Racial inequities in HIV incidence among men who have sex with men prior to and amidst an Ending the HIV Epidemic initiative

Abstract

Objective: The aim of this study was to examine trends in HIV incidence among men who have sex with men (MSM) relative to the scale up of Ending the HIV Epidemic (EHE) initiatives, including biomedical prevention strategies, and to describe racial inequities over time. Design: A cross-sectional study, matching annual cohorts of New York City (NYC) Sexual Health Clinic (SHC) patients from 2010 to 2018 to the citywide HIV registry to identify seroconversions during 1 year of follow-up, through 2019. Methods: We examined HIV incidence for each annual cohort of MSM using diagnoses within 1 year after last negative HIV test. We calculated incidence rates and rate ratios (IRR) pooled across 3-year intervals (2010–2012, 2013–2015, 2016–2018) by race/ethnicity, age, neighborhood poverty level, recent STI diagnosis, and condom use during anal sex. Results: There were 36 156 study visits among MSM attending NYC SHCs, including 37% among White MSM and 63% among MSM of color. From 2010 to 2018, HIV incidence decreased overall from 2.82 to 0.82/100 person-years, and among all race/ethnicity, age, poverty, STI, and condom use subgroups. For 2010–2012 vs. 2016–2018, adjusted IRRs (95% CI) increased for Black MSM [1.8 (1.3–2.6) vs. 6.0 (3.5–10.2)], Latino MSM [1.4 (1.0–2.0) vs. 4.0 (2.3–6.8)], and MSM of other races [1.0 (0.6–1.7) vs. 2.5 (1.3–4.9)] compared with White MSM. Black and Latino MSM seroconverted at significantly higher rates than White MSM in the same age groups and neighborhood poverty level. Conclusion: Despite decreases in HIV incidence among MSM, racial inequities were exacerbated over time. Addressing structural factors that impact racial inequities in risk of HIV should undergird EHE initiatives.