Closeted black men in US might play significant role in HIV transmission to partners

Today, Friday 7th February, is National Black HIV/AIDS Awareness Day (NBHAAD) in the USA. NBHAAD activities will encourage individuals to be tested for HIV, and to seek medical, social and psychological support services. It will emphasise that HIV/AIDS is a “state of crisis” among African- Americans.

Co-ordinated by the Centers for Disease Control and Prevention (CDC), the NBHAAD campaign is designed to strengthen community capacity for HIV prevention, and to increase the capacity of community-based organizations serving African-Americans with the intention of increasing awareness, leadership, participation and support for HIV prevention programmes and services.

The day coincides with the publication of a report from the Young Men’s Study which has analysed HIV/STI risks among men who have sex with men (MSM) who do not disclose their sexual orientation. The study covers six US cities (Baltimore, Dallas, Los Angeles, Miami, New York and Seattle) over the period 1994-2000. Data from 5,589 men aged 15-29 were included.

Participants were interviewed with a standard questionnaire, had blood drawn for testing, and were provided HIV/STI prevention counseling and referral for care. Specimens were tested for HIV and hepatitis B.

The study found that young black men were more likely than their non-black counterparts to be closeted, meaning that they have not disclosed details of their sexual preferences to others. Being closeted was not associated with an increased risk of acquiring HIV or other sexually transmitted infections, but researchers found that HIV-positive men who were not “out” about their sexuality were more likely than men who are out to report being unaware of their infection (98% versus 75%; p<0.01) as well as having had one or more female sex partners (35% versus 10%; p<0.01) and to engage in unprotected intercourse with sex partners (20% versus 5%;p=0.01).

This would suggest that public awareness campaigns that target men who are not out should be developed. Such campaigns will need to focus on reducing internalised homophobia and other factors that reduce the likelihood that these men will test for HIV and make contact with prevention services. In an accompanying editorial note the CDC state that “the data suggest that a substantial proportion of non-disclosers are infected with HIV and are at high risk for transmitting these infections to their male and female sex partners”.

A total of 637 (11%) MSM were defined as non-disclosers; of these 349 were aged 15-22 (median 22 years; interquartile range: 19-25). Black (18%), mixed-race (14%), Hispanic (13%), and Asian/Pacific Islander (10%) MSM were more likely to be non-disclosers than were white MSM (8%) (p<0.05). Among white MSM, the proportion of non-disclosers decreased with age: 12% among those aged 15-19 years, 8% among those aged 20-24 years, and 5% among those aged 25-29 years (p<0.01), but this was not observed in men from ethnic minorities.

Among men who were not out, the prevalence of HIV was higher among black men than all other racial groups combined (14% versus 5%) [AOR=2.9; CI=1.5-5.6).

Researchers suggested that “the finding that more than one in three non-disclosers reported having recent female sex partners suggests that non-disclosing MSM might have an important role in HIV/STD transmission to women. This might be particularly true for black non-disclosing MSM.”