The HPTN 061 study showed that the overall rate of new HIV infection among black gay and bisexual men was 2.8% per year, a rate that is nearly 50% higher than among white gay and bisexual men in the U.S. Even more alarming, the study found that those age 30 and younger were becoming infected at a rate of 5.9% per year—three times the rate among their white counterparts.
The overall infection rate among black gay and bisexual men in this U.S study is comparable to the rate seen in the general populations of countries in sub-Saharan Africa hardest hit by the HIV epidemic.
The large multi-site study was conducted in six U.S. cities, and is the first to determine the rate of new HIV infection (referred to as HIV incidence) among such a large prospective cohort of U.S. black gay and bisexual men.
“The HPTN 061 study findings are a sobering wake-up call,” said Wafaa El-Sadr, MD, MPH, co-principal investigator and director of ICAP at Columbia University’s Mailman School of Public Health. “These results, and others to be garnered from further analysis of the study, highlight the enormity of the challenges ahead and offer important insights into how to design research studies and programs for prevention of HIV in this population.”
The study enrolled a total of 1,553 men in six U.S. cities: Atlanta, Boston, New York, Los Angeles, San Francisco, and Washington, D.C. The Harlem Prevention Center, ICAP at Columbia University’s clinical research site, dedicated to addressing the impact of HIV in New York City’s medically underserved communities, was one of two New York City sites conducting the study. The Harlem Prevention Center enrolled 154 participants with excellent follow-up of participants for the 12 month duration of the study.
The HIV incidence results, presented today at the XIX International AIDS Conference in Washington, D.C., are among the first findings to come out of the study. Other early analyses show that HIV infection in this population was associated with very high rates of untreated sexually transmitted infections and with poverty. Of the men who indicated that they were HIV-negative or were unaware of their HIV status at the time of enrollment in the study and who agreed to have an HIV test at time of enrollment, 12% were HIV-positive. This finding suggests that not enough men in this population are receiving HIV testing. All HIV-infected study participants were referred for HIV care and treatment services. During the study, all participants were offered the chance to work with “peer health navigators” to provide support and to assist them with access to needed services. In addition, they were provided with condoms, testing and referral treatment of sexually transmitted infections, risk reduction counseling and other standard HIV prevention services.
The study’s success in recruiting and retaining black gay and bisexual men –including 97% uptake of HIV testing—answered a primary objective of the study, and paves the way for future HIV prevention research.
Sharon Mannheimer, MD, who directed the study at the Harlem Prevention Center, said, “These results are an opportunity to understand how to address critical issues in this community. It is especially important that we consider social factors that contribute to HIV risk, such as poverty and unemployment, moving forward.”
While further analysis of data from the study is ongoing to assess how HIV risk in this population might be affected by factors such as childhood experiences, social and sexual networks, discrimination, and barriers to health care, these findings can be used to help inform decisions by local policy and public health officials when HIV prevention resources are allocated in major U.S. cities. This study also provides support for future programs to be developed that address multi-level factors including individual, community, and structural influences that have an impact on among black gay and bisexual men.
The HPTN 061 study was conducted between 2009-2011 and is funded by the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute on Drug Abuse (NIDA), and the National Institute of Mental Health (NIMH).
The HIV Prevention Trials Network (HPTN) is a worldwide collaborative clinical trials network that develops and tests the safety and efficacy of primarily non-vaccine interventions designed to prevent the acquisition and transmission of HIV. The HPTN research agenda is focused primarily on reduction of HIV transmission and acquisition through the use of ART for HIV-infected persons and ARVs as pre-exposure prophylaxis (PrEP) for HIV-negative persons for HIV prevention, reducing the impact of behavioral and biologic co-factors that increase risk of infection, treatment of substance use (particularly injection drug use), behavioral risk reduction interventions, and structural interventions. The highest priority of the HPTN is to develop and implement combination prevention strategies that demonstrate a significant and measurable reduction in HIV incidence in a variety of populations and epidemic settings.
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