A new report by the Centers for Disease Control found that about one in five men who have sex with men (MSM) in large U. S. cities has HIV. While HIV prevalence in Philadelphia was slightly lower than in other locales, the city’s percentage of men who were unaware of their HIV status was markedly higher.
The study, published in Morbidity and Mortality Weekly Report on Sept. 24, looked at data from 21 metropolitan statistical areas, including Philadelphia that participated in the CDC’s National HIV Behavioral Surveillance system in 2008. In the cities, researchers interviewed and tested 8,153 MSM and found that approximately 19 percent of the men were HIV-positive.
The report also examined the number of men who were previously unaware that they were infected with HIV — about 44 percent of the total 1,562 infected men across the 21 cities.
In Philadelphia, 440 men were included in the study, with 48, about 11 percent, eventually testing positive for the disease. Of those participants, 34 — or 71 percent — had not known their status. While the city was in the lower bracket for HIV prevalence, only Baltimore and San Juan, P.R., reported higher percentages of men who had been unaware of their HIV status.
Brian Green, executive director of The Safeguards Project, noted that the CDC study looked at prevalence — the number of HIV infections per a population — as opposed to incidence — the overall rate of new HIV infections. While the city reported 11 percent of men included in the study were HIV-positive, Green noted that Philadelphia’s HIV incidence is alarming, recently found to be twice that of New York City and five times the national average.
“The incidence data for Philadelphia is very striking,” Green said. “And the fact that 71 percent of newly diagnosed people were unaware of the infection is also extremely concerning.”
Green said the demographic factors of both those infected and those unaware of the infections illustrate where more work needs to be done.
Demographics
The CDC did not release demographic data on each geographic region but, overall, black MSM were most significantly impacted, with 28 percent of men testing positive. About 18 percent of HIV-positive participants were Hispanic and 16 percent were white. Black men were also less likely to be aware of their HIV status, with about 59 percent who tested positive not having previously been aware of the infection, compared with 46 percent for Hispanics and 26 percent for whites.
HIV was most prevalent among the 40-49 age group, although awareness of HIV status increased with age. For instance, about 19 percent of the men over 50 who tested positive had been unaware of their status, compared with 75 percent of men ages 18 and 19.
Green noted that the data squared with the rates in Philadelphia that show younger MSM contracting the disease at alarming rates.
“This younger age group is the group in Philadelphia that is increasingly coming up as HIV infected, and they’re predominantly African American, predominantly male and predominantly MSM,” Green said. “This is a new trend for Philadelphia. In the past decade, incidence dropped among MSM as a whole and heterosexual transmission was increasing, but the numbers are going back up for MSM. And it’s trending younger; the rates in Philadelphia for those 18-24 just jump out at you.”
Kevin Burns, executive director of ActionAIDS, said the CDC statistics should urge the healthcare community to more vigorously promote routine testing and may also reflect a need for more frequent testing: Currently, CDC recommends MSM be tested annually.
Burns said prevention methods are needed that more effectively communicate that MSM should not become complacent about HIV.
“One of the things talked about in the National AIDS Strategy is the need to reengage the LGBT community about HIV. This data really substantiates that issue,” he said. “We need to educate gay men that HIV continues to be a huge issue for them and that they do need to be protecting themselves. It’s a bit discouraging that we don’t do a better job and that these numbers aren’t better, and I think that speaks to the fact that the prevention things we’ve been doing are not as effective as we’d like to think they were.”
Green agreed that more intense, MSM-specific messaging is needed to curb the infection rates, especially among the younger population, and heighten awareness of regular testing.
“It’s about promoting testing but also about reinvigorating prevention methods. These are people who grew up without the benefit of the more in-your-face, sex-positive messages that may be something that a gay man could recognize instead of this broader, blander messaging,” Green said. “Unfortunately, a lot of people have tuned out prevention because there haven’t been these type of messages for gay men or MSM in a very long time due to regulations and federal restrictions that don’t allow us to have depictions of sexuality that’s considered to promote homosexuality. That’s been the law for two decades now and it’s had an impact on our ability to get messages out there that are sailable to MSM, as opposed to just ‘know your status.’”
Other factors
The CDC also looked at standard-of-living factors, finding that HIV prevalence decreased and awareness of an infection increased with higher levels of education and income.
Health care was also examined, with the CDC reporting that men without health insurance were more likely to be unaware of their status. About 81 percent of men who had not visited a health-care provider in the previous year and who tested positive for HIV had not known their status.
“These numbers point to the role that access to health care plays,” Green said. “Right now, there are high numbers of people who are unemployed, uninsured and living in poverty, and that all impacts access to health care.”
Jen Colletta can be reached at [email protected].