CDC researchers published a new study in the American Journal of Public Health that highlights racial, ethnic, and age differences within the HIV/AIDS epidemic among men who have sex with men (MSM).

View the journal article.

What does the study show?

For the years 2001-2004*:

• Black and Hispanic MSM had higher rates of HIV/AIDS diagnoses across all age groups compared to white MSM.
• The percentage of men who progressed to AIDS within three years of their HIV diagnoses was higher among black and Hispanic MSM than among white MSM.
• Three-year survival among black MSM was lower than that for Hispanic or white MSM.
• Overall, HIV/AIDS diagnoses rates remained stable during this time period, but the rates for younger MSM showed large increases.

* This study uses data from the 33 states with confidential, long-term, name based HIV reporting.

Why is the study important?

This study is further evidence of the racial and ethnic disparities within the HIV/AIDS epidemic as well as the urgency of educating young MSM about HIV/AIDS.

What is CDC doing about the problem?

On a national level, CDC funds special initiatives, interventions, and research addressing these disparities. CDC provides funding to state and local health departments and community-based organizations to better address the needs and gaps of the epidemic locally.

Research Summary

During the years 2001-2004, black and Hispanic men who have sex with men (MSM) had higher rates of HIV/AIDS diagnoses across all age groups than did white MSM, according to a new CDC study to be published in the June 2007 issue of the American Journal of Public Health. Additionally, even though overall HIV/AIDS diagnoses rates remained stable for MSM during this time period, the rates for younger MSM (between the ages of 13 and 24) showed large increases.

The study, led by H. Irene Hall, PhD of CDC’s Division of HIV/AIDS Prevention, also showed that the percentage of men who progressed to AIDS within three years of their HIV diagnosis was higher among black and Hispanic MSM than among white MSM. Three-year survival after an AIDS diagnosis was lower for black than for white or Hispanic MSM.

The study’s authors said the poorer outcomes for minority men may be tied to later diagnosis or lack of adequate access to treatment.

This study was performed using data from the national HIV/AIDS surveillance system that consists of 33 states [1] that have conducted HIV surveillance for at least five years.  The study sought to determine the interaction between race/ethnicity and age as well as to examine differences in late HIV diagnosis and progression to AIDS or progression from AIDS to death among racial/ethnic groups of MSM diagnosed with HIV.

It found that among all age groups, HIV/AIDS diagnosis rates were higher for black and Hispanic MSM than for white MSM. In 2004, the rate of HIV/AIDS diagnosis per 100,000 was 70.8 for black MSM, 39.0 for Hispanic MSM, and 14.6 for white MSM.  

The rates also varied by age. In 2004, the HIV/AIDS diagnosis rate for MSM aged 13 through 19 was 23.5 for black MSM, 6.1 for Hispanic MSM, and 1.2 for white MSM. From 2001- to 2004, there were no differences by race/ethnicity in trends within age groups. By age group alone, for MSM aged 13 to 19 years, HIV/AIDS diagnosis rates increased about 14% per year; for those aged 20 to 24 years, they increased about 13% per year.

Of the 43,994 MSM with a reported HIV diagnosis during 1996 through 2002, 15,174 (34.5%) had a diagnosis of AIDS by 2004. HIV was significantly more likely to progress to AIDS within 3 years of HIV diagnosis among black and Hispanic MSM than among white MSM. AIDS did not develop within 3 years for 66.8% of black MSM and 68.1% of Hispanic MSM compared with 74.7% of white MSM.

Of the 62,045 MSM with a diagnosis of AIDS during 1996 through 2002, 13,962 (22.5%) had died by the end of 2004. Black MSM were significantly less likely to be alive 3 years after AIDS diagnosis (80.6%) than were Hispanic (85.2%) or white (84.5%) MSM.

The 1990s saw a reduction in new HIV diagnoses, most likely due to better treatments coupled with prevention behaviors. However, since 1999, the downward trend in new HIV and AIDS diagnoses has leveled off, primarily because of increases in the number of HIV diagnoses among MSM. Other reports have noted that increasing rates of primary and secondary syphilis among MSM may be attributable to increases in risky sexual behaviors among members of this community and may explain the resurgence of new HIV diagnoses among MSM. Increased rates of HIV testing may also play a role in increased HIV/AIDS diagnoses in certain populations. 

This article highlights the need for increased prevention efforts to reach young gay and bisexual men. These prevention efforts need to be tailored to individual populations and behaviors and will require a combination of strategies to reduce new HIV infections among MSM.

In addition to Dr. Hall, other authors of this study are Robert H. Byers, PhD; Qiang Ling MS; and Lorena Espinoza, DDS; all with the Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.

CDC is Addressing the Disparities of HIV/AIDS  

CDC is addressing the disparities in HIV/AIDS diagnoses through a number of mechanisms.

Increasing HIV Testing: In September 2006, CDC released Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings, which encourage routine HIV screening of adults, adolescents, and pregnant women in healthcare settings in the United States. CDC also recommends that MSM get tested at least annually.

Increased testing will enable those who are infected with HIV to get into treatment that can improve their health and extend their lives and reduce further transmission of the virus. HIV testing is especially important for MSM of racial or ethnic minorities, as research has shown that black and Hispanic MSM who are infected with HIV enter treatment at a later stage than their white counterparts.

CDC is also supporting research to assess the effectiveness of different strategies to identify undiagnosed HIV infection among African American MSM. CDC has shown social networks to hold much promise in reaching MSM.

Community mobilization: CDC provides resources to state and local health departments and community-based organizations to reach MSM of all races and ethnicities. CDC has worked to mobilize African American leaders across the country to implement a heightened national response to the AIDS epidemic among African Americans. CDC is also working internally and with external partners to examine and further improve HIV prevention efforts for Hispanic populations.

Supporting research-based interventions: CDC creates and supports interventions to help people reduce the risk of getting HIV and to help those infected with HIV to live healthy lives and reduce the transmission to others. A catalogue of those interventions can be found at www.effectiveinterventions.org. An example of an intervention is Many Men, Many Voices, which is an HIV/STD prevention program for African American MSM that has been proven to reduce risk behaviors. CDC is encouraging its nationwide implementation. Together Learning Choices is an example of an intervention specifically for young people.

Adapting proven interventions: Interventions, such as Popular Opinion Leader, which trains opinion leaders to encourage safer sexual norms and behaviors within their social networks, is being adapted for African American MSM and has been successfully adapted for Latino MSM. Other interventions have also been translated for use with Hispanic populations.

Researching new interventions: CDC is studying new behavioral interventions for MSM and evaluating strategies for increasing testing rates and decreasing risky behaviors. For example, Brothers Y Hermanos is a study of African American and Hispanic MSM conducted in Los Angeles, New York, and Philadelphia. The first phase of the study consisted of epidemiologic research to identify and understand risk-promoting and risk-reducing sexual behaviors. The second phase, which is taking place in 6 US cities, will create interventions.

CDC is also conducting research evaluating community-level interventions of Mpowerment for African American MSM and research to look at risk behaviors among non-gay identified MSM of all races and ethnicities. CDC’s ARTAS II  study is evaluating the effects of linkage case management on those newly diagnosed with HIV.

For additional information on HIV/AIDS among MSM, visit the MSM topic. For additional information on HIV/AIDS among African Americans, visit the African American topic. For additional information on HIV/AIDS and Hispanics/Latinos, please view the fact sheet.