High HIV Burden in Men Who Have Sex with Men across Colombia's Largest Cities: Findings from an Integrated Biological and Behavioral Surveillance Study.

BACKGROUND: Among Latin America's concentrated HIV epidemics, little is known about men who have sex with men (MSM) in Colombia, the region's third largest country. To date, surveillance studies have been limited to Bogota, while 80% of HIV cases and deaths originate from Colombia's other cities and departments. The extent to which interventions should prioritize MSM outside of Bogota is unknown. METHODS: We recruited 2603 MSM using respondent-driven sampling from seven of Colombia's largest cities. HIV prevalence was estimated by site from dried blood spot samples. Behavioral data were collected through face-to-face interviews and risk factors for HIV infection analyzed using weighted, multi-level logistical regression models accounting for recruitment patterns. RESULTS: Across cities, HIV prevalence averaged 15%, varied from 6% to 24% and was highest in Cali, Bogota, and Barranquilla. In the past 12 months, 65% of MSM had ≥ 5 casual male partners and 23% had a female partner. Across partnerships (i.e., casual, stable, and commercial), the proportion of MSM engaging in unprotected sex was ≥ 52% with male partners and ≥ 66% with female partners. Self-reported history of STI (24%) and past-year illicit drug use (38%) were also common. In multivariate analysis, age ≥ 35 (adjusted odds ratio [AOR], 19.2) and 25-39 (AOR, 5.6) relative to ≤ 18-24 years, identifying as homosexual relative to heterosexual (AOR 0.1), meeting casual partners on the Internet (adjusted odds ratio [AOR], 3.1) and age of sexual debut of ≤ 13 years (AOR, 3.1) predicted HIV infection. HIV testing and prevention messaging reached just 24% of MSM in the past year. CONCLUSIONS: Findings support consistently elevated HIV burden among MSM throughout Colombia's largest cities and a need for enhanced behavioral prevention and HIV testing, emphasizing men who use the Internet as well as physical venues to meet sex partners.

A multilevel decomposition approach to estimate the role of program location and neighborhood disadvantage in racial disparities in alcohol treatment completion.

Large racial disparities in completion rates from substance abuse treatment programs in urban settings remain largely unexplained, although evidence is accumulating that neighborhood conditions may influence individual substance abuse patterns and consequences. Understanding racial disparities in alcohol treatment completion, in particular, is crucial to resolving health disparities because racial/ethnic minorities bear a disproportionate burden of alcohol-related health consequences. Patient records for all non-homeless African American (N=1677), Hispanic (N=1635), and white (N=1216) alcohol outpatients, ages 18 or older, discharged during 1998-2000 from publicly funded treatment programs in Los Angeles County, the second largest system of publicly funded substance abuse treatment in the United States, were combined with census data. We tested the hypothesis that racial differences in treatment completion are related to differences in neighborhood context, particularly neighborhood-level disadvantage. Estimates from multilevel statistical models indicate that treatment neighborhood disadvantage is independently associated with treatment completion after controlling for patient characteristics and facility- and zip code-level random effects. Results of a Oaxaca decomposition of the regression estimates indicate that racial differences in treatment neighborhood disadvantage account for 32.3% of African American-white differences in treatment completion. Hispanic-white differences in completion, and the effect of home neighborhood disadvantage on completion, were non-significant. We conclude that the location of publicly funded alcohol treatment programs is related to racial disparities in treatment completion, but additional research is necessary to understand the mechanism behind this association.