Higher HIV rates among black MSM in the US may be linked to attitudes about homosexuality

Higher prevalence of negative attitudes about homosexuality among African-Americans than among whites may help to account for why the US AIDS epidemic has disproportionately struck African-American men who have sex with men (MSM).

Two US researchers have proposed this association on the basis of their analysis of a long-running annual survey of US households. Their study appears in as an advance online publication of the Journal of Acquired Immune Deficiency Syndromes.

Study data were drawn from the General Social Survey (GSS), a recurring cross-sectional survey that began asking respondents about their perspectives on same-sex sexual activity in 1973.

The researchers found that starting in the 1990s, there has been a sharp divergence in the proportions of blacks and whites who think that homosexuality is “always wrong.” By 2008, 72.3% of blacks held this view (95% confidence interval[CI], 65.2% – 78.5%) while only 51.7% of whites did so (95% CI, 48.7% to 54.7%).

Furthermore, among respondents who identified themselves as MSM in surveys conducted between 1991 and 2008, twice as many black MSM as white MSM expressed the belief that homosexuality is “always wrong.”

At the same time, MSM who viewed homosexuality as “always wrong” were less likely than other MSM to undergo HIV testing.

Taken together, these findings raise important questions about how homophobia may indirectly increase black men’s vulnerability to HIV. Although African-Americans make up only 13% of the US population, a quarter of all MSM diagnosed with HIV in 2007 were African-American.

For much of the 1970s and 1980s, about three-quarters of all GSS respondents thought that homosexuality was “always wrong.” A rapid decline in negative attitudes was observed during the 1990s, and by 1996, only 61.0% of respondents still held that view (95% confidence interval [CI], 58.5% – 63.5%).

Blacks have viewed homosexuality more negatively than whites have from the earliest years onward, but the gap between the two groups began to increase steadily in the mid-1990s. While there was a 6.6 percentage-point difference between the proportions of blacks and whites who disapproved of homosexuality in 1990, the difference widened to 25.3 points by 2004, then declined slightly.

The GSS is a nationally representative survey that has collected information about US adults’ attitudes and behaviors since 1972. The GSS dataset analysed in this study included 30,837 white and black respondents from 22 study cycles, the most recent in 2008.

The researchers further investigated the relationship between race and attitudes about homosexuality by conducting multivariate analyses that controlled for year of survey and demographic variables.

Black respondents and male respondents were significantly more likely than their white and female counterparts to think homosexuality was “always wrong.” This negative view was also associated with a number of other demographic factors including older age, less education and lower income.

From 1991 onward, the GSS asked a subset of survey participants about the gender of their sexual partners in the previous five years. Among men who reported having same-sex partners, there was again a racial difference in attitudes about homosexuality, with about twice as many black MSM as white MSM reporting that it was “always wrong” (57.1% versus 26.8%, p = 0.003).

If, as findings from this study and other studies have suggested, MSM with negative attitudes about homosexuality are less likely to undergo HIV testing, then racial difference in attitudes about homosexuality may have important HIV prevention implications, since receiving an HIV-positive diagnosis can lead people to modify behaviors that might transmit the virus to others.

Nonetheless, much uncertainty remains about the dynamics of racial and sexual identity, sexual risk-taking, health-seeking behavior and health outcomes. A 2007 literature review concluded that black and white MSM in the United States did not have significantly different HIV testing histories or levels of sexual risk behavior. Other research has shown that HIV-positive black MSM learn their status at a more advanced disease stage and use antiretroviral therapy less than HIV-positive white MSM.

HIV-positive black MSM may thus be more infectious overall, and as the authors of the study discussed here observe, “The fact that MSM, like heterosexuals, preferentially choose sex partners of the same race further magnifies the population-level impact of what might otherwise be relatively small differences in behavior.”

Reference

Glick SN et al. Persistence of racial differences in attitudes toward homosexuality in the United States. J Acquir Immune Defic Syndr, advance online publication, September 16, 2010. (Link to abstract and full text article here).