Thanks to an $8.7-million grant from the National Institutes of Health-National Institute on Drug Abuse, the largest comprehensive study of young men who sleep with men ( MSM ) recently launched.
The multidisciplinary study, "Multilevel Influences on HIV and Substance use in a YMSM Cohort," will include psychologists, physicians, virologists, developmentalists, network scientists and statisticians from Northwestern University, Oxford University and the University of Edinburgh in Scotland.
Throughout the study, researchers will look at the genetics of the virus, effects of medications, individual behavior, sexual partner and relationship characteristics, networks and community-level factors.
Dr. Brian Mustanski—director of the IMPACT LGBT Health and Development Program in the Feinberg School of Medicine at Northwestern University—will lead the study.
"We are motivated by the fact that each year in the United States about one-third of the HIV infections that occur are among adolescents and young adults ages 13-29. … Seventy percent of those infections are among young gay and bisexual men and other young men who have sex with men ( MSM )," Mustanski said.
The Center for Disease Control recently found that 15 percent of men who have sex with men ages 25-29 were HIV positive.
"If the current rate of infection continues it is estimated that 40 percent of these young men will be HIV positive by the time they turn 40," Mustanski said.
He added, "The face of AIDS is changing to really be young gay men in the United States. And, of course, Black gay men are disproportionately affected."
By taking a multilevel approach the study will try to determine what is driving this epidemic, and how factors are interrelated.
"We've had little pieces of the puzzle over the last few years, different studies looking at a specific aspect of it, whether it be the role of a medication or the role of an individual behavior, people are starting to study networks, but this will be the first study of its kind to look at all of these different levels of drivers at the same time," Mustanski explained. "That is really what is so exciting about this study."
Mustanski pointed out that young Black men are disproportionately affected, but previous studies have indicated they are not taking any greater risks than their white counterparts.
"They don't have any more unprotected sex. They don't use condoms less. They don't use drugs more," Mustanski noted. "In fact, Black young men are doing a very good job of trying to protect themselves, but unfortunately they are getting infected more often."
He said that a recent study focused on social and sexual networks is shedding some light on the reason that young Black men might be facing higher HIV-infection rates.
"Their networks are denser, they are more tight-knit, they are more likely to have a sexual partner from a neighborhood in Chicago that has a higher HIV prevalence," he explained.
"I think that is one example that sets up why we need to be looking at things from this very interdisciplinary, multilevel way, because we are never going to really understand the epidemic if we just focus on individuals, if we just focus on biology, if we just focus on behavior. The explanations come from looking at these different levels at the same time.
Another big difference will be the age of the study participants. Mustanski said that the study will seek out 16- and 17-year-olds, and noted that this group of young people is rarely looked at in scientific studies of HIV.
"We actually know very little about LGBT people before the age of 18," he said. "That is when our habits develop, that is when we start to form our identity, when we start to form romantic and sexual relationships, and it's really important that we have information about people before they turn 18."
Mustanski will be inviting participants from his "Project Q2" study, which is the longest running longitudinal study of LGBT youth ever conducted, to be involved.
"So, by the end of the initial five year period of this grant we will have been following and interviewing some of the young men for 10 years," he said.
Mustanski expects 1,300 young gay and bisexual men as well as MSM from the Chicago area to participate in the study, which will include interviews every six months for five years as well as biomedical research such as blood samples and testing for sexually transmitted infections.
"Chicago is a really great place to understand and conduct this kind of research because of its diversity, because of the different neighborhoods, so its really going to be the base for the study," Mustanski said.
He hopes the grant will be renewed after the first five period so that the researchers will be able to continue following the participants and so that additional studies may be conducted.
"The focus of this grant is really to be a launching pad for many studies," he explained. "This is really to create a framework where we can build many, many studies, whether they be virology studies, behavioral science or network science, all these different things. People will be able to propose add on studies to our scientific team to continue to expand the science and address new issues that come out."
Mustanski said that the purpose is also to begin to address the findings immediately.
The Chicago Department of Public Health is a partner in the study along with many community organizations like Center on Halsted and Vida/SIDA. These partners will be vital in disseminating and addressing the study findings.
"It's so important to us that we take the science and we start putting it into applications, and really our goal is to change the course of the epidemic," he said.
