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Structural Determinants of Black MSM HIV Testing Coverage (2011–2016)

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Abstract

Over 30 years into the US HIV/AIDS epidemic, Black men who have sex with men (BMSM) continue to carry the highest burden of both HIV and AIDS cases. There is then, an urgent need to expand access to HIV prevention and treatment for all gay and bisexual men, underscoring the importance of the federal initiative ‘Ending the Epidemic: A Plan for America’. This research examines structural factors associated with BMSM HIV testing coverage over time (2011–2016) in 85 US Metropolitan Statistical Areas (MSAs). We calculated MSA-specific annual measures of BMSM HIV testing coverage (2011–2016). Variables suggested by the Theory of Community Action (i.e., need, resource availability, institutional opposition and organized support) were analyzed as possible predictors of coverage using multilevel modeling. Relationships between BMSM HIV testing and the following covariates were positive: rates of BMSM living with HIV (b = 0.28), percent of Black residents employed (b = 0.19), Black heterosexual testing rate (b = 0.46), health expenditures per capita (b = 0.16), ACT UP organization presence in 1992 (b = 0.19), and syringe service presence (b = 0.12). Hard drug arrest rates at baseline (b = − 0.21) and change since baseline (b = − 0.10) were inversely associated with the outcome. Need, resources availability, organized support and institutional opposition are important determinants of place associated with BMSM HIV testing coverage. Efforts to reduce HIV incidence and lessen AIDS-related disparities among BMSM in the US require improved and innovative HIV prevention approaches directed toward BMSM including a fuller understanding of structural factors that may influence place variation in BMSM testing patterns and risk behavior in places of high need.

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Notes

  1. To create this variable, we examined state policies pertinent to gay/lesbian citizens and created a dichotomous measure of policies over time (from 1999 to 2014) using a growth mixture model. The growth mixture model was based on the number of protective laws in each year and as well as presence or absence two discriminatory laws (LGBT marriage bans and HIV criminalization laws). Policy coding was performed and made available to the authors by LGBT Movement Advancement Project (MAP, lgbtmap.org). The eight laws protective of sexual minorities were those that protected lesbian/gay citizens in the domains of: (1) employment, (2) public accommodations, and (3) housing non-discrimination laws as well as (4) adoption, (5) medical decision making, (6) school anti-bullying, (7) marriage, and (8) anti-hate crime laws. For each year we summed the number of protective laws and subtracted the number of discriminatory laws. We then used a growth mixture model to create the state law variable and assign states to one of two classes. One class reflected states that increasingly passed laws protective of sexual minorities from 1999 to 2014 and the other class included states that did not pass these laws. The state variable was mapped onto MSAs and for multistate MSAs we assigned the state where the majority of the MSA population lived in 2010.

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Acknowledgements

This research was supported by the National Institutes of Health: “Metropolitan Trajectories of HIV Epidemics and Responses in US Key Populations” (DA037568; HFL Cooper, SR Friedman, R Stall, M Hatzenbuehler MPIs). We thank the Centers and Disease Control and Prevention, Division of HIV/AIDS Prevention Program Evaluation Branch for processing our data request on HIV testing events from the Expanded Testing Program Initiative database (Janet Heitgerd; Guoshen Wang; Lisa Belcher).

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Authors and Affiliations

  1. Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA

    Barbara Tempalski

  2. Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA

    Stephanie Beane, Hannah L. F. Cooper & Umedjon Ibragimov

  3. Department of Population Health, New York University, 550 First Avenue, New York, NY, 10016, USA

    Samuel R. Friedman

  4. Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY, 10032, USA

    Sarah C. McKetta

  5. Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, 1603 W. Taylor Street, Chicago, IL, 60612, USA

    Leslie D. Williams

  6. University of Pittsburgh School of Public Health, 130 De Soto St., Pittsburgh, PA, 15261, USA

    Ronald Stall

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Tempalski, B., Beane, S., Cooper, H.L.F. et al. Structural Determinants of Black MSM HIV Testing Coverage (2011–2016). AIDS Behav 24, 2572–2587 (2020). https://doi.org/10.1007/s10461-020-02814-4

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