Gay black men with housing, social support less likely to be part of HIV transmission “clusters”
With the lifetime risk of HIV for black gay men nearing 50% in the U.S., public health experts are keen to identify what’s putting young gay black men at higher risk—and figure out what can be done to protect young gay black men from HIV.
A new study, by Ethan Morgan, PhD and colleagues, tried to answer some of these questions with research that included young African American and black men who have sex with men living in the South side of Chicago. The researchers studied HIV “transmission clusters,” which are groups of people living with HIV who are linked by genetically similar strains of HIV (and therefore known to have transmitted HIV to one another).
“This method of studying HIV transmission clusters allows us to observe cluster growth and formation and direct resources in a more efficient manner,” explained Morgan. “For example, if we are able to determine that many individuals in an HIV transmission cluster have also been using intravenous drugs such as opioids, we are then able to better target prevention resources to prevent further transmission.”
In the study, the researchers wanted to find out what life experiences put people at higher risk of being part of a transmission cluster. And, they were interested in identifying the factors that are associated with someone not being part of an HIV transmission cluster (which may have a protective effect).
The people included in the study
The men in the study were between the ages of 16 and 29 and reported oral or anal sex with another man in the previous 24 months. The final sample included 86 men who were HIV-positive, 36% who were members of a transmission cluster. (The researchers were able to identify a total of 9 clusters total in the sample.)
Housing instability increased risk
Housing instability was associated with being part of large HIV transmission clusters. This aligns with previous research, the authors explained, which has shown homelessness to be associated with HIV risk among people who use substances and also survival sex (which may increase HIV risk).
“While engaging those YBMSM [young black men who have sex with men] who perceive themselves as homeless in HIV prevention services may aid in disrupting HIV transmission clusters, these individuals may be more impacted through structural interventions vis-à-vis stable housing,” the authors said. Said another way—HIV prevention among young men experiencing homelessness may be most effective when it includes help finding stable housing.
Social support was protective
Interestingly, having more “confidants” was associated with less risk of being part of an HIV transmission cluster. The researchers asked participants about the people in their life that they could talk about important things with, and used the number of confidants as a measure of social support. “Greater social support in one’s network plays a protective role in the movement of HIV through transmission networks of YBMSM,” they said.
“We were excited to see that having a stronger support network (a higher number of confidants) is quite beneficial in terms of reducing your chances of being in an HIV transmission cluster,” said Morgan. It’s possible, he said, that those participants may feel more comfortable with confiding in or discussing HIV prevention methods with their friends or family, which in turn reduces HIV risk.
Morgan, E. and colleagues. Determinants of HIV phylogenetic clustering in Chicago among young black men who have sex with men from the uConnect cohort. JAIDS, July 2017.
Read more about HIV risk among men who have sex with men of color on BETA.