CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Background: Previous studies have documented disproportionate rates of HIV diagnosis in the southern United States compared to other regions, with half of all HIV diagnoses occurring in the South. U.S. national HIV prevention goals will be difficult to achieve without success in the region. To monitor prevention efforts, we provide updated information about current rates and trends in HIV diagnoses in the South. Methods: Using National HIV Surveillance System data for persons aged ≥13 years, we analyzed HIV diagnosis rates, counts, and trends for 2010–2015 by U.S. Census region, and in the South by race/ethnicity, age at diagnosis, transmission category, and population size of area of residence at diagnosis. We calculated estimated annual percent change (EAPC) in diagnoses; significance is assessed at p<0.05. Rates use U.S. census data for denominators and are per 100,000 population. Results: HIV diagnoses among persons aged ≥13 years declined significantly in all regions during 2010–2015, most steeply in the Northeast (EAPCs: Northeast=-4.5; Midwest=-1.6, South=-1.5, West=-1.1). In 2015, rates were highest in the South (Northeast=13.6; Midwest=9.0, South=20.2, West=11.7), and 52% (20,348) of the 39,393 diagnoses were in the South. Diagnoses in the South declined among blacks and persons of multiple races, and increased among Hispanics/Latinos, American Indian/Alaska Natives and Asian/Pacific Islanders (Table). In the South, diagnoses attributable to male-to-male sexual contact increased. Declines by mode of transmission were steepest for diagnoses attributable to injection drug use (EAPC for males=-9.08, females=- 9.18). Metropolitan statistical areas (MSAs) had the highest rates, as well as the steepest declines in diagnoses (Table). In 2015, more than half of HIV diagnoses in the South were among blacks, with about one-fifth among whites and one- fifth among Hispanics/Latinos. Half of all new diagnoses were attributable to male-to-male sexual contact, and three-fourths of new diagnoses were among residents of MSAs. Conclusion: The South continues to be disproportionately affected by HIV. Although decreasing diagnoses are encouraging, especially among blacks and in MSAs, continued disparities are cause for concern. Increased, ongoing efforts to reach at-risk populations and addressing contextual factors unique to the region will be critical to reducing ongoing disparities and ultimately, to achieving national prevention goals.

906 INDIVIDUAL AND NETWORK DRIVERS OF RACIAL DISPARITIES AMONG YMSM Brian Mustanski , Ethan Morgan, Richard D’Aquila, Michelle Birkett, Patrick Janulis, Gregory Phillips, Michael E. Newcomb Northwestern University, Chicago, IL, USA Background: Individual sexual risk behaviors have failed to explain the observed racial disparity in HIV acquisition. To increase understanding of potential drivers in these disparities, we assessed differences across individual and network domains. Methods: Data come from the first wave of RADAR (N=1015), an ongoing longitudinal cohort study of multilevel HIV risk factors among young men who have sex with men (YMSM) aged 16-29 in Chicago. Data collection includes biological specimens; network data, including detailed information about social, sexual, and drug-use networks of cohort members; and psychosocial characteristics of YMSM. Results: Compared to White YMSM (24.8%) and Hispanic YMSM (30.0%), Black YMSM (33.9%) had a higher prevalence of both HIV (32%;p<0.001) and rectal STIs (26.5%;p=0.011) with no observed differences in PrEP use. Black YMSM reported lower rates of sexual risk behaviors compared to all other YMSM as well as a greater number of lifetime HIV tests (p<0.001), however, HIV-positive Black YMSM were significantly less likely to achieve viral suppression than all other YMSM (p=0.01). Black YMSM, compared to all other YMSM, had the highest rate of cannabis use (p=0.03) and reported greater levels of stigma (p<0.001), victimization (p=0.04), trauma (p<0.001), and childhood sexual abuse (p<0.001). White YMSM reported higher rates of depression (p<0.001) and also had the highest rates of alcohol (p<0.001) and prescription drug use (p<0.001). In network analyses, Black YMSM reported a greater number of sexual partners identifying as non-male and non-gay, and reported more HIV-positive sexual partners (p<0.001). Black YMSM were also more likely to report having stronger ties (p<0.001) and greater racial homophily with sexual partners (p<0.001). Significant differences existed across network characteristics with Black YMSM having the lowest transitivity (p=0.002), the highest density (p<0.001), and the highest concurrency of YMSM alters (p<0.001). Conclusion: Black YMSM do not report higher rates of HIV risk behaviors, however, they do report more HIV-positive sexual partners and more concurrent sexual partners, have more homogeneous sexual networks, higher rates of rectal STIs, and are less likely to have viral suppression when HIV-infected. These results support the role of network factors in racial disparities in HIV acquisition and the types of interventions that may be useful to reduce disparities. 907 HIV DIAGNOSES AND TRENDS IN THE SOUTHERN UNITED STATES, 2010- 2015 Meg Watson , Andre Dailey, Alexandra M. Oster CDC, Atlanta, GA, USA

Poster Abstracts

908 DEGREE OF HOUSING INSTABILITY SHOWS INDEPENDENT “DOSE- RESPONSE”WITH HIV SUPPRESSION Angelo A. Clemenzi-Allen 1 , Elvin Geng 1 , Katerina A. Christopoulos 1 , Hali Hammer 2 , Susan P. Buchbinder 2 , Diane V. Havlir 1 , Monica Gandhi 1 1 University of California San Francisco, San Francisco, CA, USA, 2 San Francisco Department of Public Health, San Francisco, CA, USA Background: Housing instability is associated with worse clinical outcomes among people living with HIV (PLHIV), but housing status is often dichotomized to homeless vs not without a nuanced evaluation of the continuum of unstable housing. We evaluated the association of multiple levels of housing status and virologic suppression (VS) among PLHIV in a large clinic-based cohort. Methods: We collected self-reported housing status data in a safety-net HIV clinic in San Francisco (“Ward 86”) from 2/1/17-7/21/17. Patients circled current housing status at check-in on a pictorial survey depicting 6 different living arrangements: 1) Rent/Own; 2) Treatment/Transitional Program; 3) Hotel/ Single Room Occupancy (SRO); 4) Staying with Friend; 5) Homeless Shelter; 6) Outdoors/In Vehicle. Viral loads (VL) performed ±90 days of survey completion

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