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HIV Prevalence and New Infections Highest Among Gay Men in Southern U.S.

The burden of HIV in the U.S. is disproportionately high for gay and bisexual men -- who account for about two-thirds of all newly diagnosed infections each year -- and HIV prevalence and new infections among men who have sex with men (MSM) is highest in states in the southeast, according to a new analysis published recently in the Journal of Medical and Internet Research -- Public Health and Surveillance.

Eli Rosenberg and colleagues from Emory University Rollins School of Public Health combined their recently published estimates of the number of MSM in the U.S. with publicly available HIV surveillance data from AIDSVu.organd the Centers for Disease Control and Prevention (CDC) to estimate the number of people living with HIV (prevalence), number diagnosed with HIV (diagnosed prevalence), and newly diagnosed infections at the national, state, city, and county levels.

The overall estimated HIV prevalence was 15.0% and the overall diagnosed prevalence was 11.1% among MSM in the U.S. in 2012, but rates varied considerably by geography. 6 states in the south -- Alabama, Arkansas, Georgia, Louisiana, Mississippi, and South Carolina, along with Washington, DC -- had diagnosed prevalence rates higher than 15 per 100 MSM.

States with large populations had the highest total number of cases, with 5 (California, Florida, Illinois, New York, and Texas) having more than 15,000 total cases and diagnosed prevalence rates of 10% to 15%. But only Georgia had both diagnosed prevalence above 15% and more than 15,000 total cases.

Of the 25 metropolitan areas with the highest diagnosed prevalence, 21 were in the south; 6 of these had diagnosed prevalence rates of 25% or higher. But high prevalence was found in rural as well as urban counties in the south.

Rates of new HIV diagnoses among MSM followed the same pattern as HIV prevalence. The overall rate of new diagnoses in 2013 was 0.7 per 100 MSM. Only southern states had new diagnosis rates of 1.0 per 100 MSM or higher, and Louisiana and Mississippi had rates exceeding 2.0 per 100 previously undiagnosed MSM.

"HIV infection is hyperendemic among MSM in many areas of the United States, particularly in the South," the study authors concluded. "Our data emphasize the priorities for HIV prevention and care set forth in the United States National HIV/AIDS Strategy (NHAS) and provide updatable local estimates of NHAS indicators. Jurisdictions can use these results to direct resources, programs, and policies to optimally benefit the health of MSM."

"To stop the spread of HIV, we have to understand how, where, and among whom the epidemic is striking the hardest," said Jonathan Mermin, director of CDC’s Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "Today's analyses provides an important new piece of the puzzle. Data suggest that new approaches and intensified prevention efforts are already paying off for gay and bisexual men, yet we still face major challenges and more must be done."

A related article in the same journal describes results from the Annual American Men's Internet Survey of behaviors of men who have sex with men in the U.S.

Below is an edited excerpt from an Emory University press releasesummarizing the study findings.

New Analyses Offer Clearer Picture of Where to Target HIV Prevention and Care Efforts to Reach Gay and Bisexual Men at Greatest Need

HIV Infection among Gay and Bisexual Men Especially High in the South

May 17, 2016 -- In the United States, the burden of HIV is disproportionately high for men who have sex with men (MSM), who account for approximately two-thirds of all new diagnoses each year. Results from a new study estimating rates of HIV prevalence (number of people living with an HIV diagnosis) among MSM at local levels highlight areas where gay and bisexual men are at greatest risk for HIV infection. Focusing on these areas will allow health departments and community-based organizations to provide HIV prevention and care resources to MSM who need them most. 

A new report in JMIR Public Health and Surveillance, authored by researchers at Emory University’s Rollins School of Public Health, provides state, city, and county estimates of the rate of MSM living with HIV. According to the report, HIV prevalence among MSM in 2012 was 15 percent (i.e., 15 in 100 MSM were living with HIV infection), but rates vary dramatically by geographic area.

"We know from surveillance data that MSM represent a high percentage of people living with HIV and annual HIV diagnoses, and prior studies have shown that rates of HIV among MSM are dramatically higher than among other populations. However, our analyses are the first to present HIV rates among MSM broken down by states, counties, and metropolitan statistical areas," says research team lead, Eli Rosenberg, PhD, assistant professor of epidemiology at Rollins School of Public Health. "These refined results are an additional tool for regional and local public health action and provide further evidence for the need to prioritize HIV prevention efforts for MSM and particularly for MSM living in the South."

Results indicate:

• There were six states where more than 15 percent of MSM were living with diagnosed HIV infection in 2012, all of which were in the U.S. South.
• Of the 25 metropolitan statistical areas (MSAs) with the highest levels of MSM living with an HIV diagnosis, 21 were located in southern states.
• Estimates showed in 2012, at least one in four MSM were diagnosed with HIV in the following MSAs: Jackson, MS; Columbia, SC; El Paso, TX; Augusta, GA; Baton Rouge, LA.

"By pinpointing where HIV strikes the hardest, we have a key piece of the puzzle highlighting the largest disparities within states and the South," says Dr. Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "We hope these data empower local public health officials, community-based organizations and everyone fighting HIV to bring resources to the gay and bisexual men who need them the most." 

The analyses were funded in part by a CDC cooperative agreement with the Rollins School of Public Health aimed at creating and adapting models to improve public health decision-making and effectiveness. HIV prevalence estimates were calculated by dividing CDC HIV surveillance data from AIDSVu.org and CDC publications by recently published MSM population estimates from a team led by Jeremy A. Grey, PhD, epidemiologist at the Rollins School of Public Health.

5/25/16

References

ES Rosenberg, JA Grey, TH Sanchez, and PS Sullivan. Rates of Prevalent HIV Infection, Prevalent Diagnoses, and New Diagnoses Among Men Who Have Sex With Men in US States, Metropolitan Statistical Areas, and Counties, 2012-2013. JMIR Public Health and Surveillance 2(1):e22. January-June 2016 (May 17, 2016 online publication).

T Sanchez, M M Zlotorzynska, C Sineath, et al. The Annual American Men's Internet Survey of Behaviors of Men Who have Sex with Men in the United States: 2014 Key Indicators Report. JMIR Public Health and Surveillance 2(1):e23. January-June 2016 (May 25, 2016 online publication).

JA Grey, KT Bernstein, PS Sullivan, et al. Estimating the Population Sizes of Men Who Have Sex With Men in US States and Counties Using Data From the American Community Survey. JMIR Public Health and Surveillance 2(1):e14. January-June 2016 (April 21, 2016 online publication).

Other Source

Emory University. New Analyses Offer Clearer Picture of Where to Target HIV Prevention and Care Efforts to Reach Gay and Bisexual Men at Greatest Need. Press release. May 17, 2016.