ICAP study finds concerningly high HIV infection rates for young black gay and bisexual men in US

The HPTN 061 study showed that the overall rate of new HIV infection among black MSM in this study was 2.8% per year, a rate that is nearly 50% higher than in white MSM in the U.S. Even more alarming, HPTN 061 found that young black MSM—those 30 years of age and younger—acquired HIV infection at a rate of 5.9% per year, three times the rate among U.S. white MSM. The overall infection rate among black MSM 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. HPTN 061 was a large multi-site study of HIV and black MSM conducted in six U.S. cities, and the first to determine the rate of new HIV infection among such a large prospective cohort of U.S. black MSM (referred to as HIV incidence).

"The HPTN 061 study findings are a sobering wake-up call," said Wafaa El-Sadr, MD, MPH Co-Principal Investigator for the HPTN 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 among black MSM."

HPTN 061 Study enrolled a total of 1,553 men in six US cities: Atlanta, GA, Boston, MA, New York, NY, Los Angeles, CA, San Francisco, CA, 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 from HPTN 061, 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 study 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 success of the HPTN 061 in recruiting and retaining black MSM in a year-long study, including 97% uptake of HIV testing, answered a primary objective of the study, and paves the way for the conduct of 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 among black MSM 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 US 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 MSM.

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.

Provided by Columbia University's Mailman School of Public Health