{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T19:29:16Z","timestamp":1772479756783,"version":"3.50.1"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>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\u2019s EHE goals.<\/jats:p>","DOI":"10.1371\/journal.pone.0333665","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T18:25:43Z","timestamp":1772475943000},"page":"e0333665","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7901-0037","authenticated-orcid":true,"given":"Adolph J.","family":"Delgado","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeralynn S.","family":"Cossman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rhonda","family":"BeLue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"key":"pone.0333665.ref001","unstructured":"Office of Infectious Disease and HIV\/AIDS Policy. Ending the HIV Epidemic: About Ending the HIV Epidemic in the U.S.: Overview. 2025. [Cited 2025 December 5]. https:\/\/www.hiv.gov\/federal-response\/ending-the-hiv-epidemic\/overview"},{"key":"pone.0333665.ref002","volume-title":"National HIV\/AIDS Strategy for the United States 2022\u20132025","author":"The White House","year":"2022"},{"issue":"6","key":"pone.0333665.ref003","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1056\/NEJMoa1105243","article-title":"Prevention of HIV-1 infection with early antiretroviral therapy","volume":"365","author":"MS Cohen","year":"2011","journal-title":"N Engl J Med"},{"issue":"27","key":"pone.0333665.ref004","doi-asserted-by":"crossref","first-page":"2587","DOI":"10.1056\/NEJMoa1011205","article-title":"Preexposure chemoprophylaxis for HIV prevention in men who have sex with men","volume":"363","author":"RM Grant","year":"2010","journal-title":"N Engl J Med"},{"key":"pone.0333665.ref005","volume-title":"Science brief: Evidence that HIV cluster and outbreak detection and response strengthens HIV prevention and care services","author":"Centers for Disease Control and Prevention","year":"2023"},{"key":"pone.0333665.ref006","unstructured":"Centers for Disease Control and Prevention. Core indicators for monitoring the Ending the HIV Epidemic initiative: National HIV Surveillance System data reported through December 2023. 2024. https:\/\/stacks.cdc.gov\/view\/cdc\/156512"},{"key":"pone.0333665.ref007","volume-title":"America\u2019s HIV Epidemic Analysis Dashboard (AHEAD)","author":"U.S. Department of Health and Human Services","year":"2019"},{"key":"pone.0333665.ref008","volume-title":"2021 Texas HIV Program Annual Report","author":"Texas Department of State Health Services","year":"2022"},{"key":"pone.0333665.ref009","unstructured":"Office of Disease Prevention and Health Promotion. Increase knowledge of HIV status\u2014HIV-02. Healthy People 2030. [Cited 2025 January 27]. https:\/\/health.gov\/healthypeople\/objectives-and-data\/browse-objectives\/sexually-transmitted-infections\/increase-knowledge-hiv-status-hiv-02"},{"key":"pone.0333665.ref010","volume-title":"Rapidly growing clusters of ongoing HIV transmission in Texas: Health advisory","author":"Texas Department of State Health Services","year":"2017"},{"key":"pone.0333665.ref011","volume-title":"2022 Community Health Needs Assessment Report: Bexar County","author":"The Health Collaborative","year":"2022"},{"key":"pone.0333665.ref012","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.copsyc.2015.09.019","article-title":"Social media interventions to prevent HIV: A review of interventions and methodological considerations","volume":"9","author":"LS Tso","year":"2016","journal-title":"Curr Opin Psychol"},{"issue":"1","key":"pone.0333665.ref013","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/S0025-5564(98)10010-X","article-title":"The effect of changing sexual activity on HIV prevalence","volume":"151","author":"M Kremer","year":"1998","journal-title":"Math Biosci"},{"issue":"2","key":"pone.0333665.ref014","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1007\/s40615-021-00975-z","article-title":"Correlates of Casual Sex Amidst Vulnerability to HIV Among ACB Heterosexual Men in Ottawa and Windsor, Ontario Canada","volume":"9","author":"FI Omorodion","year":"2022","journal-title":"J Racial Ethn Health Disparities"},{"issue":"5","key":"pone.0333665.ref015","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1007\/s10461-014-0921-x","article-title":"Relative Risk for HIV Infection Among Men Who Have Sex with Men Engaging in Different Roles in Anal Sex: A Systematic Review and Meta-analysis on Global Data","volume":"19","author":"X Meng","year":"2015","journal-title":"AIDS Behav"},{"issue":"2","key":"pone.0333665.ref016","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1177\/0044118X16669259","article-title":"Sexual Partner Characteristics, Relationship Type, and HIV Risk Among a Community Venue-based Sample of Urban Adolescent and Young Adult Men Who Have Sex with Men","volume":"51","author":"CB Boyer","year":"2019","journal-title":"Youth Soc"},{"issue":"5","key":"pone.0333665.ref017","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1097\/QAI.0000000000001549","article-title":"Acute Alcohol Consumption Directly Increases HIV Transmission Risk: A Randomized Controlled Experiment","volume":"76","author":"PA Shuper","year":"2017","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"9","key":"pone.0333665.ref018","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1007\/s10461-015-1075-1","article-title":"The Association Between Alcohol Consumption and Condom Use: Considering Correlates of HIV Risk Among Black Men Who Have Sex with Men","volume":"19","author":"VC Jr Allen","year":"2015","journal-title":"AIDS Behav"},{"issue":"3","key":"pone.0333665.ref019","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1007\/s10461-011-9993-z","article-title":"Prescription drug misuse and sexual risk taking among HIV-negative MSM","volume":"17","author":"BC Kelly","year":"2013","journal-title":"AIDS Behav"},{"issue":"8","key":"pone.0333665.ref020","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1097\/OLQ.0000000000000305","article-title":"Recent HIV Testing Prevalence, Determinants, and Disparities Among U.S. Older Adult Respondents to the Behavioral Risk Factor Surveillance System","volume":"42","author":"CL Ford","year":"2015","journal-title":"Sex Transm Dis"},{"issue":"10","key":"pone.0333665.ref021","doi-asserted-by":"crossref","first-page":"2942","DOI":"10.1007\/s10461-020-02845-x","article-title":"A Scoping Review of Employment and HIV","volume":"24","author":"CH Maulsby","year":"2020","journal-title":"AIDS Behav"},{"key":"pone.0333665.ref022","volume-title":"American Community Survey: New Data on Detailed Languages Spoken at Home and the Ability to Speak English","author":"U.S. Census Bureau","year":"2025"},{"key":"pone.0333665.ref023","article-title":"Uninsured Texans: Many more lose coverage in pandemic","author":"S Grubbs","year":"2020","journal-title":"Fiscal Notes"},{"key":"pone.0333665.ref024","volume-title":"QuickFacts: Bexar County, Texas","author":"U.S. Census Bureau","year":"2024"},{"key":"pone.0333665.ref025","volume-title":"Wages: Median\u2014United States (median hourly wages for white workers and workers of color, ages 25\u201364)","author":"National Equity Atlas","year":"2024"},{"key":"pone.0333665.ref026","volume-title":"Healthy Bexar Plan: Community Health Improvement Plan (CHIP)","author":"City of San Antonio, San Antonio Metropolitan Health District","year":"2024"},{"key":"pone.0333665.ref027","volume-title":"Status of poverty in San Antonio: 2024 report on economic hardship and community wellbeing","author":"City of San Antonio Department of Human Services","year":"2024"},{"key":"pone.0333665.ref028","volume-title":"The coverage gap: Uninsured poor adults in states that do not expand Medicaid","author":"R Garfield","year":"2020"},{"key":"pone.0333665.ref029","volume-title":"HIV prevention in Texas","author":"Centers for Disease Control and Prevention","year":"2025"},{"key":"pone.0333665.ref030","volume-title":"2022 Texas HIV Program Annual Report","author":"Texas Department of State Health Services","year":"2023"},{"key":"pone.0333665.ref031","volume-title":"San Antonio\/Bexar County 95\u201395\u201395 targets and HIV care continuum","author":"International Association of Providers of AIDS Care","year":"2020"},{"issue":"9","key":"pone.0333665.ref032","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1007\/s10461-015-1284-7","article-title":"How different are men who do not know their hiv status from those who do? Results from an U.S. online study of gay and bisexual men","volume":"20","author":"C Grov","year":"2016","journal-title":"AIDS Behav"},{"issue":"7","key":"pone.0333665.ref033","doi-asserted-by":"crossref","first-page":"2113","DOI":"10.1007\/s10461-017-1894-3","article-title":"Correlates of Unknown HIV Status Among MSM Participating in the 2014 American Men\u2019s Internet Survey (AMIS)","volume":"22","author":"SM Traynor","year":"2018","journal-title":"AIDS Behav"},{"issue":"3","key":"pone.0333665.ref034","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1089\/apc.2012.0415","article-title":"Sociodemographic characteristics explain differences in unprotected sexual behavior among young HIV-negative gay, bisexual, and other YMSM in New York City","volume":"27","author":"PN Halkitis","year":"2013","journal-title":"AIDS Patient Care STDS"},{"issue":"4","key":"pone.0333665.ref035","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1097\/01.qai.0000151079.33935.79","article-title":"Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs","volume":"39","author":"G Marks","year":"2005","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0333665.ref036","volume-title":"IBM SPSS Statistics for Windows, Version 29.0","author":"IBM Corp","year":"2025"},{"issue":"15","key":"pone.0333665.ref037","doi-asserted-by":"crossref","first-page":"2083","DOI":"10.1097\/QAD.0b013e3282e9a64b","article-title":"Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors","volume":"21","author":"GA Millett","year":"2007","journal-title":"AIDS"},{"issue":"3","key":"pone.0333665.ref038","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(14)00011-3","article-title":"Understanding the HIV disparities between black and white men who have sex with men in the USA using the HIV care continuum: a modeling study","volume":"1","author":"ES Rosenberg","year":"2014","journal-title":"Lancet HIV"},{"issue":"1","key":"pone.0333665.ref039","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1136\/emj.20.1.54","article-title":"Observational research methods. Research design II: cohort, cross sectional, and case-control studies","volume":"20","author":"CJ Mann","year":"2003","journal-title":"Emerg Med J"},{"issue":"4","key":"pone.0333665.ref040","first-page":"1051","article-title":"Bias in online recruitment and retention of men who have sex with men in an Internet-based HIV prevention study: Results from the Web-based HIV Behavioral Surveillance project","volume":"15","author":"PS Sullivan","year":"2011","journal-title":"AIDS Behavior"},{"issue":"5","key":"pone.0333665.ref041","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1093\/poq\/nfl033","article-title":"Nonresponse rates and nonresponse bias in household surveys","volume":"70","author":"RM Groves","year":"2006","journal-title":"Public Opinion Quarterly"},{"issue":"3","key":"pone.0333665.ref042","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1177\/1525822X12443097","article-title":"Data Quality in web-based HIV\/AIDS research: Handling invalid and suspicious data","volume":"24","author":"J Bauermeister","year":"2012","journal-title":"Field methods"},{"issue":"2","key":"pone.0333665.ref043","doi-asserted-by":"crossref","DOI":"10.1111\/j.1083-6101.2005.tb00248.x","article-title":"The story of subject nought: A cautionary but optimistic tale of Internet survey research","volume":"10","author":"JA Konstan","year":"2005","journal-title":"J Comput Mediat Commun"},{"issue":"5","key":"pone.0333665.ref044","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1037\/0033-2909.133.5.859","article-title":"Sensitive questions in surveys","volume":"133","author":"R Tourangeau","year":"2007","journal-title":"Psychol Bull"},{"issue":"6","key":"pone.0333665.ref045","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1080\/00981389.2013.772554","article-title":"The role of race and english proficiency on the health of older immigrants","volume":"52","author":"D Nguyen","year":"2013","journal-title":"Soc Work Health Care"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333665","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T18:25:51Z","timestamp":1772475951000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333665"}},"subtitle":[],"editor":[{"given":"Daniel","family":"Demant","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,3,2]]},"references-count":45,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0333665","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,2]]}}}