New data from CDC show young MSM, Black MSM, and Hispanic/Latino MSM most at-risk for undiagnosed HIV in the U.S.
BETA is reporting from the 2017 Conference on Retroviruses and Opportunistic Infections (CROI) this week in Seattle—bringing you the latest news, updates, and research on HIV treatment and prevention.
At an oral abstract session at CROI today, Sonia Singh, from the Centers for Disease Control and Prevention, shared new HIV data on men who have sex with men (MSM) in the U.S. spanning the years of 2008 to 2014. Although gains in some areas were apparent, significant increases in the number of new HIV infections were seen among Hispanic/Latino men and men between the ages of 25 to 34. High levels of HIV infection among Black MSM also persist with no declines apparent in recent years.
“Differences in HIV diagnoses by race and ethnicity and age have been described, but less data are available on incidence and prevalence,” said Singh. “Estimating HIV outcomes among MSM is important for guiding prevention efforts and monitoring progress toward the goals of the National HIV/AIDS Strategy.”
Men who have sex with men represent approximately 2% of the U.S. population yet make up 67% of people with HIV diagnoses (in 2014). Singh and colleagues used data from the National HIV Surveillance System on HIV diagnoses among MSM and CD4 test result data to estimate HIV incidence, prevalence and the percentage of undiagnosed infection by racial/ethnic and age groups.
Number of annual HIV infections across the U.S. on the decline
First—the good news: Singh shared that annual HIV infection rates are on the decline. From 2008 through 2014, the number of annual HIV infections in the U.S. declined nearly 20%, from 45,700 infections in 2008 to 37,600 in 2014. This averages out to a decline of about 3.6% per year.
At the press conference accompanying Singh’s abstract session, Singh shared that annual infection rates declined over the same period by 36% among heterosexual people and 56% among people who inject drugs.
No declines among men who have sex with men
The number of HIV infections attributed to male-to-male sexual contact, however, did not decrease from 2008 to 2014, said Singh. The number of new HIV infections among men who have sex with men has hovered somewhere between 25,000 and 30,000 every year from 2008 to 2014.
“Among all risk groups, MSM had the highest HIV incidence, HIV prevalence, and percentage of undiagnosed HIV infection,” said Singh, as she turned to a closer analyses of HIV diagnoses among MSM revealed.
Hispanic/Latino MSM HIV infections on the rise, while number of HIV infections among Black MSM remains high
HIV infections among white MSM are on the decline—an encouraging finding that’s tempered by steady increases among Hispanic/Latino MSM and overall high rates among Black MSM.
HIV infections among Black MSM are highest, with about 10,000 new infections happening every year since 2008. New infections among Hispanic/Latino men are on the rise—increasing about 2.4% per year from 2008 (6,100 infections) to 2014 (7,200 infections).
Among white MSM, HIV incidence has declined to about 7,400 new infections every year (representing a decline of about -3.1% per year).
Increases in HIV incidence among MSM age 25 – 34
There is also a concerning increase in the number of HIV infections happening among young MSM between the ages of 25 and 34. There were 7,100 infections in this group in 2008, which grew to 9,700 in 2014. There was a corresponding rise in HIV prevalence among MSM in this age group (84,300 in 2008; 128,000 in 2014).
MSM in other age groups (13 – 24 year olds, 35 – 44 year olds, 45 – 54 year olds, and 55+ year olds) saw declines in HIV incidence or smaller increases.
Very high rates of undiagnosed infection among young MSM, Hispanic/Latino MSM, and Black MSM
Between 2008 and 2014, the percentage of MSM living with undiagnosed HIV infection decreased in every race/ethnicity category. However, Hispanic/Latino MSM and Black MSM living with HIV are still much more likely to be undiagnosed than men of other races and ethnicities. About 21% of Hispanic/Latino MSM and 20% of Black MSM living with HIV are estimated to be undiagnosed. (By comparison, only 12.5% of white MSM living with HIV are estimated to be undiagnosed.)
The percentage of HIV infections that are undiagnosed in younger MSM also decreased over time—although rates are still very high. About 70% of 13 to 24 year old MSM in 2010 were undiagnosed, which declined to 52% in 2014.
“Disparities among MSM need to be addressed to reduce incidence. Black MSM continue to have the highest incidence and incidence is increasing among Hispanic and Latinos as well as 25 to 34 year olds,” said Singh. “Tailoring testing, prevention and treatment to these risk groups is needed to reduce HIV transmission.”