A new report from the Chicago Public Health Department ( CDPH ) reveals—not for the first time—stark disparities in HIV-infection rates between different racial and ethnic groups. The report finds much higher rates of infection in communities of Black men who have sex with men ( MSM ) than in communities of white and Latino MSM—though Black MSM do not appear to engage in significantly riskier sexual practices.
Co-authored by CDPH epidemiologists Nikhil Prachand and Britt Skaathun Livak, the report is the result of a survey conducted last fall among various communities of men who have sex with men. Men were asked to participate in the survey at places where MSM congregate; the 57 locations, dispersed geographically throughout the city of Chicago, included gay bars and clubs; bathhouses and other public-sex venues; and social organizations such as athletic leagues.
Survey participants—who, in the results, were broken down primarily into demographics of race and age—were tested for HIV antibodies and asked questions about their sexual practices. According to Christopher Brown, Assistant Commissioner in CDPH's STI/HIV/AIDS Division, similar surveys occur regularly, for MSM as well as other high-risk demographics such as injection drug users. Though past surveys have been limited to questions about sexual behavior and HIV status, this is the first in which participants were actually tested for HIV.
The report, Brown told Windy City Times, "shows that the epidemic in Chicago continues to grow and spread." And MSM continue to have infection rates higher than other at-risk groups. In similar surveys over the past several years, CDPH found that HIV prevalence among injection-drug users was 8-10%; rates among heterosexual men and women from at-risk neighborhoods was 1.8%.
By contrast, the prevalence rate among MSM was 17.4%, or 91 positives among 524 men tested. The rate of HIV prevalence among Black survey participants was nearly three times higher than that of white participants, and two and a half times higher than Latino participants.
The prevalence rate was especially pronounced among Black MSM under the age of 35, who were found to have a 30% prevalence rate—a statistic that Brown called "staggering." In comparison, white MSM in the same age group had a rate of 4%, and Latino men a rate of 11.6%.
At the same time, the CDPH report found that Black MSM do not engage in riskier sexual behavior than their white or Latino counterparts, and in some cases engage less frequently in risky sexual behaviors than other survey participants: for instance, Black MSM reported less drug and alcohol use before or during sex than others.
A theory put forth in the report to explain higher infection rates among Black MSM is that simply HIV prevalence is higher in all Chicago's Black communities. While Black people make up 35% of Chicago's population, they make up 54% of known HIV cases. The report posits an idea of infection based on "assortative mixing"—the notion that when people are more likely to have sex within their own communities, a higher prevalence of HIV within a community will express itself through high, or increasing, rates of infection.
Brown also expressed concern about the number of people who, previous to taking the survey, had not known their HIV-positive status: fully half of people who tested positive when taking the survey had been unaware of their status. This finding, too, broke down along racial lines: 66% of Black MSM who tested positive were unaware of their status, as compared to 50% of Latino MSM and 23% of white MSM. Though testing habits seemed to be consistent across groups, the survey found that 66% of Black MSM who tested positive had acquired the infection within the past 12 months—as opposed to 33% of white MSM.
Alicia Ozier, executive director of Task Force Prevention and Community Services, said that public-health workers and service agencies need to take a holistic approach to HIV infection, identifying broad risk factors that go beyond sexual behavior. She cited economic status, education levels and overall access to healthcare as correlates to HIV infection.
Intervention, she said, needs to happen far beyond basic HIV testing and education, starting with: "How are they getting their basic needs fulfilled?
Brown echoed her comments. Though there are some things "we know are working," he said—such as widespread condom distribution and accessible HIV testing—a more "multi-pronged approach" is needed. Brown said that researchers have begun to analyze how root causes of behaviors function: "adverse childhood experiences," he said, have been correlated to higher sexual risk behaviors.
Ozier, too, acknowleged the successes in terms of testing, but said the same thing demonstrated by the new report: it's not nearly enough. "It's like sticking pieces of gum in a wall that has many leaky spots," said Ozier. " [ We have to ] resurface the wall."
