A comparative analysis of HIV status by sociodemographic and sexual behavior characteristics among men in Bexar county, Texas: An Ending the HIV Epidemic priority county

A combination of sociodemographic and sexual behaviors is associated with HIV status awareness. We collaborated with HIV service organizations to collect survey data from 389 men in Bexar County, Texas, an Ending the HIV Epidemic (EHE) priority county. We examined sociodemographic and behavioral characteristics across three self-reported HIV status groups: HIV-negative, HIV-positive, and unknown HIV status. Bivariate tests compared characteristics across the three groups, and multinomial logistic regression models assessed factors associated with HIV status, using HIV-negative and unknown status as alternating reference categories. Overall, 35% of respondents were HIV-negative, 26% were HIV-positive, and 39% did not know their HIV status. Compared with men who did not know their status, HIV-negative men were more likely to be non-Hispanic White, employed, married, and to have higher educational attainment and income. In multivariable models, higher education and employment were associated with greater odds of being HIV-negative relative to unknown status, whereas lower education and unemployment were associated with unknown status. Income differences were more nuanced, with men of unknown status more likely to report higher income categories than HIV-negative men. Men with unknown status reported lower condom use and less alcohol use during sex than HIV-negative men. Compared with men with unknown status, HIV-positive men were less likely to report recent casual and anal sex but more likely to report condom use and drug use during sex. These findings indicate that, in this EHE county, HIV status awareness among men is patterned by intersecting sociodemographic and behavioral characteristics rather than by single risk indicators. Men who know their HIV status, particularly those who are HIV-negative, more often occupy socioeconomically advantaged positions and report distinct sexual behavior profiles compared with men whose HIV status is unknown. Although these cross-sectional associations cannot establish causality, they highlight men with lower education, unstable employment, and unknown status as a locally relevant, under-reached group for targeted HIV testing and outreach to advance Bexar County's EHE goals.