Ethnicity and HIV vulnerabilities among men who have sex with men in China

Ethnic affiliation can define sociocultural boundaries and contribute to the HIV vulnerabilities faced by men who have sex with men (MSM). This study investigated the influence of ethnic affiliation on HIV vulnerabilities among MSM in North China. Our study analyzed a cross-sectional survey of MSM (n?=?398) in two major North China cities. We examined associations between ethnic affiliation and (a) HIV status, (b) sexual behaviors and experiences, and (c) substance use. Compared to ethnic majority Han MSM: MSM belonging to ethnic minority groups of South China had significantly greater odds of HIV infection (AOR: 7.40; 95% CI: 2.33–23.47) and experience of forced sex (AOR: 3.27; 95% CI: 1.12–9.52). Compared to ethnic majority Han MSM, Ethnic Hui MSM had significantly lower odds of condomless anal sex (AOR: 0.41; 95% CI: 0.21–0.82) and significantly greater odds of circumcision (AOR: 2.62; 95% CI: 1.24–5.51). HIV prevalence and riskier sexual behaviors among MSM in China appear to vary significantly by ethnic affiliation. Current epidemiological practices of aggregating all ethnic minority groups in China into a single category may be masking important interethnic differences in HIV risk, and precluding opportunities for more culturally appropriate interventions.     

HIV and HCV testing at clinical encounters among people who inject drugs, 2013–2018—Opportunities for increased testing and prevention

People who inject drugs (PWID) with unsafe injection practices have substantial risk for HIV and hepatitis C virus (HCV) infections. We describe frequency of, and factors associated with, HIV and HCV testing during clinical encounters with PWID. Inpatient and Emergency Department clinical encounters at an Atlanta hospital were abstracted from medical records spanning January 2013–December 2018. We estimated frequency of HIV and HCV testing during injection drug use (IDU)-related encounters among PWID without previous diagnoses. We assessed associations between patient factors and testing using generalized estimating equations models. HIV testing occurred in 39.3% and HCV testing occurred in 17.1% of eligible IDU-related encounters. Testing was more likely in IDU-related encounters during 2017–2018 than in encounters during 2013–2014; (HIV, AOR = 2.14, 95% CI, 1.32–3.49, p < .01). Testing was less likely among Black/African American patients compared to White patients (adjusted odds ratio [AOR]: HIV, AOR = 0.48, 95% confidence interval [CI], 0.33–0.72, p < .01); HCV, AOR = 0.41, 95% CI, 0.24–0.70, p < .01). This difference may be attributable to recent testing among Black patients in non-IDU related encounters. HIV and HCV testing improved over time; however, missed opportunities for testing still existed. Strategies should aim to improve equitable HIV and HCV testing among PWID.     

Mindfulness,Mental Health and HIV Outcomes Among Female Sex Workers in the Dominican Republic and Tanzania

We examined the relationship between mindfulness, mental health and HIV outcomes among female sex workers (FSW) from the Dominican Republic (DR) (n?=?201) and Tanzania (n?=?208) using cross-sectional survey and biologic data. We employed stratified multivariate linear and logistic regression. Depression was associated with lower odds of ART adherence in the DR (AOR 0.25, 95% CI: 0.08–0.78) and of viral suppression in Tanzania (AOR 0.49, 95% CI: 0.24–0.97). In both countries, mindfulness was associated with lower odds of moderate to severe depression (AOR 0.82, 95% CI: 0.76–0.88 for the DR; AOR 0.85, 95% CI: 0.77–0.95 for Tanzania). In the DR, mindfulness was associated with lower odds of anxiety (AOR 0.83, 95% CI: 0.77–0.89), lower HIV stigma (β?=?? 0.28 per unit change, 95% CI: ? 0.37 to ? 0.19) and greater odds of viral suppression (AOR 1.09, 95% CI: 1.02–1.15). Findings demonstrate the potential of tailored mindfulness interventions to improve mental health and HIV outcomes among FSW.

     

High Uptake of HIV Testing in a Cohort of Male Injection Drug Users in Delhi, India: Prevalence and Correlates of HIV Infection

We report baseline findings from a longitudinal cohort study to examine HIV incidence, high-risk injection and sexual behaviors of 3,792 male injection drug users (IDUs) in Delhi. The majority (95.4 %) accepted HIV testing; HIV prevalence was 21.9 %. In multivariate analysis, belonging to states adjacent to Delhi (AOR: 1.23; 95 % CI: 1.07–1.52), earning INR 500–1,500 (AOR: 2.38; 95 % CI: 1.43–3.96); duration of drug use 2–5 years (AOR: 2.02; 95 % CI: 1.09–3.73), 6–10 years (AOR: 2.81; 95 % CI: 1.55–5.11), ≥11 years (AOR: 3.35; 95 % CI: 1.84–6.11); prior HIV testing (AOR: 1.60; 95 % CI: 1.35–1.91), self-reported risky-injection behavior (AOR: 1.60; 95 % CI: 1.33–1.92), and utilization of harm-reduction services (AOR: 1.32; 95 % CI: 1.11–1.58) were positively associated with HIV infection. Alcohol use ≤2 times/week (AOR: 0.67; 95 % CI: 0.55–0.82) or ≥3 times/week (AOR: 0.74; 95 % CI: 0.54–1.01), unit increase in age (AOR: 0.99; 95 % CI: 0.98–1.00), ≥7 years of schooling (AOR: 0.82; 95 % CI: 0.66–1.02) and unsafe sex with any female partner (AOR: 0.69; 95 % CI: 0.55–0.86) were negatively associated with HIV infection. HIV prevalence remains high among male IDUs in Delhi. HIV prevention programs should include comprehensive package of services for IDUs.     

Successes and gaps in uptake of regular,voluntary HIV testing for hidden street- and off-street sex workers in Vancouver,Canada

Despite evidence globally of the heavy HIV burden among sex workers (SWs) as well as other poor health outcomes, including violence, SWs are often excluded from accessing voluntary, confidential and non-coercive health services, including HIV prevention, treatment, care and support. This study therefore assessed the prevalence and association with regular HIV testing among street- and off-street SWs in Vancouver, Canada. Cross-sectional baseline data were used from a longitudinal cohort known as “An Evaluation of Sex Worker’s Health Access” (AESHA; January 2010–July 2012). This cohort included youth and adult SWs (aged 14+ years). We used multivariable logistic regression to assess the relationship between explanatory variables and having a recent HIV test (in the last year). Of the 435 seronegative SWs included, 67.1% reported having a recent HIV test. In multivariable logistic regression analysis, having a recent HIV test remained significantly independently associated with elevated odds of inconsistent condom use with clients [adjusted (multivariable) odds ratios, AOR: 2.59, 95% confidence intervals [95% CIs]: 1.17–5.78], injecting drugs (AOR: 2.33, 95% CIs: 1.17–4.18) and contact with a mobile HIV prevention programme (AOR: 1.76, 95% CIs: 1.09–2.84) within the last six months. Reduced odds of having a recent HIV test was also significantly associated with being a migrant/new immigrant to Canada (AOR: 0.33, 95% CIs: 0.19–0.56) and having a language barrier to health care access (AOR: 0.26, 95% CIs: 0.09–0.73). Our results highlight successes of reaching SWs at high risk of HIV through drug and sexual pathways. To maximize the effectiveness of including HIV testing as part of comprehensive HIV prevention and care to SWs, increased mobile outreach and safer-environment interventions that facilitate access to voluntary, confidential and non-coercive HIV testing remain a critical priority, in addition to culturally safe services with language support.     

Socio-demographic and health associations with body mass index at the time of enrollment in HIV care in Nyanza Province,Kenya

Low body mass index (BMI) at the time of enrollment into HIV care has been shown to be a strong predictor of mortality independent of CD4 count. This study investigated socio-demographic associations with underweight (BMI < 18.5) among adults in Nyanza Province, Kenya, upon enrollment into HIV care. BMI, socio-demographic, and health data from a cross-sectional sample of 8254 women and 3533 men were gathered upon enrollment in the Family AIDS Care and Education Services (FACES) program in Nyanza Province, Kenya, between January 2005 and March 2010. Overall, 27.4% of adults were underweight upon enrollment in HIV care. Among each women [W] and men [M], being underweight was associated with younger age (W: adjusted odds ratio [AOR], 2.90; 95% confidence interval [CI], 1.85–4.55; M: AOR, 5.87; 95% CI, 2.80–12.32 for those aged 15–19 compared to ≥50 years old), less education (W: AOR, 2.92; 95% CI, 1.83–4.65; M: AOR, 1.55; 95% CI, 1.04–2.31 for primary education compared to some college/university), low CD4 count (W: AOR, 2.13; 95% CI, 1.50–3.03; M: AOR, 1.43; 95% CI, 0.76–2.70 for 0–250 compared to ≥750 cells/mm³), and poor self-reported health status (W: AOR, 1.72; 95% CI, 0.89–3.33; M: AOR, 9.78; 95% CI, 1.26–75.73 for poor compared to excellent). Among all enrollees to HIV care, low BMI was associated with male gender, lower educational attainment, younger age, and poor self-reported health. HIV care and treatment programs should consider using socio-demographic and health risk factors associated with low BMI to target and recruit patients with the goal of preventing late enrollment into care.     

Alcohol Use and Associated Sexual and Substance Use Behaviors Among Men Who Have Sex with Men in Moscow,Russia

Alcohol use is a public health problem in the Russian Federation. This study explored relationships between alcohol use and behavioral risks for HIV transmission among men who have sex with men (MSM) in Moscow, Russia. Alcohol use disorder identification test (AUDIT) scores for 1367 MSM participating in a cross-sectional survey and HIV testing were categorized to: “abstinence/low use”, “hazardous use”, “harmful use/dependency”. Multiple logistic regression models compared dependent variables for sexual and drug use behaviors across alcohol use strata. Hazardous and harmful/dependent alcohol use were significantly associated with high-risk sexual behaviors and drug use. Harmful use/dependency was associated with an increased odds of having more than five male sex partners (last 12 months; adjusted odds ratios—AOR 1.69; 95 % CI 1.25–2.27), inconsistent condom use during anal intercourse (AOR 2.19; 95 % CI 1.61–2.96) and, among those using recreational drugs, injection drug use (last month; AOR 4.38: 95 % CI 1.13–17.07) compared to abstinent/low-level users. Harmful/dependent use was marginally associated with HIV infection (AOR 1.48; 95 % CI 0.97–2.25). HIV prevention efforts for MSM in Moscow may benefit from addressing problem alcohol use to mitigate high-risk behaviors.     

HIV risk behaviors among rural stimulant users: variation by gender and race/ethnicity.

We examined data from a community sample of rural stimulant users (n = 691) in three diverse states to identify gender and racial/ethnic differences in HIV risk behaviors. Bivariate and logistic regression analyses were conducted with six risk behaviors as dependent variables: injecting drugs, trading sex to obtain money or drugs, trading money or drugs to obtain sex, inconsistent condom use, multiple sex partners, and using drugs with sex. Controlling for state, income, age, heavy drinking, and type of stimulant used, men had lower odds than women for trading sex to obtain money or drugs (adjusted odds ratio [AOR] =0.4, confidence interval [CI] = 0.28-0.59; p < .0001), greater odds than women for trading money or drugs to obtain sex (AOR = 44.4, CI = 20.30-97.09; p < .0001), greater odds than women of injecting drugs (adjusted odds ratio (AOR =1.6, CI = 1.11-2.42; p = .01), and lower odds than women of using condoms inconsistently (AOR = 0.6, CI = 0.35-0.92; p = .02); African Americans had lower odds than Whites of injecting drugs (AOR = .08, CI = 0.04-0.16; p < .0001), greater odds than Whites for trading sex to obtain money or drugs (AOR = 1.7, CI = 1.01-2.85; p = .04) and for trading money or drugs to obtain sex (AOR = 2.9, CI = 1.53-5.59; p = .001), and greater odds than Whites of using drugs with sex (AOR = 3.9, CI = 1.47-10.09; p = .006). These findings indicate HIV prevention efforts should be tailored to address gender and racial/ethnic differences in risk behaviors among rural stimulant users.     

Missed opportunities for HIV testing in health care settings among young African American men who have sex with men: implications for the HIV epidemic

Limited health care access and missed opportunities for HIV and other sexually transmitted infection (STI) education and testing in health care settings may contribute to risk of HIV infection. In 2008, we conducted a case-control study of African American men who have sex with men (MSM) in a southeastern city (Jackson, Mississippi) with an increase in numbers of newly reported HIV cases. Our aims were to evaluate associations between health care and HIV infection and to identify missed opportunities for HIV/STI testing. We queried 40 potential HIV-infected cases and 936 potential HIV-uninfected controls for participation in this study. Study enrollees included HIV-infected cases (n=30) and HIV-uninfected controls (n=95) who consented to participate and responded to a self-administered computerized survey about sexual risk behaviors and health care utilization. We used bivariate analysis and logistic regression to test for associations between potential risk factors and HIV infection. Cases were more likely than controls to lack health insurance (odds ratio [OR]=2.5; 95% confidence interval [CI]=1.1-5.7), lack a primary care provider (OR=6.3; CI=2.3-16.8), and to not have received advice about HIV or STI testing or prevention (OR=5.4; CI=1.3-21.5) or disclose their sexual identity (OR=7.0; CI=1.6-29.2) to a health care provider. In multivariate analysis, lacking a primary health care provider (adjusted odds ratio [AOR]=4.5; CI=1.4-14.7) and not disclosing sexual identity to a health care provider (AOR=8.6; CI=1.8-40.0) were independent risk factors for HIV infection among African American MSM. HIV prevention interventions for African American MSM should address access to primary health care providers for HIV/STI prevention and testing services and the need for increased discussions about sexual health, sexual identity, and sexual behaviors between providers and patients in an effort to reduce HIV incidence and HIV-related health disparities.     

The Impact of Discrimination on the Mental Health of Trans*Female Youth and the Protective Effect of Parental Support

Significant health disparities exist for transgender female (trans*female) youth. We assessed differences in mental health outcomes based on exposure to discrimination among transgender female youth in the San Francisco Bay Area aged 16–24 years. Youth were recruited using a combination of respondent driven sampling with online and social media methods. Logistic regression models were used to estimate odds ratios for the mental health outcomes, comparing levels of discrimination and levels of resiliency promoting protective factors among sexually active youth in the sample (N = 216). High transgender-based discrimination was significantly associated with greater odds of PTSD (AOR, 2.6; 95 % CI 1.4–5.0), depression (AOR, 2.6; 95 % CI 1.2–5.9), and stress related to suicidal thoughts (AOR 7.7, 95 % CI 2.3–35.2). High racial discrimination was significantly associated with greater odds of psychological stress (AOR 3.6; 95 % CI 1.2–10.8), PTSD (AOR 2.1; 95 % CI 1.1–4.2) and stress related to suicidal thoughts (AOR 4.3, 95 % CI 1.5–13.3). Parental closeness was related to significantly lower odds of all four mental health outcomes measured, and intrinsic resiliency positively reduced risk for psychological stress, PTSD, and stress related to suicidal thoughts. Transgender and racial discrimination may have deleterious effects on the mental health of trans*female youth. Interventions that address individual and intersectional discrimination and build resources for resiliency and parental closeness may have success in preventing mental health disorders in this underserved population.     

Evidence of increased STI/HIV-related risk behavior among male perpetrators of intimate partner violence in Guatemala: results from a national survey

Intimate partner violence (IPV) is a significant public health problem with a demonstrated link to increased sexually transmitted infection (STI)/HIV-related risk and vulnerability. While IPV is an important issue in Central America, the link to STI/HIV risk has not been explored in this region. In this study, the relationship between emotional and physical/sexual IPV and the STI/HIV-related risk behaviors of sex worker patronage and infidelity is assessed among male IPV perpetrators using data from a national survey conducted in 2009 in Guatemala (n = 4773 married/partnered men). Bivariate associations between background characteristics and emotional and physical IPV perpetration were explored. Logistic regression models were run to test associations between IPV for each sexual risk behavior. Perpetration of emotional and physical/sexual IPV was more common among married/partnered men who were older than 24, had more education, lived in urban areas, or were in common law versus married unions. Reports of past-year emotional IPV perpetration increased as wealth quintile increased. After adjusting for demographics and other characteristics, physical/sexual IPV perpetration was associated with past-year infidelity (AOR 1.9, 95% CI: 1.1–3.6). Lifetime emotional IPV (AOR 1.4, 95% CI: 1.1–1.7) and physical/sexual IPV 1.6 (95% CI 1.2–2.0) were positively associated with a history of sex worker patronage. Endorsement of traditional gender role norms showed a marginally positive association with past-year infidelity in the adjusted model (AOR 1.3, 95% CI 1.0–1.8). The study findings from Guatemala reinforce the growing evidence globally that male IPV perpetrators are more likely to engage in risky sexual behavior, including sex worker patronage and main partner infidelity. The concurrency of violence and increased STI/HIV risk may compound the health risks for female victims of IPV who also face injury and psychological trauma. Integration of prevention and screening of IPV and STI/HIV prevention services should be adopted in Guatemala and other similar contexts.     

HIV testing among youth in a high-risk city: prevalence,predictors, and gender differences

While HIV is prevalent among adolescents and young adults, testing levels remain low and little is known about gender differences in HIV testing. The objectives of this study were to describe the prevalence of past-year HIV testing and evaluate associations between HIV testing and individual- and partner-level factors by gender among heterosexually experienced youth (15–24 years) in Baltimore, Maryland (N = 352). Past-year HIV testing was prevalent (60.1%) and differed by gender (69.4% among women vs. 49.6% among men, p = 0.005). For women, African-American race (AOR 3.09) and recent older partner by ≤2 years (AOR 4.04) were significantly associated with testing. Among men, only African-American race was associated with testing (OR 4.23), with no patterns identified based on risk behavior or perceived partner risk. HIV testing among adolescent and young adults was prevalent in this highly affected urban area. Findings emphasize the value of a gender lens, and provide direction for optimizing engagement in HIV testing.     

What Prevents Central Asian Migrant Workers from Accessing HIV Testing? Implications for Increasing HIV Testing Uptake in Kazakhstan

Several barriers prevent key populations, such as migrant workers, from accessing HIV testing. Using data from a cross-sectional study among Central Asian migrant workers (n = 623) in Kazakhstan, we examined factors associated with HIV testing. Overall, 48% of participants had ever received an HIV test. Having temporary registration (AOR 1.69; (95% CI [1.12–2.56]), having an employment contract (AOR 2.59; (95% CI [1.58–4.23]), being able to afford health care services (AOR 3.61; (95% CI [1.86–7.03]) having a medical check-up in the past 12 months (AOR 1.85; 95% CI [1.18–2.89]), and having a regular doctor (AOR 2.37; 95% CI [1.20–4.70]) were associated with having an HIV test. HIV testing uptake among migrants in Kazakhstan falls far short of UNAIDS 90-90-90 goals. Intervention strategies to increase HIV testing among this population may include initiatives that focus on improving outreach to undocumented migrants, making health care services more affordable, and linking migrants to health care.     

Racial and ethnic disparities in cancer screening the importance of foreign birth as a barrier to care

CONTEXT: Racial/ethnic groups comprised largely of foreign-born individuals have lower rates of cancer screening than white Americans. Little is known about whether these disparities are related primarily to their race/ethnicity or birthplace. OBJECTIVE: To determine whether foreign birthplace explains some racial/ethnic disparities in cancer screening. DESIGN, SETTING, AND SUBJECTS: Cross-sectional study using 1998 data from the National Health Interview Survey. MAIN OUTCOME MEASURES: Completion of cervical, breast, or colorectal cancer screening. RESULTS: Of respondents, 15% were foreign born. In analyses adjusted for sociodemographic characteristics and illness burden, black respondents were as or more likely to report cancer screening than white respondents; however, Hispanic and Asian-American and Pacific Islander (AAPI) respondents were significantly less likely to report screening for most cancers. When race/ethnicity and birthplace were considered together, U.S.-born Hispanic and AAPI respondents were as likely to report cancer screening as U.S.-born whites; however, foreign-born white (adjusted odds ratio [AOR], 0.58; 95% confidence interval [CI], 0.41 to 0.82), Hispanic (AOR, 0.65; 95% CI, 0.53 to 0.79), and AAPI respondents (AOR, 0.28; 95% CI, 0.19 to 0.39) were less likely than U.S.-born whites to report Pap smears. Foreign-born Hispanic and AAPI respondents were also less likely to report fecal occult blood testing (FOBT); AORs, 0.72; 95% CI, 0.53 to 0.98; and 0.61; 95% CI, 0.39 to 0.96, respectively); and sigmoidoscopy (AORs, 0.70; 95% CI, 0.51 to 0.97; and 0.63; 95% CI, 0.40 to 0.99, respectively). Furthermore, foreign-born AAPI respondents were less likely to report mammography (AOR, 0.49; 95% CI, 0.28 to 0.86). Adjusting for access to care partially attenuated disparities among foreign-born respondents. CONCLUSION: Foreign birthplace may explain some disparities previously attributed to race or ethnicity, and is an important barrier to cancer screening, even after adjustment for other factors. Increasing access to health care may improve disparities among foreign-born persons to some degree, but further study is needed to understand other barriers to screening among the foreign-born.     

Behavioral intention to take up different types of HIV testing among men who have sex with men who were never-testers in Hong Kong

Human immunodeficiency virus (HIV) testing is an important global prevention strategy but underutilized by local men who have sex with men (MSM). This study investigated the prevalence of behavioral intention to take up HIV testing (specific or any type), in the next six months among MSM who had not been tested for HIV in the last three years (never-testers) in Hong Kong. The data was based on 141 never-testers of 430 MSM who completed the anonymous baseline telephone survey of an ongoing randomized controlled trial from January 2015 to August 2015. Only 17.7% of them showed strong intention to take up any type of HIV testing in the next six months. Adjusted analysis showed that perceived benefit of HIV testing (adjusted odds ratio [AOR]: 1.29, 95% confidence interval [CI]: 1.01, 1.66), perceived psychological barriers of HIV testing (AOR: 0.85, 95%CI: 0.73, 1.00), and perceived self-efficacy in taking up HIV testing (AOR: 1.28, 95%CI: 1.07, 1.52) were significantly associated with behavioral intention to take up any HIV testing. Perceived cue to action from non-governmental organization staff was positively associated with a marginal p-value of 0.077 (AOR: 2.37, 95%CI: 0.97, 5.77). It is warranted to strengthen perceived benefit, remove psychological barriers, and increase perceived self-efficacy related to HIV testing. Innovative and effective health promotions are greatly needed to increase HIV testing coverage among never-testers.     

Stigma and suicide among gay and bisexual men living with HIV

HIV positive gay and bisexual men (GBM) continue to struggle with the pervasiveness of HIV stigma, but little is known about the health effects of stigma. In this article, suicidal ideation and attempts are measured among GBM living with HIV, evaluating the extent to which these experiences are associated with stigma and suicide. Drawing from an online national survey of Canadian GBM completed by 7995 respondents, a sub-set of data provided by respondents self-reporting HIV-positive status was used for the current study. The associations between suicidal ideation (SI) and attempts (SA) and four measures of HIV stigma were measured: social exclusion, sexual rejection, verbal abuse and physical abuse. A total of 673 HIV-positive men completed the survey (8% of total sample). Among this group, 22% (n?=?150) reported SI and 5% (n?=?33) SA in the last 12 months. After adjusting for sociodemographic factors, SI and SA were associated with each of the four measures of HIV stigma: being excluded socially for being HIV positive (SI adjusted odds ratio, AOR 2.0 95% CI 1.4–3.1; SA AOR 3.8 95% CI 1.9–7.9), rejected as a sexual partner (SI AOR 1.6 95% CI 1.1–2.4; SA AOR 2.6 95% CI 1.1–6.0), verbally abused (SI AOR 2.9 95% CI 1.9–4.5; SA AOR 2.4 95% CI 1.1–5.1), and physically abused (SI AOR 4.5 95% CI 1.8–11.7; SA AOR 6.4 95% CI 2.0–20.1). Furthermore, experiencing multiple forms of stigma was associated with significantly increased risk of SI and SA. The authors conclude that HIV positive GBM experience significant levels of stigma that are associated with heightened risk for suicide. The findings affirm the need for targeted interventions to prevent suicide amid public health efforts to de-stigmatize HIV and mental illness.     

Racial and Ethnic Disparities in Future Testing Intentions for HIV: United States, 2007–2010: Results from the National Health Interview Survey

This study examined racial/ethnic differences in rationale for intending to test for HIV. Data were analyzed from 98,971 adults from the 2007–2010 National Health Interview Survey. An estimated 38.5 % of respondents previously tested for HIV. Testing as part of a medical checkup or procedure was the most common reason for being tested among studied racial/ethnic groups. Non-Hispanic whites (80.7 %) and non-Hispanic Asians (71.2 %) had higher proportions (p < 0.001) of respondents that have not been tested for HIV due to believing they were unlikely exposed. Non-Hispanic blacks (ARR: 2.55; 95 % CI 2.39–2.72) and Hispanics (ARR: 1.81; 95 % CI 1.68–1.95) who ever tested for HIV were significantly more likely to report positive future testing intentions compared to non-Hispanic whites. Additional efforts to increase the availability of HIV tests by making HIV testing a routine part of medical care and increasing knowledge of HIV transmission, risk-perception, and treatment may reduce racial/ethnic disparities in HIV testing.     

Racial/ethnic disparities in delayed HIV diagnosis among men who have sex with men,Florida, 2000–2014

Only about 85% of men who have sex with men (MSM) with human immunodeficiency virus (HIV) have been tested for and diagnosed with HIV. Racial/ethnic disparities in HIV risk and HIV care outcomes exist within MSM. We examined racial/ethnic disparities in delayed HIV diagnosis among MSM. Males aged ≥13 reported to the Florida Enhanced HIV/AIDS Reporting System 2000–2014 with a reported HIV transmission mode of MSM were analyzed. We defined delayed HIV diagnosis as an AIDS diagnosis within three months of the HIV diagnosis. Multilevel logistic regressions were used to estimate adjusted odds ratios (aOR). Of 39,301 MSM, 27% were diagnosed late. After controlling for individual factors, neighborhood socioeconomic status, and rural–urban residence, non-Latino Black MSM had higher odds of delayed diagnosis compared with non-Latino White MSM (aOR 1.15, 95% confidence interval [CI] 1.08–1.23). Foreign birth compared with US birth was a risk factor for Black MSM (aOR 1.27, 95% CI 1.12–1.44), but a protective factor for White MSM (aOR 0.77, 95% CI 0.68–0.87). Rural residence was a risk for Black MSM (aOR 1.79, 95% CI 1.36–2.35) and Latino MSM (aOR 1.87, 95% CI 1.24–2.84), but not for White MSM (aOR 1.26, 95% CI 0.99–1.60). HIV testing barriers particularly affect non-Latino Black MSM. Social and/or structural barriers to testing in rural communities may be significantly contributing to delayed HIV diagnosis among minority MSM.