Abstract
Black gay, bisexual, and other Black sexual minority men (BSMM) continue to experience some of the largest sexual health disparities in the U.S. Engaging BSMM in PrEP is crucial to improving sexual health outcomes and reducing disparities. However, knowledge of the profiles of sexual risk and PrEP initiation among this group is limited. This study used latent class analysis to identify HIV risk and PrEP initiation patterns among BSMM in the HPTN 073 Study (n = 226). Guided by current Centers for Disease Control screening guidelines, latent class indicators included relationship status, condom use, number of sexual partners, substance use, sexually transmitted infection (STI) history, and partner HIV status. Age and PrEP initiation were used in a multinomial regression to identify correlates of class membership. Three latent classes were identified: Single, Condomless Partners, Single, Multiple Partners, and Serodiscordant Partners. Single, Condomless Partners had the highest conditional probabilities of having greater than three male partners, substance use before sex, and receiving an STI diagnosis. Serodiscordant Partners had a 100% conditional probability of condomless sex and having a male partner living with HIV. BSMM who initiated PrEP were less likely to be classified as Single, Condomless Partners than Serodiscordant Partners (AOR = 0.07, 95% CI = 0.02, 0.66). Findings support the need for culturally relevant tailored and targeted messaging for BSMM with multiple sexual risk indicators.
Similar content being viewed by others
References
Asparouhov, T., & Muthén, B. (2014). Auxiliary variables in mixture modeling: Three-step approaches using Mplus. Structural Equation Modeling: A Multidisciplinary Journal, 21(3), 329–341. https://doi.org/10.1080/10705511.2014.915181
Bakk, Z., Tekle, F. B., & Vermunt, J. K. (2013). Estimating the association between latent class membership and external variables using bias-adjusted three-step approaches. Sociological Methodology, 43(1), 272–311. https://doi.org/10.1177/0081175012470644
Cahill, S., Taylor, S. W., Elsesser, S. A., Mena, L., Hickson, D., & Mayer, K. H. (2017). Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care, 29(11), 1351–1358. https://doi.org/10.1080/09540121.2017.1300633
Centers for Disease Control and Prevention. (2017). Effectiveness |HIV Basics|HIV/AIDS|CDC. https://www.cdc.gov/hiv/basics/prep/prepeffectiveness.html
Centers for Disease Control and Prevention. (2018). US Public Health Service: Pre-exposure prophylaxis for the prevention of HIV infection in the United States—2017 Update: A clinical practice guideline. Retrieved March, 2018 from https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf
Centers for Disease Control and Prevention. (2020). HIV and African American gay and bisexual men | HIV by group | HIV/AIDS | CDC. Retrieved October 23, 2020 from https://www.cdc.gov/hiv/group/msm/bmsm.html
Dangerfield II, D. T., Carmack, C. C., Gilreath, T. D., & Duncan, D. T. (2018a). Latent classes of sexual positioning practices and sexual risk among men who have sex with men in Paris, France. AIDS and Behavior, 22(12), 4001–4008. https://doi.org/10.1007/s10461-018-2267-2
Dangerfield II, D. T., Carmack, C. C., Gilreath, T. D., & Duncan, D. T. (2020). Latent classes of partner-seeking venues and sexual risk among men who have sex with men in Paris, France. International Journal of STD & AIDS, 31(6), 502–509. https://doi.org/10.1177/0956462419899012
Dangerfield II, D. T., Craddock, J. B., Bruce, O. J., & Gilreath, T. D. (2017a). HIV testing and health care utilization behaviors among men in the United States: A latent class analysis. Journal of the Association of Nurses in AIDS Care, 28(3), 306–315. https://doi.org/10.1016/j.jana.2017.02.001
Dangerfield II, D. T., Harawa, N. T., Smith, L. R., Jeffries, W. L., Baezconde-Garbanati, L., & Bluthenthal, R. (2018b). Latent classes of sexual risk among Black men who have sex with men and women. Archives of Sexual Behavior, 47(7), 2071–2080. https://doi.org/10.1007/s10508-017-1142-y
Dangerfield II, D. T., Ober, A. J., Smith, L. R., Shoptaw, S., & Bluthenthal, R. N. (2018c). Exploring and adapting a conceptual model of sexual positioning practices and sexual risk among HIV-negative Black men who have sex with men. Journal of Sex Research. https://doi.org/10.1080/00224499.2018.1433287
Dangerfield II, D. T., Smith, L. R., Williams, J., Unger, J., & Bluthenthal, R. (2017b). Sexual positioning among men who have sex with men: A narrative review. Archives of Sexual Behavior, 46(4), 869–884. https://doi.org/10.1007/s10508-016-0738-y
Eisinger, R. W., Dieffenbach, C. W., & Fauci, A. S. (2019). HIV viral load and transmissibility of HIV infection: Undetectable equals untransmittable. Journal of the American Medical Association, 321(5), 451–452. https://doi.org/10.1001/jama.2018.21167
Ezennia, O., Geter, A., & Smith, D. K. (2019). The PrEP care continuum and black men who have sex with men: A scoping review of published data on awareness, uptake, adherence, and retention in PrEP care. AIDS and Behavior, 23(10), 2654–2673. https://doi.org/10.1007/s10461-019-02641-2
Gilreath, T. D., Astor, R. A., Estrada, J. N., Johnson, R. M., Benbenishty, R., & Unger, J. B. (2014). Substance use among adolescents in California: A latent class analysis. Substance Use & Misuse, 49(1–2), 116–123. https://doi.org/10.3109/10826084.2013.824468
Grant, R. M., Anderson, P. L., McMahan, V., Liu, A., Amico, K. R., Mehrotra, M., Hosek, S., Mosquera, C., Casapia, M., Montoya, O., Buchbinder, S., Veloso, V. G., Mayer, K., Chariyalertsak, S., Bekker, L.-G., Kallas, E. G., Schechter, M., Guanira, J., Bushman, L., … Glidden, D. V. (2014). Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: A cohort study. The Lancet Infectious Diseases, 14(9), 820–829. https://doi.org/10.1016/S1473-3099(14)70847-3
Hall, G., Li, K., Wilton, L., Wheeler, D., Fogel, J., Wang, L., & Koblin, B. (2015). A comparison of referred sexual partners to their community recruited counterparts in The BROTHERS Project (HPTN 061). AIDS and Behavior, 19(12), 2214–2223. https://doi.org/10.1007/s10461-015-1005-2
Hess, K. L., Hu, X., Lansky, A., Mermin, J., & Hall, H. I. (2017). Lifetime risk of a diagnosis of HIV infection in the United States. Annals of Epidemiology, 27(4), 238–243. https://doi.org/10.1016/j.annepidem.2017.02.003
Hightow-Weidman, L. B., Magnus, M., Beauchamp, G., Hurt, C. B., Shoptaw, S., Emel, L., Piwowar-Manning, E., Mayer, K. H., Nelson, L. E., Wilton, L., Watkins, P., Whitfield, D., Fields, S. D., & Wheeler, D. (2019). Incidence and correlates of sexually transmitted infections among black men who have sex with men participating in the HIV Prevention Trials Network 073 Preexposure Prophylaxis Study. Clinical Infectious Diseases, 69, 1597–1604. https://doi.org/10.1093/cid/ciy1141
Hoots, B. E., Finlayson, T., Nerlander, L., Paz-Bailey, G., Wortley, P., Todd, J., Sato, K., Flynn, C., German, D., Fukuda, D., Doherty, R., Wittke, C., Prachand, N., Benbow, N., Jimenez, A. D., Poe, J., Sheu, S., Novoa, A., Al-Tayyib, A., & Xia, M. (2016). Willingness to take, use of, and indications for pre-exposure prophylaxis among men who have sex with men—20 US cities, 2014. Clinical Infectious Diseases, 63(5), 672–677. https://doi.org/10.1093/cid/ciw367
Irvin, R., Vallabhaneni, S., Scott, H., Williams, J. K., Wilton, L., Li, X., & Buchbinder, S. (2015). Examining levels of risk behaviors among black men who have sex with men (MSM) and the association with HIV acquisition. PLoS ONE, 10(2), e0118281. https://doi.org/10.1371/journal.pone.0118281
Lancki, N., Almirol, E., Alon, L., McNulty, M., & Schneider, J. A. (2018). Preexposure prophylaxis guidelines have low sensitivity for identifying seroconverters in a sample of young Black MSM in Chicago. AIDS, 32(3), 383–392. https://doi.org/10.1097/QAD.0000000000001710
Lanza, S. T., & Rhoades, B. L. (2011). Latent class analysis: An alternative perspective on subgroup analysis in prevention and treatment. Prevention Science, 14(2), 157–168. https://doi.org/10.1007/s11121-011-0201-1
Liu, A., Cohen, S. E., Vittinghoff, E., Anderson, P.L., Doblecki-Lewis, S., Bacon, O., Chege, W., Postle, B.S., Matheson, T., Amico, K.R. & Liegler, T. (2016). Preexposure prophylaxis for HIV infection integrated with municipal- and community-based sexual health services. JAMA Internal Medicine, 176(1), 75–84. https://doi.org/10.1001/jamainternmed.2015.4683
Maulsby, C., Millett, G., Lindsey, K., Kelley, R., Johnson, K., Montoya, D., & Holtgrave, D. (2013). HIV among black men who have sex with men (MSM) in the United States: A review of the literature. AIDS and Behavior, 18(1), 10–25. https://doi.org/10.1007/s10461-013-0476-2
Millett, G. A., Peterson, J. L., Flores, S. A., Hart, T. A., Jeffries, W. L., 4th., Wilson, P. A., Rourke, S. B., Heilig, C. M., Elford, J., Fenton, K. A., & Remis, R. S. (2012). 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. The Lancet, 380(9839), 341–348. https://doi.org/10.1016/S0140-6736(12)60899-X
Muthen, B. (2004). Latent variable analysis. In D. Kaplan (Ed.), The Sage handbook of quantitative methodology for the social sciences (pp. 345–368). Sage Publications.
Muthen, L. K., & Muthen, B. O. (2005). Statistical analysis with latent variables: User’s guide. Muthen & Muthen.
Nylund, K. L., Asparouhov, T., & Muthén, B. O. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study. Structural Equation Modeling: A Multidisciplinary Journal, 14(4), 535–569. https://doi.org/10.1080/10705510701575396
Ober, A. J., Dangerfield II, D. T., Shoptaw, S., Ryan, G., Stucky, B., & Friedman, S. R. (2017). Using a “positive deviance” framework to discover adaptive risk reduction behaviors among high-risk HIV negative Black men who have sex with men. AIDS and Behavior, 22(5), 1699–1712. https://doi.org/10.1007/s10461-017-1790-x
Rolle, C.-P., Rosenberg, E. S., Luisi, N., Grey, J., Sanchez, T., del Rio, C., Peterson, J. L., Frew, P. M., Sullivan, P. S., & Kelley, C. F. (2017a). Willingness to use pre-exposure prophylaxis among Black and White men who have sex with men in Atlanta, Georgia. International Journal of STD & AIDS, 28(9), 849–857. https://doi.org/10.1177/0956462416675095
Rolle, C.-P., Rosenberg, E. S., Siegler, A. J., Sanchez, T. H., Luisi, N., Weiss, K., Cutro, S., del Rio, C., Sullivan, P. S., & Kelley, C. F. (2017b). Challenges in translating PrEP interest into uptake in an observational study of young black MSM. JAIDS Journal of Acquired Immune Deficiency Syndromes, 76, 250–258. https://doi.org/10.1097/QAI.0000000000001497
Sullivan, P. S., Peterson, J., Rosenberg, E. S., Kelley, C. F., Cooper, H., Vaughan, A., Salazar, L. F., Frew, P., Wingood, G., DiClemente, R., del Rio, C., Mulligan, M., & Sanchez, T. H. (2014). Understanding racial HIV/STI disparities in black and white men who have sex with men: A multilevel approach. PLoS ONE, 9(3), e90514. https://doi.org/10.1371/journal.pone.0090514
Sullivan, P. S., Rosenberg, E. S., Sanchez, T. H., Kelley, C. F., Luisi, N., Cooper, H. L., Diclemente, R. J., Wingood, G. M., Frew, P. M., Salazar, L. F., Del Rio, C., Mulligan, M. J., & Peterson, J. L. (2015). Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: A prospective observational cohort study. Annals of Epidemiology, 25(6), 445–454. https://doi.org/10.1016/j.annepidem.2015.03.006
Turner, D., Lockhart, E., Wang, W., Shore, R., Daley, E. M., & Marhefka, S. L. (2020). PrEP implementation behaviors of community-based HIV testing staff: A mixed-methods approach using latent class analysis. JAIDS Journal of Acquired Immune Deficiency Syndromes, 83(5), 467–474. https://doi.org/10.1097/QAI.0000000000002289
Vallabhaneni, S., Li, X., Vittinghoff, E., Donnell, D., Pilcher, C. D., & Buchbinder, S. P. (2012). Seroadaptive practices: Association with HIV acquisition among HIV-negative men who have sex with men. PLoS ONE, 7(10), e45718. https://doi.org/10.1371/journal.pone.0045718
Volk, J. E., Marcus, J. L., Phengrasamy, T., Blechinger, D., Nguyen, D. P., Follansbee, S., & Hare, C. B. (2015). No new HIV infections with increasing use of HIV preexposure prophylaxis in a clinical practice setting. Clinical Infectious Diseases, 61(10), 1601–1603. https://doi.org/10.1093/cid/civ778
Wheeler, D. P., Fields, S. D., Beauchamp, G., Chen, Y. Q., Emel, L. M., Hightow-Weidman, L., Hucks-Ortiz, C., Kuo, I., Lucas, J., Magnus, M., Mayer, K. H., Nelson, L. E., Hendrix, C. W., Piwowar-Manning, E., Shoptaw, S., Watkins, P., Watson, C. C., & Wilton, L. (2019). Pre-exposure prophylaxis initiation and adherence among Black men who have sex with men (MSM) in three US cities: Results from the HPTN 073 Study. Journal of the International AIDS Society, 22(2), e25223. https://doi.org/10.1002/jia2.25223
Wilton, L., Koblin, B., Nandi, V., Xu, G., Latkin, C., Seal, D., Flores, S. A., & Spikes, P. (2015). Correlates of seroadaptation strategies among black men who have sex with men (MSM) in 4 US cities. AIDS and Behavior, 19(12), 2333–2346. https://doi.org/10.1007/s10461-015-1190-z
Funding
Overall support for the HPTN and the HPTN Scholars Program is provided by the National Institute of Allergy and Infectious Diseases (NIAID), National Institute on Drug Abuse (NIDA), and the National Institute of Mental Health (NIMH) under Award Number UM1AI068619. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors report no conflicts of interests.
Informed Consent
The HPTN 073 Study protocol was reviewed and approved by Institutional Review Boards of University of California at Los Angeles, The University of North Carolina at Chapel Hill, and George Washington University. All study participants provided written informed consent, and study procedures for the present analysis were approved by the Johns Hopkins School of Medicine Institutional Review Board.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Dangerfield, D.T., Kuo, I., Magnus, M. et al. Sexual Risk Profiles Among Black Sexual Minority Men: Implications for Targeted PrEP Messaging. Arch Sex Behav 50, 2947–2954 (2021). https://doi.org/10.1007/s10508-021-02066-w
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10508-021-02066-w