Historical Context and Current Situation of HIV Prevalence on MSM

Black MSM Homelessness and HIV Positive
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Part 1 - Problem Statement Section
Historical Context
Since the pandemic in the early 1980s, bisexuals, homosexuals and other men who have sex with men (MSM) in the United States have been adversely affected by HIV. In 2015, 39,513 new HIV infections were identified, with MSM accounting for 66.8% of the total (Duncan et al., 2019). The annual prevalence of HIV-infected persons and most transmitting risk categories, for example, individuals who inject drugs, high-risk heterosexuals, dropped between 2008 and 2014. However, the overall prevalence among MSM remained steady. If present HIV prevention and treatment trends continue, one in every six MSM will be diagnosed with the virus in their life.
Current Situation
HIV abnormally affects BMSM in the US. In the country, the prevalence of HIV among BMSM is 10,000 new cases compared to 6,700 new cases annually for white MSM (Creasy et al., 2019). Besides, many BMSM with HIV are undiagnosed and have lower proportions of antiretroviral therapy viral suppression and adherence compared with their white counterparts. Therefore, although precise numbers are unclear, BMSM is more prone to experience housing instability and homelessness. Despite making up only 13 percent of the overall population, Black Americans account for nearly 40 percent of the homeless community, according to the 2017 Annual Homeless Assessment Report to Congress (Creasy et al., 2019).
Similarly, gender and sexual minorities are at a higher risk of being homeless. As a result, it is plausible to assume that BMSM has percentages of housing instability and homelessness comparable to or greater than the general Black American population. Given the link between housing insecurity and HIV prevalence, this is a major problem.
HIV prevalence is three to nine times greater in those suffering housing instability or homelessness in the United States than in people deemed stable. Homelessness, including other variables linked to economic disadvantage and housing insecurity, has been associated with worse HIV-related consequences, including adherence to antiretroviral therapy. An ecological approach offers a basis for understanding HIV risk and how its risk is impacted (Duncan et al., 2019). Nested structures about the individual, home, neighborhood, social, and international levels, which have reciprocity impacts on one another, are the influencing variables. Whereas HIV infection is inevitably a biological event at the personal level, it is also made more likely by a variety of factors such as marginalization in care environments (interpersonal), the availability of HIV-related services (neighborhood), poverty (individual), stigma (societal), and racism (societal) (Creasy et al., 2019). Although the impact of these risk variables is well documented, it is uncertain if housing insecurity impacts HIV-related consequences in addition to the impacts of these risk variables. Current studies explore HIV test rates, engagement in its related care, and antiretroviral therapy adherence among homeless and unstably housed Black MSM to address the gap (Nelson et al., 2018). Several covariates h...