The Social Context of HIV Prevention and Care among Black Men Who Have Sex with Men in Three U.S. Cities: The Neighborhoods and Networks (N2) Cohort Study

Background: In many parts of the world, stark racial disparities in human immunodeficiency virus (HIV) prevalence, incidence, prevention, and care outcomes persist among gay, bisexual, and other men who have sex with men (MSM), with Black MSM significantly impacted in the United States (U.S.). Individual-level characteristics, including sexual behaviors and socioeconomic status, do not fully account for racial/ethnic disparities in HIV among MSM. We hypothesize that neighborhood contexts and network characteristics influence risk for HIV infection as well as HIV-related prevention and care behaviors. As such, the study design includes the use of real-time geospatial methods and in-depth assessments of multiple network typologies to investigate the impact of neighborhood and network-level factors on HIV prevention and treatment among Black MSM residing in longstanding priority HIV elimination areas in the U.S., namely Chicago, Illinois and in the Deep South (Jackson, Mississippi and New Orleans, Louisiana) (n = 450, n = 50, and n = 100, respectively). We describe the design, sampling methods, data collection, data management methods, and preliminary findings of the ongoing ‘Neighborhoods and Networks (N2) Cohort Study’. Methods/Design: N2 employs a prospective longitudinal design. The sample includes Black MSM participants in Chicago recruited via respondent-driven sampling and assessed every six months over two years of follow-up. Participants enrolled in Jackson and New Orleans are being recruited through existing health and community services and assessed every six months over one year of follow-up. Mobility within and between neighborhoods is being assessed using global positioning system (GPS) technology. Social and sexual networks among Black MSM are being studied through egocentric network inventories as well as newer methods of creating meso-level networks that involve social media (Facebook) and mobile phone contacts. Key HIV prevention outcomes such as pre-exposure prophylaxis (PrEP) care engagement, and HIV/STI (sexually transmitted infections) biomarkers will be examined at baseline and follow-up. Results: As of 31 December 2018, a total of 361 men were enrolled across all study sites: 259 in Chicago and 102 in the Deep South (75 in New Orleans and 27 in Jackson). At baseline, participants ranged in age from 17 to 65 years old (mean = 34.3, standard deviation = 5.1) with 123 men (34.1%) self-reported as HIV positive. While HIV treatment levels were similar between sites, men in the Deep South reported higher rates of adherence than men in Chicago (63.3% versus 49.4%, p = 0.03). Sexual risk profiles were mainly the same between men from different study sites, with 22.9% of men in Chicago and 28.9% in the Deep South reporting consistent condom use during vaginal and anal sex (p = 0.26). Regarding their home neighborhoods, men in the Deep South were more likely than those in Chicago to characterize theirs as having a good reputation (43.1% versus 24.7%, p < 0.001) and as being safe (37.3% versus 21.2%, p = 0.002). Conclusions: The focus on Black MSM in the N2 Study will allow for a nuanced exploration of the attitudes, beliefs, behaviors, and practices of a diverse group of Black MSM. The study is also positioned to provide novel insight about neighborhood and network characteristics that influence HIV-related behaviors. A health equity framework ensures that Black MSM are not explicitly or implicitly deemed as deviant, disordered, or the non-reference group. Findings from N2 will provide guidance for the implementation of more impactful HIV prevention interventions that engage a diverse population of Black MSM as we work toward HIV elimination in the U.S.

[1]  R. Redfield,et al.  Ending the HIV Epidemic: A Plan for the United States. , 2019, JAMA.

[2]  S. Friedman,et al.  Feasibility and Acceptability of Global Positioning System (GPS) Methods to Study the Spatial Contexts of Substance Use and Sexual Risk Behaviors among Young Men Who Have Sex with Men in New York City: A P18 Cohort Sub-Study , 2016, PloS one.

[3]  David Ostrow,et al.  Network mixing and network influences most linked to HIV infection and risk behavior in the HIV epidemic among black men who have sex with men. , 2013, American journal of public health.

[4]  Micah Altman,et al.  Numerical Issues in Statistical Computing for the Social Scientist , 2003 .

[5]  Ju Yeong Kim,et al.  Network Centrality and Geographical Concentration of Social and Service Venues that Serve Young Men Who Have Sex with Men , 2017, AIDS and Behavior.

[6]  L. Kuhns,et al.  Project nGage: Network Supported HIV Care Engagement for Younger Black Men Who Have Sex with Men and Transgender Persons , 2013, Journal of AIDS & clinical research.

[7]  Jessica K. Athens,et al.  Quantifying spatial misclassification in exposure to noise complaints among low-income housing residents across New York City neighborhoods: a Global Positioning System (GPS) study. , 2017, Annals of epidemiology.

[8]  Benjamin Cornwell,et al.  Network dynamics of HIV risk and prevention in a population-based cohort of young Black men who have sex with men , 2017, Network Science.

[9]  J. LeSage Introduction to spatial econometrics , 2009 .

[10]  Daniel M. Sheehan,et al.  Associations Among Neighborhood Characteristics and Sexual Risk Behavior Among Black and White MSM Living in a Major Urban Area , 2017, AIDS and Behavior.

[11]  J. Schneider,et al.  Care continuum entry interventions: seek and test strategies to engage persons most impacted by HIV within the United States. , 2018, AIDS.

[12]  S. Reisner,et al.  Acceptability and Feasibility of Using a Novel Geospatial Method to Measure Neighborhood Contexts and Mobility Among Transgender Women in New York City , 2017, Transgender health.

[13]  JoEllen Wilbur,et al.  Activity space environment and dietary and physical activity behaviors: a pilot study. , 2011, Health & place.

[14]  P. Y. Georgiadou,et al.  On carrier signal multipath effects in relative GPS positioning , 1988, manuscripta geodaetica.

[15]  Lindsay E. Young,et al.  Preexposure Prophylaxis Awareness and Use in a Population-Based Sample of Young Black Men Who Have Sex With Men. , 2016, JAMA internal medicine.

[16]  S. Michaels,et al.  Estimating the Number of Young Black Men who have Sex with Men (YBMSM) on the South Side of Chicago: Towards HIV Elimination within US Urban Communities , 2013, Journal of Urban Health.

[17]  P. Sullivan,et al.  Understanding Racial HIV/STI Disparities in Black and White Men Who Have Sex with Men: A Multilevel Approach , 2014, PloS one.

[18]  Michael R. Kramer,et al.  The Effect of Commuting Patterns on HIV Care Attendance Among Men Who Have Sex With Men (MSM) in Atlanta, Georgia , 2015, JMIR public health and surveillance.

[19]  A. S. Johnson,et al.  HIV Incidence, Prevalence, and Undiagnosed Infections in U.S. Men Who Have Sex With Men , 2018, Annals of Internal Medicine.

[20]  A. Adimora,et al.  Sex With Older Partners Is Associated With Primary HIV Infection Among Men Who Have Sex With Men in North Carolina , 2010, Journal of acquired immune deficiency syndromes.

[21]  Luc Anselin,et al.  Spatial Dependence in Linear Regression Models with an Introduction to Spatial Econometrics , 1995 .

[22]  S. Friedman,et al.  Network Viral Load: A Critical Metric for HIV Elimination , 2017, Journal of acquired immune deficiency syndromes.

[23]  J. Bauermeister,et al.  A Multilevel Analysis of Neighborhood Socioeconomic Disadvantage and Transactional Sex with Casual Partners Among Young Men Who Have Sex with Men Living in Metro Detroit , 2016, Behavioral medicine.

[24]  J. Havens,et al.  Accuracy of name and age data provided about network members in a social network study of people who use drugs: implications for constructing sociometric networks. , 2016, Annals of epidemiology.

[25]  V. Frye,et al.  Congruence of Home, Social and Sex Neighborhoods among Men Who Have Sex with Men, NYCM2M Study , 2017, Journal of Urban Health.

[26]  Scott Duncan,et al.  Dynamic Accuracy of GPS Receivers for Use in Health Research: A Novel Method to Assess GPS Accuracy in Real-World Settings , 2014, Front. Public Health.

[27]  T. Finlayson,et al.  Willingness to Take, Use of, and Indications for Pre-exposure Prophylaxis Among Men Who Have Sex With Men-20 US Cities, 2014. , 2016, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[28]  C. Beyrer,et al.  Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics , 2013, BMC Public Health.

[29]  Antony Chum,et al.  Contextual determinants of cardiovascular diseases: overcoming the residential trap by accounting for non-residential context and duration of exposure. , 2013, Health & place.

[30]  K. Theall,et al.  Considering high alcohol and violence neighborhood context using daily diaries and GPS: A pilot study among people living with HIV. , 2018, Drug and alcohol dependence.

[31]  R. Wolitski,et al.  HIV Testing and Risk Behaviors Among Gay, Bisexual, and Other Men Who Have Sex with Men — United States , 2013, MMWR. Morbidity and mortality weekly report.

[32]  S. Buchbinder,et al.  Correlates of HIV Acquisition in a Cohort of Black Men Who Have Sex with Men in the United States: HIV Prevention Trials Network (HPTN) 061 , 2013, PloS one.

[33]  J. Schneider,et al.  Facebook network structure and awareness of preexposure prophylaxis among young men who have sex with men. , 2017, Annals of epidemiology.

[34]  J. Bauermeister,et al.  Where You Live Matters: Structural Correlates of HIV Risk Behavior Among Young Men Who Have Sex with Men in Metro Detroit , 2015, AIDS and Behavior.

[35]  Lindsay E. Young,et al.  PrEP Chicago: A randomized controlled peer change agent intervention to promote the adoption of pre-exposure prophylaxis for HIV prevention among young Black men who have sex with men , 2018, Clinical trials.

[36]  P. Halkitis,et al.  Collecting Mobility Data with GPS Methods to Understand the HIV Environmental Riskscape Among Young Black Men Who Have Sex with Men: A Multi-city Feasibility Study in the Deep South , 2018, AIDS and behavior.

[37]  Andy P. Jones,et al.  How well do modelled routes to school record the environments children are exposed to?: a cross-sectional comparison of GIS-modelled and GPS-measured routes to school , 2014, International Journal of Health Geographics.

[38]  B. Chaix,et al.  Neighbourhoods in eco-epidemiologic research: delimiting personal exposure areas. A response to Riva, Gauvin, Apparicio and Brodeur. , 2009, Social science & medicine.

[39]  K. Fujimoto,et al.  Neighbourhoods, networks and pre-exposure prophylaxis awareness: a multilevel analysis of a sample of young black men who have sex with men , 2018, Sexually Transmitted Infections.

[40]  F. Muggia,et al.  Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men--New York City and California. , 1981, MMWR. Morbidity and mortality weekly report.

[41]  O. Adeyemi,et al.  Racial/ethnic disparities in engagement in care and viral suppression in a large urban HIV clinic. , 2013, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[42]  J. Becker,et al.  Effect of ageing on neurocognitive function by stage of HIV infection: evidence from the Multicenter AIDS Cohort Study. , 2017, The lancet. HIV.

[43]  L. Anselin Spatial Econometrics: Methods and Models , 1988 .

[44]  P. Sullivan,et al.  Disparities in herpes simplex virus type 2 infection between black and white men who have sex with men in Atlanta, GA , 2015, International journal of STD & AIDS.

[45]  Melody Oliver,et al.  Linking GPS and travel diary data using sequence alignment in a study of children's independent mobility. , 2011, International journal of health geographics.

[46]  Elizabeth Goodman,et al.  Adolescents’ use of the built environment for physical activity , 2015, BMC Public Health.

[47]  Lindsay E. Young,et al.  Marijuana Use Among Young Black Men Who Have Sex With Men and the HIV Care Continuum: Findings From the uConnect Cohort , 2016, Substance use & misuse.

[48]  Michelle Birkett,et al.  The Sexual Networks of Racially Diverse Young Men Who Have Sex with Men , 2015, Archives of sexual behavior.

[49]  B. Mustanski,et al.  Racial Differences in Same-Race Partnering and the Effects of Sexual Partnership Characteristics on HIV Risk in MSM: A Prospective Sexual Diary Study , 2013, Journal of acquired immune deficiency syndromes.

[50]  Charlene A Flash,et al.  Social networks as drivers of syphilis and HIV infection among young men who have sex with men , 2018, Sexually Transmitted Infections.

[51]  Ronald S. Burt,et al.  Network items and the general social survey , 1984 .

[52]  S. Michaels,et al.  Family Network Proportion and HIV Risk Among Black Men Who Have Sex With Men , 2012, Journal of acquired immune deficiency syndromes.

[53]  P. Halkitis,et al.  Examination of Spatial Polygamy among Young Gay, Bisexual, and Other Men Who Have Sex with Men in New York City: The P18 Cohort Study , 2014, International journal of environmental research and public health.

[54]  T. Hart,et al.  Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis , 2012, The Lancet.

[55]  M. Friend,et al.  Diagnoses of HIV infection in the United States and dependent areas (updated), 2018 , 2020 .

[56]  Mei-Po Kwan,et al.  How GIS can help address the uncertain geographic context problem in social science research , 2012, Ann. GIS.

[57]  V. Frye,et al.  Sexual Orientation- and Race-Based Discrimination and Sexual HIV Risk Behavior Among Urban MSM , 2014, AIDS and Behavior.

[58]  W. Mcfarland,et al.  Concurrent sexual partnerships and racial disparities in HIV infection among men who have sex with men , 2009, Sexually Transmitted Infections.

[59]  Basile Chaix,et al.  GPS tracking in neighborhood and health studies: a step forward for environmental exposure assessment, a step backward for causal inference? , 2013, Health & place.

[60]  J. Abowd,et al.  Session 04a - The Decennial Census of Population and Housing , 2011 .

[61]  Mark S Handcock,et al.  MODELING SOCIAL NETWORKS FROM SAMPLED DATA. , 2010, The annals of applied statistics.

[62]  P. Halkitis,et al.  A Longitudinal Investigation of Syndemic Conditions Among Young Gay, Bisexual, and Other MSM: The P18 Cohort Study , 2015, AIDS and Behavior.

[63]  R. Suzman The National Social Life, Health, and Aging Project: an introduction. , 2009, The journals of gerontology. Series B, Psychological sciences and social sciences.

[64]  Stephen A. Matthews,et al.  Spatial Polygamy and the Heterogeneity of Place: Studying People and Place via Egocentric Methods , 2011 .

[65]  K. Matthews,et al.  PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES Socioeconomic Status, Resources, Psychological Experiences, and Emotional Responses: A Test of the Reserve Capacity Model , 2005 .

[66]  David R. Holtgrave,et al.  Unmet HIV Service Needs Among Black Men Who Have Sex with Men in the United States , 2013, AIDS and Behavior.

[67]  M. Magnus,et al.  Engaging, recruiting, and retaining black men who have sex with men in research studies: don't underestimate the importance of staffing--lessons learned from HPTN 061, the BROTHERS study. , 2014, Journal of public health management and practice : JPHMP.

[68]  David R Williams,et al.  Examination of how neighborhood definition influences measurements of youths' access to tobacco retailers: a methodological note on spatial misclassification. , 2014, American journal of epidemiology.

[69]  I. Meyer Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. , 2003, Psychological bulletin.

[70]  S. Friedman,et al.  HIV Prevalence Rates Among Men Who Have Sex with Men in the Southern United States: Population-Based Estimates by Race/Ethnicity , 2011, AIDS and Behavior.

[71]  R. Sampson,et al.  Community Structure and Crime: Testing Social-Disorganization Theory , 1989, American Journal of Sociology.

[72]  J. Bauermeister,et al.  Geospatial Indicators of Space and Place: A Review of Multilevel Studies of HIV Prevention and Care Outcomes Among Young Men Who Have Sex With Men in the United States , 2017 .

[73]  Lindsay E. Young,et al.  Social-structural properties and HIV prevention among young men who have sex with men in the ballroom house and independent gay family communities. , 2017, Social science & medicine.

[74]  G. Weiss,et al.  “It’s Like Our Own Little World”: Resilience as a Factor in Participating in the Ballroom Community Subculture , 2013, AIDS and Behavior.

[75]  P. Halkitis,et al.  Individual, psychosocial, and social correlates of unprotected anal intercourse in a new generation of young men who have sex with men in New York City. , 2013, American journal of public health.

[76]  M. Oliver,et al.  What constitutes a ‘trip’? Examining child journey attributes using GPS and self-report , 2014 .

[77]  P. Sullivan,et al.  Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: a prospective observational cohort study. , 2015, Annals of epidemiology.

[78]  S. Buchbinder,et al.  Sexual Networks and HIV Risk among Black Men Who Have Sex with Men in 6 U.S. Cities , 2015, PloS one.

[79]  E. Laumann,et al.  A new HIV prevention network approach: sociometric peer change agent selection. , 2015, Social science & medicine.

[80]  W. El-Sadr,et al.  The HIV care continuum: no partial credit given. , 2012, AIDS.

[81]  J. Hirsch,et al.  The limitations of ‘Black MSM’ as a category: Why gender, sexuality, and desire still matter for social and biomedical HIV prevention methods , 2016, Global public health.

[82]  A. Oster,et al.  HIV risk among young African American men who have sex with men: a case-control study in Mississippi. , 2011, American journal of public health.

[83]  Edward O. Laumann,et al.  Structural Bridging Network Position is Associated with HIV Status in a Younger Black Men Who Have Sex with Men Epidemic , 2014, AIDS and Behavior.

[84]  S. Galea,et al.  The Urban Environment and Sexual Risk Behavior among Men who have Sex with Men , 2006, Journal of Urban Health.

[85]  Douglas D. Heckathorn,et al.  Respondent-driven sampling : A new approach to the study of hidden populations , 1997 .

[86]  Garry Robins,et al.  Missing data in networks: exponential random graph (p∗) models for networks with non-respondents , 2004, Soc. Networks.

[87]  John A. Schneider,et al.  At the intersection of criminal justice involvement and sexual orientation: Dynamic networks and health among a population-based sample of young Black men who have sex with men , 2017, Soc. Networks.

[88]  C. Latkin,et al.  Social Network Predictors of Disclosure of MSM Behavior and HIV-Positive Serostatus Among African American MSM in Baltimore, Maryland , 2012, AIDS and Behavior.

[89]  L. Bowleg,et al.  ANNUAL REVIEW OF SEX RESEARCH SPECIAL ISSUE Intersectional Epistemologies of Ignorance: How Behavioral and Social Science Research Shapes What We Know, Think We Know, and Don ’ t Know About U.S. Black Men ’ s Sexualities , 2017 .

[90]  M. Kwan The Uncertain Geographic Context Problem , 2012 .

[91]  P. Sullivan,et al.  Understanding Local Spatial Variation Along the Care Continuum: The Potential Impact of Transportation Vulnerability on HIV Linkage to Care and Viral Suppression in High-Poverty Areas, Atlanta, Georgia , 2016, Journal of acquired immune deficiency syndromes.