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Crosby: Condom intervention may be best tool to reduce HIV infection in young, black, gay & bisexual men

Even as HIV infection rates in the US decline, deep disparities persist. Despite accounting for an estimated two percent of the U.S. population, gay and bisexual men also account for an estimated three-fourths of all newly diagnosed cases of HIV. Most affected are young black men who have sex with men; these men have a one-in-four chance of becoming infected with HIV before age 25, and a one-in-two chance of becoming infected in their lifetime.

 

A new publication from the University of Kentucky College of Public Health examining the efficacy of a single-session, clinic-based intervention designed to promote condom use among young black men who have sex with men (YBMSM) appears in the journal Sexually Transmitted Diseases. Dr. Richard Crosby, Endowed Professor in the Department of Health, Behavior & Society, is lead author; co-authors include Dr. Rachel Vickers Smith, a 2016 graduate of the UK College of Public Health PhD program in Epidemiology and Biostatistics.

 

Although recently emerging biomedical forms of intervention, such as pre-exposure prophylaxis (PrEP) and consistent use of antiretroviral therapies, hold great promise for future success of public health efforts to reduce the HIV/acquired immune deficiency syndrome (AIDS) disparities for YBMSM, uptake of these interventions has been slower among MSM of color compared to white peers. Recent evidence suggests that as few as four percent of MSM who are indicated for use of PrEP actually start and use the treatment effectively. Uptake and adherence to antiretroviral therapies among the group is estimated to be as low as 25 percent. Disparities are even deeper for MSM of color. Because of these existing conditions, the clinic-based intervention emphasized condom use as an HIV prevention strategy.

 

Six hundred YBMSM were enrolled in a randomized controlled trial, using a 12-month observation period. Compared with the reference group, HIV-infected men in the intervention group had 64 percent greater odds of reporting consistent condom use for anal receptive sex over 12 months. Also, compared with the reference group, HIV-uninfected men in the intervention group had more than twice the odds of reporting consistent condom use over 12 months. Significant intervention effects relative to incident sexually transmitted diseases were not observed.

 

The investigators thus conclude that a single-session, clinic-based, intervention to encourage condom use may help protect HIV-uninfected YBMSM against HIV acquisition, and HIV-infected YBMSM from transmitting the virus to partners.