Reducing the Risk of HIV/STD Infection Among African American Men

HIV/AIDS has had a devastating impact on African Americans, who have the highest rates of HIV/AIDS as compared with Whites, Hispanics, Asians, and Native Americans. Although African Americans comprise only 13% of the US population, more than 40% of people living with HIV/AIDS in the US are African American-some 192,277 people. New diagnoses of HIV/AIDS underscore the epidemic's impact on African Americans. Almost 50% of the people newly diagnosed with HIV/AIDS in the 33 states with confidential name-based HIV infection reporting in 2006 were African Americans. The overall rate of newly diagnosed cases was 19 cases per 100,000, but among African Americans, it was 68 per 100,000. The estimated rates of HIV/AIDS in 2006 were higher among African American men (121 per 100,000) as compared with White men (17 per 100,000), Latino/Hispanic men (51 per 100,000), and African American women (57 per 100,000). Heterosexual exposure is a key HIV transmission category among African Americans. To be sure, the largest number of estimated cases of HIV/AIDS among African American men fell in the men who have sex with men (MSM) HIV-transmission category. However, the second largest number of cases was attributed to heterosexual transmission, with the injection-drug-use HIV-transmission category ranking third. Moreover, heterosexual exposure was a more important HIV-transmission category among African American men than among other men. It accounted for 23% of HIV/AIDS cases among African American men, but 19% among Hispanic men and only 7% of cases among White men. Furthermore, among African American women, who comprised over 60% of the women with HIV/AIDS in 2006, heterosexual exposure was by far the most important transmission category, accounting for 83% of cases. Heterosexual exposure is especially important in Philadelphia, Pennsylvania, where the proposed study will be conducted. According to the Philadelphia Department of Public Health, among African American men, heterosexual exposure surpassed male-to-male contact as the modal exposure category in 2006, 2007, and 2008.

Furthermore, another important health disparity affecting African Americans particularly in urban areas is the high rate of sexually transmitted disease (STD). About 47% of the cases of Chlamydia trachomatis (CT) reported to Centers for Disease Control and Prevention (CDC) in 2006 occurred in African Americans. The CT rate was 7 times higher among African American women than among White women. The Neisseria gonorrhea rate was 25 times higher among African American men than among White men and 14 times higher among African American women than among their White counterparts. Despite the high rate of heterosexual exposure to HIV and the high rates of other STDs in African American men and women, little research has focused on interventions targeting heterosexually active men.

Sexual Risk Behavior among Heterosexually Active African American Men

Two key behaviors that increase risk of STD, including HIV, are failing to use condom consistently and having multiple sexual partners. Although unmarried African American men were more likely to report consistent condom use than were their Hispanic or White counterparts, which may reflect recognition of higher risk of STD among African American men, a large percentage of African American men (47%) risked exposure to HIV and other STDs. Moreover, consistent condom use declined substantially with increasing age, from 68% in those 15 to 19 years of age, to 31% in those 25 to 29 years of age, and to only 26% in those 40 to 44 years of age. In the National Survey of Family Growth, among men 15-44 years of age, unmarried African American men were more likely to have had 4 or more partners in the past year (13%) compared with White (6%) and Hispanic men (7%).

Interventions to Reduce Risk of Heterosexual Transmission of HIV in African American Men