Why African-American Men Are At Higher Risk Of Getting HIV Infection?

According to latest statistics, African-American men who engage in unprotected sex with other men are at higher risk of getting HIV infection when compared with other races. For example, based on a study conducted in the 5 major metropolitan regions and among 2261 men, investigators identified that the prevalence of HIV in African-American MSM (men who have sex with men) is 46% compared with 17% in Hispanic MSM and 21% among white MSM (1). Even more alarming is the fact that the risk is even greater in younger African-American MSM. Based on a new study reported in the Journal of Adolescent Health (1), investigators discovered that young African-American homosexual men (aged 18-24 years) are approximately 5-times more likely to contract HIV infection when compared with white or Hispanic homosexual men.

So far little is known about the exact cause of this disparity in the prevalence of HIV, but a lot of research is being done to explore the possible risk factors.

What Are Some Factors That May Explain This High Prevalence?

Investigators suggested that several factors can play a role in explaining this strong racial disparity in the prevalence of HIV infection. For example:

Age Of Partner: It has been observed that the sex partner of most young African-American men are older and mature African-American men. On the contrary, most young men of Caucasian or Hispanic origin engaged in sexual encounters with males of their own age group (2). Since the prevalence of HIV is already fairly high in older African-American MSM, the likelihood pf contracting the infection is much higher.
Decision-Making Regarding Condom Use: The decision to use condom during an anal encounter is usually taken by the older, more powerful or more masculine partner (2). Investigators conducted interviews and surveys to discover that most young African-American homosexual men engage in unprotected sexual encounters on the demand/ pressure from the older mature partner.
Anal Sex And High risk Of Tissue Injury: The younger African-American men are usually on the receptive end, while the older partner is usually on the insertive end. This also means that the young African-American men are at greater risk of going through anal injury or trauma; thereby a higher risk of catching HIV infection in case of an unprotected encounter. According to another study, investigators proposed that the risk of HIV transmission is 18-times higher from an unprotected anal sexual encounter when compared with unprotected vaginal sex.
Anal Tissue Is More Receptive To HIV: It has been observed that anal tissues are more receptive to the HIV virus and other infectious agents when compared with vagina.
Lower Socioeconomic Status And Education: Most young African-American men lives under poor socioeconomic circumstances with limited access to quality education and healthcare resources. The rate of unemployment and drug use is also much higher in African-American men which serves as a barrier to counseling and education efforts by authorities (3).

What Can Be Done To Reduce The Prevalence Of HIV Infection In The Young African-American MSM?

According to latest data reported by Centers for Disease Control and Prevention, it was reported that the diagnoses of HIV cases in young African-American men has increased by about 87% from 2005 to 2014 (3). The report also suggested that one out of two African American men are at risk of getting diagnosed with HIV infection during their lifetime. Therefore, it is imperative to mention that there is a strong need to expand education and counseling efforts to at-risk population.

Here are some strategies that CDC is undertaking to control growing risk of HIV in the young African-American population:

Engaging and spreading awareness in African-American communities regarding the importance of early detection, screening and diagnosis of HIV.
Focusing on the preventive approach to reduce the number of cases.
Introducing and advertising campaigns like “Doing It”, “HIV Treatment Works” and “Start Talking. Stop HIV” to encourage all the adults to opt for early screening and detection of their HIV status. These interventions are expected to prevent as well as detect and treat early case of HIV in younger MSM.

References

1. Harawa, N. T., Greenland, S., Bingham, T. A., Johnson, D. F., Cochran, S. D., Cunningham, W. E., … & McFarland, W. (2004). Associations of race/ethnicity with HIV prevalence and HIV-related behaviors among young men who have sex with men in 7 urban centers in the United States. JAIDS Journal of Acquired Immune Deficiency Syndromes, 35(5), 526-536.

2. Fields, E. L., Bogart, L. M., Smith, K. C., Malebranche, D. J., Ellen, J., & Schuster, M. A. (2012). HIV risk and perceptions of masculinity among young black men who have sex with men. Journal of Adolescent Health, 50(3), 296-303.

3. Maulsby, C., Millett, G., Lindsey, K., Kelley, R., Johnson, K., Montoya, D., & Holtgrave, D. (2014). 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.