Latent class analysis of a syndemic of risk factors on HIV testing among black men

AIDS Care. 2019 Feb;31(2):216-223. doi: 10.1080/09540121.2018.1524117. Epub 2018 Sep 21.

Abstract

Syndemic methodology has been employed in several studies of HIV-related outcomes affecting Black men who have sex with men (BMSM) and rarely in Black heterosexual men. In contrast to the most common method for assessing syndemics, the use of a syndemic component index, latent class analysis can identify unique combinations of risk factors that may form a syndemic. Analyzing a primarily heterosexual sample of 1,786 Black men from the 2015 Behavioral Risk Factor Surveillance System (BRFSS), we used a 4 latent class model based on depression diagnosis, poverty, and healthcare access to predict ever having been HIV tested. Class 1 was characterized by low proportions of all the risk factors. Class 2 had relatively high healthcare barriers, being the most likely to not have a personal doctor (.8175) and the most likely to have no routine checkup in the past year (.6327) but had relatively low depression diagnosis and poverty. Class 3 had relatively high poverty (.8853), but generally low barriers to healthcare access. Class 4 was characterized by high proportions of all the risk factors. Using log-binomial regression models, there was a significantly lower prevalence of ever having been HIV tested among class 3 (PR = 0.69, 95% CI 0.49, 0.98) and class 4 (PR = 0.49, 95% CI 0.28, 0.84) compared to class 1. When adjusting for education, age, and marital status, the associations were attenuated but still significant for class 3 (aPR = 0.71, 95% CI 0.52, 0.96) and class 4 (aPR = 0.60, 95% CI 0.46, 0.78). Latent class analysis may better serve syndemic research aims in understanding HIV-related outcomes among high-risk populations. Future research using this method to evaluate HIV testing outcomes among BMSM is recommended.

Keywords: HIV; LCA; black; syndemic; testing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS Serodiagnosis / statistics & numerical data*
  • Adolescent
  • Adult
  • Behavioral Risk Factor Surveillance System
  • Black or African American / statistics & numerical data*
  • Depression* / complications
  • HIV Infections / diagnosis*
  • Health Services Accessibility / statistics & numerical data*
  • Heterosexuality / statistics & numerical data
  • Humans
  • Latent Class Analysis
  • Male
  • Middle Aged
  • Poverty*
  • Risk Factors
  • Syndemic
  • Young Adult