrations among MSM in the demo project. In: 9th international conference on HIV treatment and prevention. Miami; 2014.Google Scholar
  35. 35.
    Eaton LA, Driffin DD, Kegler C, Smith H, Conway-Washington C, White D, et al. The role of stigma and medical mistrust in the routine health care engagement of black men who have sex with men. Am J Public Health. 2015;105(2):e75–82.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Harper GW. Sex isn’t that simple: culture and context in HIV prevention interventions for gay and bisexual male adolescents. Am Psychol. 2007;62(8):806–19.CrossRefGoogle Scholar
  37. 37.
    Hightow-Weidman LB, Jones K, Wohl AR, Futterman D, Outlaw A, Phillips G, et al. Early linkage and retention in care: findings from the outreach, linkage, and retention in care initiative among young men of color who have sex with men. AIDS Patient Care STDS. 2011;25(S1):S31–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Magnus M, Jones K, Phillips G, Binson D, Hightow-Weidman LB, Richards-Clarke C, et al. Characteristics associated with retention among African American and Latino adolescent HIV-positive men: results from the outreach, care, and prevention to engage HIV-seropositive young MSM of color special project of national significance initiative. J Acquir Immune Defic Syndr. 2010;53(4):529–36.PubMedCrossRefGoogle Scholar
  39. 39.
    Department of State. PEPFAR Blueprint: Creating an AIDS-free Generation. Washington, D.C.; 2012.Google Scholar
  40. 40.
    Balaji AB, Bowles KE, Le BC, Paz-Bailey G, Oster AM, Group NS. High HIV incidence and prevalence and associated factors among young MSM, 2008. AIDS. 2013;27(2):269–78.PubMedCrossRefGoogle Scholar
  41. 41.
    Buchbinder SP, Vittinghoff E, Heagerty PJ, et al. Sexual risk, nitrite inhalant use, and lack of circumcision associated with HIV seroconversion in men who have sex with men in the United States. J Acquir Immune Defic Syndr. 2005;39(1):82–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Derrick D. Matthews
    • 1
    Email author
  • A. L. Herrick
    • 1
  • Robert W. S. Coulter
    • 1
  • M. Reuel Friedman
    • 2
  • Thomas C. Mills
    • 3
  • Lisa A. Eaton
    • 4
  • Patrick A. Wilson
    • 5
  • Ron D. Stall
    • 1
  • The POWER Study Team
  1. 1.Department of Behavioral and Community Health SciencesUniversity of Pittsburgh Graduate School of Public HealthPittsburghUSA
  2. 2.Department of Infectious Diseases and MicrobiologyUniversity of Pittsburgh Graduate School of Public HealthPittsburghUSA
  3. 3.Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghUSA
  4. 4.Department of Human Development and Family StudiesUniversity of ConnecticutStorrsUSA
  5. 5.Department of Sociomedical SciencesColumbia University Mailman School of Public HealthNew YorkUSA

Personalised recommendations