HIV health center affiliation networks of black men who have sex with men: Disentangling fragmented patterns of HIV prevention service utilization

摘要

BACKGROUND: In the United States, black men who have sex with men (BMSM) are at highest risk for HIV infection and are at high risk for limited health service utilization. We describe HIV health center (HHC) affiliation network patterns and their potential determinants among urban BMSM. METHODS: The Men's Assessment of Social and Risk Network instrument was used to elicit HHC utilization, as reported by study respondents recruited through respondent-driven sampling. In 2010, 204 BMSM were systematically recruited from diverse venues in Chicago, IL. A 2-mode data set was constructed that included study participants and 9 diverse HHCs. Associations between individual-level characteristics and HHC utilization were analyzed using Multiple Regression Quadratic Assignment Procedure. Visualization analyses included computation of HHC centrality and faction membership. RESULTS: High utilization of HHCs (45.9%-70.3%) was evident among BMSM, 44.4% who were HIV infected. Multiple Regression Quadratic Assignment Procedure revealed that age, social network size, and HIV status were associated with HHC affiliation patterns (coeff., 0.13-0.27; all P < 0.05). With the exception of one HHC, HHCs offering HIV prevention services to HIV-infected participants occupied peripheral positions within the network of health centers. High-risk HIV-uninfected participants affiliated most with an HHC that offers only treatment services. CONCLUSIONS: Subcategories of BMSM in this sample affiliated with HHCs that may not provide appropriate HIV prevention services. Using 2-mode data, public health authorities may be better able to match prevention services to BMSM need; in particular, HIV prevention services for high-risk HIV-uninfected men and HIV "prevention for positives" services for HIV-infected men.