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Very High HIV Incidence and Associated Risk Factors in a Longitudinal Cohort Study of Diverse Adolescent and Young Adult Men Who Have Sex with Men and Transgender Women

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Abstract

To report HIV incidence and associated factors among young men who have sex with men (YMSM) and transgender women (TW). Data were collected February 2015 to July 2018 in the RADAR longitudinal cohort study of YMSM/TW aged 16–29 years (N = 1093). Data included tests for HIV and rectal STIs and self-reported sexual behaviors and networks characteristics. HIV incidence rates were 2.91 per 100 person years (44 seroconversions among 1513 person years). Incidence was significantly higher in Black participants than white (IRR 8.81; 95% CI 2.72–45.26) and Latinx (IRR 3.15; 1.49–7.28) participants, but no significant differences by gender identity were found. Testing positive for rectal STIs (HR 2.50; 95% CI 1.27–4.92) and sex with a partner from a high HIV incidence community area (HR 2.46; 95% CI 1.19–5.07) were associated with higher incidence. HIV incidence was very high and Black YMSM/TW experienced higher HIV incidence attributable to partner race and geographic residence. Rectal STIs were associated with increased HIV incidence.

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Notes

  1. To increase comparability of annual incidence estimates values were converted published estimates per 100,000 people to estimates per 100 people by dividing numerator by 1000.

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Acknowledgements

This study was funded by the National Institute on Drug Abuse (U01DA036939). We acknowledge the support of the Third Coast Center for AIDS Research (P30AI117943) and the Northwestern University Clinical and Translational Sciences Institute (UL1TR001422). We thank the participants in the RADAR study for sharing their experiences. We acknowledge the contributions of the RADAR study staff, particularly Antonia Clifford, Justin Franz, Roky Truong, Christian Castro, and Hannah Hudson.

Funding

This study was funded by the National Institute on Drug Abuse (U01DA036939).

Author information

Authors and Affiliations

  1. Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA

    Brian Mustanski, Daniel T. Ryan, Michael E. Newcomb, Richard T. D’Aquila & Margaret Matson

  2. Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Brian Mustanski, Daniel T. Ryan, Michael E. Newcomb & Margaret Matson

  3. Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Richard T. D’Aquila

  4. Northwestern Institute for Sexual and Gender Minority Health and Wellbeing, 625 N Michigan Ave, Suite 1400, Chicago, IL, 60611, USA

    Brian Mustanski

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  1. Brian Mustanski
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Correspondence to Brian Mustanski.

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Appendix

Appendix

Comparison of Point of Care and Laboratory 4th Generation HIV Tests

Methods

For the first nine months of the study, laboratory confirmation was conducted on all participants, regardless of result, to assess sensitivity and specificity of this diagnostic tool. After this evaluation period, laboratory confirmation was only conducted on participants with a reactive rapid test result. Laboratory confirmation followed the Centers for Disease Control and Prevention (CDC) guidelines for HIV testing [24].

Results

HIV rapid testing as described in primary methods, with follow-up laboratory confirmation, was conducted on 579 specimens of which 13.6% (n = 79) were confirmed to be infected with HIV. Sensitivity, specificity and accuracy of the rapid test was 97.5% (95% CI 94.0–100.0%), 99.8% (95% CI 99.4–100.0%) and 99.5% (95% CI 98.9–100.0%) respectively. Two false negative cases were found and both came from participants who were on antiretroviral therapy (ART). A single false positive case was verified based on the results of a HIV-1 nucleic acid amplification test. Of the 77 true positive cases, zero tested reactive for free HIV-1 p24 antigen.

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Mustanski, B., Ryan, D.T., Newcomb, M.E. et al. Very High HIV Incidence and Associated Risk Factors in a Longitudinal Cohort Study of Diverse Adolescent and Young Adult Men Who Have Sex with Men and Transgender Women. AIDS Behav 24, 1966–1975 (2020). https://doi.org/10.1007/s10461-019-02766-4

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