By Andrew M. Seaman
(Reuters Health) - For young gay and bisexual men, the risk of HIV infection is linked with societal issues, a new study says.
"What we're starting to say here, if you're black and Hispanic you're more likely to become HIV positive, but really this is driven by you're low income, you live in a poor neighborhood or you live in a neighborhood with higher HIV prevalence," said lead author Perry Halkitis of New York University.
The Centers for Disease Control and Prevention (CDC) estimates that some 1.1 million people in the U.S. are living with human immunodeficiency virus, the virus that causes AIDS. About one case in six is undiagnosed.
While only about 4 percent of U.S. males have sex with other men, they represent about two-thirds of the country's new infections, according to the CDC.
In 2010, about 73 percent of new infections were in people 13 to 24 years old, the CDC says.
In previous research, behaviors didn't explain disparities in HIV among young men who have sex with men, Halkitis and his colleagues say.
Young black and Hispanic men who have sex with men "do not appear to engage in more or riskier sexual behaviors compared with their white peers," they write in the Journal of Acquired Immune Deficiency Syndromes
For the new study, the researchers analyzed patterns of new HIV infections among 594 young men who have sex with men.
Participants were recruited from the New York City area between 2009 and 2011 and were 18 or 19 when they entered the study. At that point they were all HIV-negative.
Over the next three years, 43 participants became infected with HIV.
About a third of black, Hispanic and mixed or other race participants became HIV-positive during the study, compared to about 7 percent of white participants.
People who described themselves as being in low to average social and economic groups were more likely to become HIV-positive than those in higher socioeconomic groups.
Also, the authors found, young age at first sexual experience with another male was tied to an increased risk of becoming HIV-positive, compared to a first encounter at an older age.
"The bigger point here is that it's just too simplistic to (blame) everything on race," Halkitis said. "We're trying to get at the reason that's happening. This paper starts to point to it."
The researchers point out that social and economic status is closely tied to race in the U.S. People with lower social and economic status likely live in areas with more poverty, less access to healthcare and more untreated sexually transmitted infections (STI), they write.
They also point out that young gay and bisexual men may not be properly educated about STIs, and their heterosexual parents may not be equipped to educate on those topics.
"I think that one way we can begin to address this issue is through comprehensive sexual health education," said Jason Coleman, an expert on HIV and STI prevention at the University of Nebraska-Omaha.
Additionally, young people may not have sexual autonomy in sexual decisions - especially with older partners, said Coleman, who was not involved with the new research.
Halkitis said the next step is to study how men are selecting and meeting their partners.
"HIV is a biological phenomena and it is a behavioral phenomena, but in this day and age it is a social and structural phenomena," he said.
"You need bigger approaches beyond the person and move to higher structural level," Halkitis said.
SOURCE: http://bit.ly/1GpfTrC Journal of Acquired Immune Deficiency Syndromes, online May 2015.
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