This page summarizes a CDC report in MMWR on National HIV Surveillance System data for 2014–2018.
In 2018, gay, bisexual and other men who have sex with men (MSM) accounted for 69.4% of HIV diagnoses in the United States. In the 42 jurisdictions with complete lab reporting that year, 80.8% of MSM were linked to care within 1 month of diagnosis and 68.3% were virally suppressed within 6 months, both below target. Black, Hispanic and younger MSM are disproportionately affected on all three counts.
Getting people with HIV into care quickly leads to viral suppression, which effectively prevents transmission.
How the analysis worked
CDC used surveillance data reported by December 2019 for MSM aged 13 and older, including those who inject drugs, living in the 33 jurisdictions with complete CD4 and viral load reporting in every year from 2014 to 2018. Missing transmission categories (15.6% of cases) were filled in by multiple imputation.
- Linked to care: at least one CD4 or viral load test within 1 month of diagnosis.
- Virally suppressed: a viral load below 200 copies/mL, or undetected, within 6 months of diagnosis.
- Trends were measured as the estimated annual percentage change (EAPC).
Diagnoses
Overall, diagnoses among MSM fell 2.3% a year, from 19,789 in 2014 to 18,034 in 2018. But the decline was uneven:
| Group | Change per year in diagnoses |
|---|---|
| White MSM | −4.8% overall; fell at ages 20–24, 25–34, 35–44 and 45–54 |
| Black MSM | −1.3% overall; fell at ages 20–24 (−6.0%) and 45–54 (−5.6%); rose 2.2% at ages 25–34 |
| Hispanic MSM | no significant change overall; fell 3.7% at 20–24; rose 2.0% at 25–34 |
| MSM aged 13–19 | no significant change in any group |
Black MSM had the most diagnoses of any group. CDC had earlier reported that racial and ethnic gaps in diagnosis rates widened during 2010–2015, when Black MSM had a rate 9.3 times that of White MSM.
Care and viral suppression
| Measure, all MSM | 2014 | 2018 | Change per year |
|---|---|---|---|
| Linked to care within 1 month | 66.2% | 74.4% | +2.9% |
| Virally suppressed within 6 months | 51.1% | 67.2% | +6.8% |
Gains were largest among Black and Hispanic MSM:
| Group | Linkage, change per year | Suppression, change per year |
|---|---|---|
| Black | +3.8% | +9.4% |
| Hispanic | +3.2% | +6.8% |
| White | +1.8% | +4.4% |
Even so, only 67.2% achieved viral suppression within 6 months in 2018, and proportionally fewer Black MSM were linked to care and virally suppressed than other groups. Limited access to health care, unstable housing, poverty and systemic racism commonly stand in the way.
What it calls for
- Intensified prevention for Black and Hispanic MSM, especially those aged 25–34, and for all MSM aged 13–19.
- Prevention and treatment with antiretroviral therapy. HIV pre-exposure prophylaxis (PrEP) and treatment can prevent infection. Yet in 2017, in 23 jurisdictions, Black and Hispanic MSM who had discussed PrEP with a provider were less likely than White MSM to be prescribed it. Providers' implicit racial biases often contribute to people not staying on treatment, which blocks viral suppression.
- Addressing systemic racism and bias in health care, and the social determinants of health behind high HIV risk.
Limitations
- Only 33 of 51 U.S. jurisdictions had complete lab reporting, so the data do not cover all diagnoses.
- Relying on p<0.05 to call a trend significant could label clinically meaningful changes as "no significant change."
Sources
- Jeffries WL IV, Dailey AF, Jin C, Carter JW Jr, Scales L. "Trends in Diagnosis of HIV Infection, Linkage to Medical Care, and Viral Suppression Among Men Who Have Sex with Men, by Race/Ethnicity and Age — 33 Jurisdictions, United States, 2014–2018." MMWR 69(38). https://www.cdc.gov/mmwr/volumes/69/wr/mm6938a1.htm
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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