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.
1Alabama,
Alaska, Arizona, Arkansas, Colorado,
Florida, Idaho, Indiana, Iowa,
Kansas, Louisiana, Michigan,
Minnesota, Mississippi, Missouri,
Nebraska, Nevada, New Jersey, New
Mexico, New York, North Carolina,
North Dakota, Ohio, Oklahoma, South
Carolina, South Dakota, Tennessee,
Texas, Utah, Virginia, West
Virginia, Wisconsin, and Wyoming.
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