RACIAL AND ETHNIC-DIFFERENCES IN HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 (HIV-1) SEROPREVALENCE AMONG HOMOSEXUAL AND BISEXUAL MEN

To determine whether the excess prevalence of human immunodeficiency v irus type 1 (HIV-1) infection in US black and Hispanic homosexual men relative to white men can be explained by differences in sociodemograp hic factors, history of sexually transmitted diseases, or sexual and d rug-use behaviors, the authors conducted a cross-sectional analysis of baseline HIV-1 seroprevalence and HIV-1 risk factors among 4,475 non- Hispanic white, 234 Hispanic white, and 194 black homosexual men from four centers in the United States (Baltimore/Washington, DC, Pittsburg h, Chicago, and Los Angeles). HIV-1 seroprevalence was significantly h igher in Hispanic men (50%; odds ratio (OR) = 1.83,95% confidence inte rval (CI) 1.41-2.39) and black men (47%; OR = 1.62,95% CI 1.21-2.16) c ompared with white men (35%). Both Hispanic and black men more frequen tly reported a history of sexually transmitted diseases. Overall, Hisp anics had the highest risk profile and blacks the lowest risk profile with respect to certain high-risk sexual behaviors (e.g., receptive an al intercourse and use of anonymous sexual partners) and recreational drug. use. After multivariate adjustment, black race remained a signif icant independent risk factor for HIV-1 seropositivity (OR = 1.60, 95% CI 1.132. 26), but Hispanic ethnicity was no longer statistically sig nificant (OR = 1.17, 95% CI 0.82-1.69). Most of the excess HIV-1 preva lent infection among Hispanics was explained by their predominant recr uitment from Los Angeles-the study center with the highest HIV-1 serop revalence-and their greater prevalence of a history of sexually transm itted diseases and certain high-risk sexual practices. By contrast, ad justment for these same risk behaviors failed to explain the observed black-white differences in HIV-1 seroprevalence, and further studies a re needed to elucidate the reasons for these unexplained racial differ ences. HIV-1 educational programs for homosexual men should take into account the behavioral differences that exist between white and minori ty racial/ethnic groups.