Conceptualizing the Effects of Continuous Traumatic Violence on HIV Continuum of Care Outcomes for Young Black Men Who H
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SUBSTANTIVE REVIEW
Conceptualizing the Effects of Continuous Traumatic Violence on HIV Continuum of Care Outcomes for Young Black Men Who Have Sex with Men in the United States Katherine G. Quinn1 · Antoinette Spector2 · Lois Takahashi3 · Dexter R. Voisin4 Accepted: 14 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The United States (US) is on track to achieve the 90-90-90 targets set forth by UNAIDS and the National HIV/AIDS strategy, yet significant racial disparities in HIV care outcomes remain, particularly for young Black men who have sex with men (YBMSM). Research has demonstrated that various types of violence are key aspects of syndemics that contribute to disparities in HIV risk. However, little research has looked collectively at cumulative violent experiences and how those might affect HIV treatment and care outcomes. Drawing on extant literature and theoretical underpinnings of syndemics, we provide a conceptual model that highlights how continuous traumatic violence experienced by YBMSM may affect HIV outcomes and contribute to racial disparities in HIV outcomes. The findings of this focused review suggest a need for research on how continuous exposure to various types of violence influence HIV prevention and treatment outcomes for young Black MSM. Keywords HIV continuum of care · Syndemics · Violence · Black MSM · Racial disparities
Introduction The United States (US) is on track to achieve the 90-90-90 targets set forth by UNAIDS and the National HIV/AIDS strategy (90% of persons living with HIV know their status; 90% of persons with diagnosed infection prescribed antiretroviral therapy (ART); and 90% of those on ART virally suppressed) [1, 2]. Yet, this progress has been woefully unequal when considered by race, sexuality, and age [3]. Black MSM continue to face the greatest burden of HIV. Data from 2018 suggest that 1 in 2 Black MSM are projected to acquire HIV in their lifetimes, compared to 1 in 11 white MSM [4]. HIV diagnosis rates are between 22 and 33 times higher among Black individuals as compared to white [5]. These disparities * Katherine G. Quinn [email protected] 1
Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI 53202, USA
2
Medical College of Wisconsin, Institute for Health Equity, Milwaukee, USA
3
University of Southern California, Los Angeles, USA
4
University of Toronto, Toronto, Canada
are more pronounced among young (aged 15–29 years old) Black MSM (YBMSM); nationally, these young men are three and five times more likely than their Latinx and white counterparts, respectively, to be living with HIV [6]. Despite having fewer sex partners and less condomless sex than their white counterparts [7, 8], YBMSM account for nearly half of all HIV diagnoses among MSM aged 18–29, compared to 19% among white young MSM [9]. Additionally, Black MSM fare worse on all dimensions of the HIV continuum of care outcomes (i.e., awareness of HIV status, initiation in care, ret
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