1. HIV/AIDS among Black Men Who Have Sex with Men: An Alarming Health Disparity
Bridget Malato, B.S.
DePaul University
Conceptual Framework
Results
Background & Significance
The Neuman Systems Model (1970) was utilized. It states that when individuals are faced with life stressors, such as discrimination, their risk taking behavior increases while their overall health decreases. The stressors that this community faces due to discrimination may lead to a decline in health-conscious decision making.. Homophobia, discrimination, economic privation, and lack of social support are all strongly correlated with an increased likelihood in engaging in unprotected anal intercourse with either a serodiscordant or sero-unknown partner, which puts this population in particular at risk for HIV 2.
A lack of health insurance and primary care provider was associated with a greater delay in testing 2,3,4. Fear of discrimination from a healthcare provider was cited as another reason for refusal to getting tested 2,3. A strong distrust of healthcare providers was also cited 3,5.
Risk factors for diagnosis were identified, such as being under the age of 30 6,7. Internalized homophobia within the black community was correlated with diagnosis 8,9 as was as was living in a rural area in the Southern portion of the US 6, 10. Lack of knowledge in transmission prevention methods was also a risk factor 4.
Two one-on-one educational sessions were conducted with BMSM on ways to decrease HIV and other STI transmissions by increasing condom usage 9 and taking pre-exposure prophylaxis (PrEP) medication as prescribed 11. Neither of these interventions were successful.
HIV treatment and life expectancy has improved immensely since AIDS epidemic of the 1980’s. People with HIV can live long and health lives with anti-retroviral medication. Incidence and prevalence of HIV/AIDS has decreased in most populations in the United States. However, black men who have sex with men (BMSM) still account for the highest number (38%), followed by Caucasians (31%) and Hispanics/Latinos (26%) 1. In 2014, African Americans accounted for 53% of the total deaths attributed to HIV/AIDS1.
Barriers to HIV Testing
Number of Common Barriers
Lack of health insurance 3
Lack of primary care provider
Fear of discrimination from provider 2
Distrust of healthcare provider
Problem & Purpose of Study
There is a gap in the literature regarding how to mitigate HIV transmission among BMSM. The purpose of this integrative literature review (IRL) is to explore the reasons why BMSM are disproportionately affected by HIV when compared to other groups of MSM (i.e. Caucasian). This was done by investigating the barriers that exist preventing BMSM from getting tested as well as the risk factors associated with BMSM testing positive for HIV.
Source: Author & Year
Study Design
Sample
Study Objectives
Data Analysis Technique
Results
Ayala, et al., 2012
Bivariate analysis of a cross-sectional survey
N=2235
Assess discrimination’s effect on sexual behavior
Chi-squared test and t-test utilized
Homophobia, racism, and financial hardship all increased risk taking behavior
Fields, et al., 2012
Semi-structured interviews
N=35
Assess how BMSM make decisions about sexual health practices (e.g. condom use)
Secondary analysis of data collected
Perceptions of masculinity in a sexual partner influenced behaviors
Sethi, et al., 2012
Logistical regression
N= 16,406
To investigate factors influencing MSM’s willingness to stick to HIV medication regiment
Logistical regression was utilized
Proportion of MSM who chose discontinue HIV medication was higher among BMSM than Caucasian
Phillips, et al., 2014
Univariate analysis
N=363
Characterize HIV testing experiences of a HIV positive MSM
Univariate analysis to analyze and bivariate analysis
BMSM were less likely to initiate HIV testing until symptoms of the illness began to appear
Balaji, et al., 2012
In-depth qualitative assessment through one-on-one interviews
N=16
Understand a sudden increase in HIV infections among young, BMSM in Jackson, MI
Qualitative analysis software for thematic analysis
Internalized homophobia was strongly correlated with increased sexual risk taking behaviors
Dorrell, et al., 2011
Case control study of BMSM in Jackson, MI
N=125
Assess links between health care, HIV status, and missed opportunities for HIV testing
A bivariate analysis and logistical regression
Lack of health insurance, primary care provider, and knowledge about STI prevention were all associated with testing positive for HIV
Jemmott, et al., 2015
One-on-one educational sessions
N=595
Discover if education on condoms and other preventative measures would lead to less risky sexual behavior
Descriptive statistics were used
Education did not seem to increase condom usage
Hoot, et al., 2014
Quantitative study
N=6483
To monitor the willingness of HIV negative MSM to initiate and maintain PrEP therapy.
An analysis was conducted with a 95% confidence interval
Study revealed that Caucasian MSM were twice as likely to utilize PrEP as BMSM.
Oster, et al., 2011
Case-control study conducted in Jackson, MI
N=25
To identify reasons for a 2007 outbreak of newly diagnosed cases of HIV among BMSM
Multivariable analysis of 25 participants and 85 controls.
Risk factors for HIV diagnoses included having older male partners and engaging in unprotected anal intercourse
Koblin, et al., 2013
A multi-component intervention program
N=1,164
To identify factors that lead BMSM to be at an increased risk for acquiring HIV
A univariate Cox proportional hazards regression for each covariate was conducted
Being under 30 years old was the strongest predictor of HIV diagnosis for BMSM
Risk Factors for Positive Diagnosis
Number of Common Risk Factors
Being under the age of 30 2
Internalized homophobia
Geographical location
Lack of knowledge to decrease transmission 1
Methods
An ILR was the method used to explore this phenomenon. Academic journals, primary resources, and full text articles. Cumulative Index of Nursing and Allied Health (CINAHL), PubMed and PsychINFO were used. The terms “(black OR men who have sex with men OR hiv OR aids) AND (health disparity)” which narrowed down the results from 208 to 10 articles.
HIV Diagnoses in the United States for the Most-Affected Subpopulations, 2015
Future Recommendations
Limitations
It is possible that there are more articles in existence that address this health disparity that are not included. It is difficult to search the entirety of the internet for all the articles written on why this disparity exists.
Educating clinicians on how to discuss sexuality, condom usage, and other ways to decrease acquisition of STI’s in a nonjudgment manner may decrease this disparity. There should be an attempt to increase the number of negative results published outlining failed interventions attempted. These results can guide healthcare workers towards trying new interventions while steering them away from older ones that have been proven to be ineffective.
Nursing Implications
Conclusion
Fear of discrimination from a healthcare provider was associated with decreased HIV testing 2, 3. Healthcare providers and nurses in particular should aim to gain the knowledge level of their patients in an effort to more effectively education them in ways to prevent sexually transmitted diseases (STI’s). Nurses should be expected to provide prevention care in a welcoming and judgment-free environment.
While many advancements have been made to improve the overall length and quality of life of those afflicted through medicine, BMSM are still the most heavily effect by HIV/AIDS. There is a great need within this community to establish a protocol to mitigate this issue.