Sunday, May 28, 2023
|
Characteristic |
Diagnosed HIV infection (2019)* |
Tested in past 12 mos (2017)† |
Missed opportunity for testing in past 12 mos (2017)†,§ |
|||
|---|---|---|---|---|---|---|
| No. | % (95% CI) | No. | % (95% CI) | No. | % (95% CI) | |
| Total | 692,900 > | 84.8 (84.1–85.5) | 7,577 | 78.6 (77.1–80.0) | 1,181 | 77.8 (73.9–81.7) |
| Race/Ethnicity | ||||||
| American Indian/Alaska Native | — ¶ | — ¶ | 53 | 69.0** (53.1–84.8) | — †† | — †† |
| Asian | — ¶ | — ¶ | 194 | 81.0 (73.3–88.7) | 35 | 88.6 (78.0–99.1) |
| Black/African American | 219,200 | 82.6 (81.4–83.9) | 1,965 | 80.7 (78.1–83.4) | 283 | 73.6 (65.3–82.0) |
| Hispanic/Latino §§ | 186,800 | 80.3 (79.0–81.7) | 2,098 | 77.3 (74.8–79.9) | 315 | 75.6 (68.4–82.9) |
| Native Hawaiian/Other Pacific Islander | — ¶ | — ¶ | 35 | 85.1** (65.7–100.0) | — †† | — †† |
| White | 239,600 | 90.0 (88.7–91.3) | 2,804 | 78.0 (75.5–80.5) | 481 | 78.6 (72.5–84.7) |
| Multiple races ¶¶ | — ¶ | — ¶ | 387 | 81.2 (75.2–87.2) | 48 | 82.7** (64.9–100.0) |
| Age group, yrs | ||||||
| 13–24 | 37,100 | 55.1 (52.8–57.6) | —*** | —*** | —*** | —*** |
| 18–24 | —*** | —*** | 1,359 | 79.7 (76.5–83.0) | 197 | 77.0 (67.8–86.2) |
| 25–34 | 164,600 | 71.2 (70.0–72.4) | 3,266 | 81.3 (79.2–83.4) | 372 | 80.9 (74.6–87.1) |
| 35–44 | 135,200 | 84.0 (82.8–85.3) | 1,397 | 79.3 (76.1–82.4) | 200 | 74.7 (65.2–84.2) |
| 45–54 | 155,300 | 92.4 (91.4–93.5) | 999 | 71.8 (67.6–76.0) | 220 | 71.9 (62.6–81.2) |
| ≥55 | 200,600 | 96.1 (95.0–97.2) | 556 | 65.0 (58.2–71.9) | 192 | 82.5 (73.0–91.9) |
TABLE 1. Percentage of HIV infections diagnosed, percentage of persons receiving HIV testing in the past 12 months, and percentage of missed opportunities for HIV testing in the past 12 months among gay, bisexual, and other men who have sex with men, by race/ethnicity and age group — United States, 2017 and 2019
* Based on data reported through December 2020 to the National HIV Surveillance System for year-end 2019. Percentages are estimated based on a CD4 depletion model. Defined as the number of persons who received an HIV diagnosis divided by the estimated number of persons with HIV (diagnosed and undiagnosed).
† Based on data collected by National HIV Behavioral Surveillance in 2017 in 23 U.S. urban areas (Atlanta, Georgia; Baltimore, Maryland; Boston, Massachusetts; Chicago, Illinois; Dallas, Texas; Denver, Colorado; Detroit, Michigan; Houston, Texas; Los Angeles, California; Memphis, Tennessee; Miami, Florida; Nassau and Suffolk counties, New York; New Orleans, Louisiana; New York City, New York; Newark, New Jersey; Philadelphia, Pennsylvania; Portland, Oregon; San Diego, California; San Francisco, California; San Juan, Puerto Rico; Seattle, Washington; Virginia Beach, Virginia; and Washington, DC). Excludes persons who tested HIV-positive >12 months ago.
§ Defined as visiting a health care provider in the past 12 months without being offered an HIV test. Excludes persons who tested HIV-positive >12 months ago and who tested in the past 12 months.
¶ Estimates are not available because of high relative standard errors.
** Estimates have a CI width >30 and should be interpreted with caution.
†† Estimates are not available because denominator sample sizes are <30.
§§ Hispanic/Latino men who have sex with men could be any race.
¶¶ Represents persons identified as having multiple race categories selected.
*** National HIV Behavioral Surveillance did not collect data from persons aged 13–17 years. Data from the National HIV Surveillance System are presented for persons aged 13–24 years.
|
Characteristic |
Discussed PrEP with health care provider in past 12 mos* |
Used PrEP in past 12 mos* |
|||
|---|---|---|---|---|---|
| No. | % (95% CI) | No. | % (95% CI) | ||
| Total | 4,466 | 51.5 (49.1–53.9) | 4,466 | 35.5 (33.0–38.0) | |
| Race/Ethnicity | |||||
| American Indian/Alaska Native | — ¶ | — ¶ | — ¶ | — ¶ | |
| Asian | 111 | 61.1 (48.3–74.0) | 111 | 47.4 (34.1–60.6) | |
| Black/African American | 962 | 47.2 (42.5–51.8) | 962 | 27.2 (22.7–31.7) | |
| Hispanic/Latino † | 1,250 | 45.2 (41.2–49.2) | 1,250 | 31.3 (27.5–35.2) | |
| Native Hawaiian/Other Pacific Islander | — ¶ | — ¶ | — ¶ | — ¶ | |
| White | 1,841 | 58.5 (54.9–62.0) | 1,841 | 42.2 (38.4–46.0) | |
| Multiple races § | 230 | 45.9 (36.0–55.7) | 230 | 30.1 (21.5–38.7) | |
| Age group, yrs | |||||
| 18–24 | 837 | 43.6 (38.3–49.0) | 837 | 26.7 (22.2–31.2) | |
| 25–34 | 2,073 | 52.6 (49.2–56.0) | 2,073 | 36.8 (33.3–40.3) | |
| 35–44 | 845 | 59.9 (55.0–64.8) | 845 | 44.7 (39.7–49.8) | |
| 45–54 | 480 | 48.8 (41.4–56.1) | 480 | 35.7 (28.4–42.9) | |
| ≥55 | 231 | 46.4 (36.9–56.0) | 231 | 23.7 (15.1–32.3) | |
TABLE 2. Percentage of gay, bisexual, and other men who have sex with men with a likely indication for preexposure prophylaxis who discussed preexposure prophylaxis with a health care provider in the past 12 months or used preexposure prophylaxis in the past 12 months, by race/ethnicity and age group — United States, 2017
Abbreviations: MSM = men who have sex with men; NHBS = National HIV Behavioral Surveillance; PrEP = preexposure prophylaxis.
* Based on data collected by NHBS in 2017 in 23 U.S. urban areas (Atlanta, Georgia; Baltimore, Maryland; Boston, Massachusetts; Chicago, Illinois; Dallas, Texas; Denver, Colorado; Detroit, Michigan; Houston, Texas; Los Angeles, California; Memphis, Tennessee; Miami, Florida; Nassau and Suffolk counties, New York; New Orleans, Louisiana; New York City, New York; Newark, New Jersey; Philadelphia, Pennsylvania; Portland, Oregon; San Diego, California; San Francisco, California; San Juan, Puerto Rico; Seattle, Washington; Virginia Beach, Virginia; and Washington, DC). Restricted to MSM with likely clinical indications for PrEP, who had a negative NHBS HIV test result after the NHBS interview, had a male sex partner who was HIV-positive or two or more male sex partners in the past 12 months, and had condomless anal sex with a male sex partner or a sexually transmitted infection (i.e., syphilis, gonorrhea, or chlamydia) in the past 12 months.
† Hispanic/Latino MSM could be any race.
§ Represents persons identified as having multiple race categories selected.
¶ Estimates not available because denominator sample sizes are <30.
|
Characteristic |
ART adherence (2018)* |
Viral suppression (2019)† |
HIV-related stigma score (2018)§ |
|||
|---|---|---|---|---|---|---|
| No. | % (95% CI) | No. | % | No. | Median (95% CI) | |
| Total | 1,869 | 58.3 (54.9–61.7) | 528,606 | 68.1 | 1,873 | 29.3 (28.0–30.5) |
| Race/Ethnicity | ||||||
| American Indian/Alaska Native | — ¶ | — ¶ | 1,538 | 64.7 | — ¶ | — ¶ |
| Asian | — ¶ | — ¶ | 9,779 | 71.7 | — ¶ | — ¶ |
| Black/African American | 503 | 48.3 (40.2–56.3) | 161,072 | 61.6 | 528 | 32.8 (29.3–36.3) |
| Hispanic/Latino** | 440 | 58.7 (53.4–64.1) | 135,301 | 66.6 | 436 | 32.0 (29.6–34.3) |
| Native Hawaiian/Other Pacific Islander | — ¶ | — ¶ | 590 | 66.2 | — ¶ | — ¶ |
| White | 784 | 64.1 (59.4–68.9) | 195,335 | 73.5 | 770 | 26.1 (24.0–28.2) |
| Multiple races †† | 104 | 55.7 (44.8–66.7) | 24,643 | 74.5 | 103 | 30.4 (24.2–36.6) |
| American Indian/Alaska Native, Asian, or Native Hawaiian/Other Pacific Islander §§ | 38 | 60.2 ¶¶ (40.2–80.2) | — §§ | — §§ | 36 | 20.3 (12.0–28.7) |
| Age group, yrs | ||||||
| 13–24 | —*** | —*** | 19,520 | 66.2 | —*** | —*** |
| 18–24 | 53 | 44.6 ¶¶ (29.5–59.6) | —*** | —*** | 56 | 39.3 (30.0–48.7) |
| 25–34 | 319 | 47.7 (39.7–55.7) | 105,957 | 65.0 | 332 | 33.6 (30.6–36.6) |
| 35–44 | 346 | 53.7 (47.5–59.9) | 101,620 | 66.1 | 353 | 31.5 (29.7–33.4) |
| 45–54 | 523 | 55.7 (50.3–61.1) | 140,157 | 69.3 | 517 | 28.7 (26.8–30.6) |
| ≥55 | 628 | 69.6 (64.9–74.4) | 161,352 | 70.6 | 615 | 25.4 (23.5–27.3) |
TABLE 3. Among gay, bisexual, and other men who have sex with men with diagnosed HIV infection, percentage with antiretroviral therapy adherence, percentage with viral suppression, and median HIV-related stigma scores, by race/ethnicity and age group — United States, 2018 and 2019
Abbreviations: ART = antiretroviral therapy; MSM = men who have sex with men; NHBS = National HIV Behavioral Surveillance; PrEP = preexposure prophylaxis.
* Based on data collected by the Medical Monitoring Project during June 2018–May 2019. ART adherence was defined as taking 100% of ART doses in the past 30 days among MSM currently taking ART.
† Based on data reported through December 2020 to the National HIV Surveillance System for year-end 2019. Viral suppression was defined as the number of MSM with a viral load test result of <200 copies of HIV RNA per mL at last test divided by the number of MSM with diagnosed HIV infection.
§ Based on data collected by the Medical Monitoring Project during June 2018–May 2019. HIV-related stigma was measured using a 10-item scale that measures four dimensions of HIV stigma: personalized stigma during the past 12 months, current disclosure concerns, current negative self-image, and current perceived public attitudes about persons with HIV. The stigma score ranged from 0 to 100, with 0 indicating no stigma and 100 indicating highest stigma. A median score was calculated based on responses on a five-point Likert scale to each item. Median scores with nonoverlapping 95% CIs were considered to be meaningfully different. Median scores were interpreted in the context of the national goal of reducing HIV-related stigma by 2025 by at least 50% from the 2018 baseline median score of 31.
¶ Estimates are not available because denominator sample sizes are <30.
** Hispanic/Latino MSM could be any race.
†† Represents persons identified as having multiple race categories selected.
§§ Viral suppression percentages are presented separately for American Indian or Alaska Native persons, Asian persons, and Native Hawaiian or Other Pacific Islander persons.
¶¶ Estimates have a CI width >30 and should be interpreted with caution.
*** The Medical Monitoring Project did not collect data from persons aged 13–17 years. Data from the National HIV Surveillance System are presented for persons aged 13–24 years.
This activity is intended for public health officials, infectious disease clinicians, immunologists, hematologists, internists, and other clinicians caring for patients with HIV.
The goal of this activity is that learners will be better able to describe HIV prevention and treatment outcomes among gay, bisexual, and other men who have sex with men (MSM) in the United States during the years before implementation of the Ending the HIV Epidemic in the U.S. (EHE) initiative and the progress needed to reach EHE and other national goals, according to a Centers for Disease Control and Prevention (CDC) analysis of data from 3 national surveillance systems.
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Background. Men who have sex with men (MSM) accounted for two thirds of new HIV infections in the United States in 2019 despite representing approximately 2% of the adult population.
Methods. CDC analyzed surveillance data to determine trends in estimated new HIV infections and to assess measures of undiagnosed infection and HIV prevention and treatment services including HIV testing, preexposure prophylaxis (PrEP) use, antiretroviral therapy (ART) adherence, and viral suppression, as well as HIV-related stigma.
Results. The estimated number of new HIV infections among MSM was 25,100 in 2010 and 23,100 in 2019. New infections decreased significantly among White MSM but did not decrease among Black or African American (Black) MSM and Hispanic/Latino MSM. New infections increased among MSM aged 25–34 years. During 2019, approximately 83% of Black MSM and 80% of Hispanic/Latino MSM compared with 90% of White MSM with HIV had received an HIV diagnosis. The lowest percentage of diagnosed infection was among MSM aged 13–24 years (55%). Among MSM with a likely PrEP indication, discussions about PrEP with a provider and PrEP use were lower among Black MSM (47% and 27%, respectively) and Hispanic/Latino MSM (45% and 31%) than among White MSM (59% and 42%). Among MSM with an HIV diagnosis, adherence to ART and viral suppression were lower among Black MSM (48% and 62%, respectively) and Hispanic/Latino MSM (59% and 67%) compared with White MSM (64% and 74%). Experiences of HIV-related stigma among those with an HIV diagnosis were higher among Black MSM (median = 33; scale = 0–100) and Hispanic/Latino MSM (32) compared with White MSM (26). MSM aged 18–24 years had the lowest adherence to ART (45%) and the highest median stigma score (39).
Conclusion. Improving access to and use of HIV services for MSM, especially Black MSM, Hispanic/Latino MSM, and younger MSM, and addressing social determinants of health, such as HIV-related stigma, that contribute to unequal outcomes will be essential to end the HIV epidemic in the United States.
