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A Study of Perceived Racial Discrimination in Black Men Who Have Sex with Men (MSM) and Its Association with Healthcare Utilization and HIV Testing

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Abstract

In HPTN 061, a study of Black men who have sex with men (MSM), we evaluated the association of healthcare-specific racial discrimination with healthcare utilization and HIV testing among 1167 HIV-negative participants. Median age was 38 years, 41 % were uninsured, and 38 % had an annual household income <$10,000. Overall, 19 % reported healthcare-specific racial discrimination directed toward family, friend, or self; 61 % saw a healthcare provider in the previous 6 months and 81 % HIV tested within the past year. Healthcare-specific racial discrimination was positively associated with seeing a provider [adjusted odds ratio (AOR) = 1.4 (1.0, 2.0)] and HIV testing [AOR = 1.6 (1.1, 2.4)] suggesting that barriers other than racial discrimination may be driving health disparities related to access to medical care and HIV testing among Black MSM. These results contrast with previous studies, possibly due to measurement or cohort differences, strategies to overcome discrimination, or because of greater exposure to healthcare.

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Acknowledgments

The authors would like to thank Susan Buchbinder, MD with Bridge HIV, San Francisco Department of Public Health and HPTN Scholar mentor and Leo Wilton, PhD with Binghamton University and HPTN Scholar mentor; HPTN 061 Study Participants; The HPTN Scholar Program leadership team: Sten Vermund, Darrell Wheeler, Sam Griffith, Erica Hamilton, Sarah Artis, and Janet Nicotera; The Division of Infectious Diseases at Johns Hopkins; The Johns Hopkins Center for AIDS Research; HPTN 061 Protocol Co-Chairs: Beryl Koblin, PhD, Kenneth Mayer, MD, and Darrell Wheeler, Ph.D., MPH; Emory University (Ponce de Leon Center & Hope Clinic Clinical Research Sites): Carlos del Rio, Paula Frew, Christin Root, Jermel L. Wallace; Fenway Institute at Fenway Health: Kenneth Mayer, Benjamin Perkins, Kelvin Powell, Benny Vega; George Washington University School of Public Health and Health Services: Manya Magnus, Alan Greenberg, Jeanne Jordan, Irene Kuo, Gregory Phillips II, Christopher Watson; Harlem Prevention Center: Sharon Mannheimer, Avelino Loquere Jr.; New York Blood Center: Beryl Koblin, Krista Goodman, Hong Van Tieu; San Francisco Department of Public Health: Susan P. Buchbinder, Michael Arnold, Chadwick Campbell, Mathew Sanchez; University of California Los Angeles (UCLA): Steven J. Shoptaw, Christopher Hucks-Ortiz; HPTN Coordinating and Operations Center (CORE), FHI 360; Sam Griffith, Erica Hamilton, LaShawn Jones, Georgette King, Jonathan Paul Lucas, Teresa Nelson; HPTN Network Laboratory, Johns Hopkins Medical Institute: Sue Eshleman, Vanessa Cummings; HPTN Statistical and Data Management Center, Statistical Center for HIV/AIDS Research and Prevention (SCHARP): Lei Wang, Corey Kelly, Ting-Yuan Liu; Division of AIDS (DAIDS) at the U.S. National Institutes of Health (NIH): Jane Bupp, Vanessa Elharrar; Additional HPTN 061 Protocol Team Members: Darrell Wheeler (co-chair), Sheldon Fields, Kaijson Noilmar, Steven Wakefield; Other HPTN 061 Contributors: Black Gay Research Group, HPTN Black Caucus, Kate MacQueen, Leo Wilton. HPTN 061 grant support provided by the National Institute of Allergy and Infectious Disease (NIAID), National Institute on Drug Abuse (NIDA) and National Institute of Mental Health (NIMH): Cooperative Agreements UM1 AI068619, UM1 AI068617, and UM1 AI068613. Additional site funding—Fenway Institute CRS: Harvard University CFAR (P30 AI060354) and CTU for HIV Prevention and Microbicide Research (UM1 AI069480); George Washington University CRS: District of Columbia Developmental CFAR (P30 AI087714); Harlem Prevention Center CRS and NY Blood Center/Union Square CRS: Columbia University CTU (5U01 AI069466) and ARRA funding (3U01 AI069466-03S1); Hope Clinic of the Emory Vaccine Center CRS and The Ponce de Leon Center CRS: Emory University HIV/AIDS CTU (5U01 AI069418), CFAR (P30 AI050409) and CTSA (UL1 RR025008); San Francisco Vaccine and Prevention CRS: ARRA funding (3U01 AI069496-03S1, 3U01 AI069496-03S2); UCLA Vine Street CRS: UCLA Department of Medicine, Division of Infectious Diseases CTU (U01 AI069424).

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Authors and Affiliations

  1. Division of Infectious Diseases, Johns Hopkins University, 725 N. Wolfe Street, Suite 218A, Baltimore, MD, 21205, USA

    R. Irvin

  2. Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA

    R. Irvin, H. Scott & S. Buchbinder

  3. Department of Human Development, Binghamton University, Binghamton, NY, USA

    L. Wilton

  4. Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA

    H. Scott

  5. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    G. Beauchamp & L. Wang

  6. Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA

    J. Betancourt

  7. San Francisco AIDS Foundation, San Francisco, CA, USA

    M. Lubensky

  8. Rollins School of Public Health of Emory University, Atlanta, GA, USA

    J. Wallace

  9. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA

    S. Buchbinder

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  1. R. Irvin
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  4. G. Beauchamp
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  9. S. Buchbinder
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Correspondence to R. Irvin.

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On behalf of HPTN 061.

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Irvin, R., Wilton, L., Scott, H. et al. A Study of Perceived Racial Discrimination in Black Men Who Have Sex with Men (MSM) and Its Association with Healthcare Utilization and HIV Testing. AIDS Behav 18, 1272–1278 (2014). https://doi.org/10.1007/s10461-014-0734-y

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