Trends in HIV/AIDS Diagnoses Among Men Who Have Sex with Men — 33 States, 2001–2006
In 2008, CDC conducted an analysis of trends in diagnoses of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) among men who have sex with men (MSM) in the 33 states* that have had confidential, name-based HIV case reporting since at least 2001.
This report summarizes the results of that analysis, which indicated that the number of HIV/AIDS diagnoses among MSM overall during 2001–2006 increased 8.6% (estimated annual percentage change [EAPC] = 1.5).
During 2001–2006, an estimated 214,379 persons had HIV/AIDS diagnosed in the 33 states. Of these diagnoses, 46% were in MSM, and 4% were in MSM who engaged in illicit injection-drug use (IDU) (i.e., MSM and IDU). To reduce the impact of HIV/AIDS in the United States, HIV prevention services that aim to reduce the risk for acquiring and transmitting infection among MSM and link infected MSM to treatment must be expanded.
In this report, HIV/AIDS refers to three categories of diagnoses collectively: 1) a diagnosis of HIV infection (not AIDS), 2) a diagnosis of HIV infection with subsequent AIDS diagnosis, and 3) concurrent diagnoses of HIV infection and AIDS. Reporting cases of HIV infection (not AIDS) and AIDS is now legally mandated in all U.S. states, the District of Columbia, and five U.S. territories.
The CDC case definition for HIV infection (not AIDS) requires a positive test result from an assay approved by the Food and Drug Administration that demonstrates evidence of HIV infection; the case definition for AIDS requires meeting the HIV infection (not AIDS) case definition, plus diagnosis of at least one AIDS-defining illness or a CD4+ T-lymphocyte count of <200 cells/µL.†
Using the HIV/AIDS Reporting System (HARS), case report data were collected by local and state health department staff members and then transmitted to CDC devoid of patient names.
The findings in this report are based on HIV/AIDS diagnoses made during 2001–2006 and reported to CDC as of June 30, 2007 (1).
Numbers of diagnoses were adjusted for reporting delays and for redistribution of cases with missing risk factor information, using a standard method that has been described previously (2). This method does not include statistical adjustments for diagnosed but unreported cases or for cases yet to be diagnosed. To facilitate comparisons between the estimated number of diagnoses occurring in 2001 and the number occurring in 2006, 95% confidence intervals (CIs) were calculated. To examine trends, EAPCs with corresponding CIs were calculated. EAPC measures the differences between adjacent years under examination and then averages these inter-year differences. In this report, transmission categories§ are discrete (e.g., "MSM" is distinct from "MSM and IDU" and "IDU" is distinct from "MSM and IDU"). Accordingly, MSM who were also injection-drug users (MSM and IDU) were excluded from analysis of MSM.
Of 214,379 HIV/AIDS diagnoses in 33 states during 2001–2006, a total of 97,577 (46%) were among MSM.
Decreases in diagnoses were observed in all transmission categories except MSM (excluding MSM and IDU) (Figure 1).
Among males, MSM accounted for 97,577 (63%) of cases.
Men aged 25–44 years accounted for 64% of cases among MSM (Table).
Among MSM, the number of diagnoses increased from 16,081 (CI = 15,784–16,377) in 2001 to 17,465 (CI = 16,938–17,992) in 2006; (EAPC = 1.5) (Figure 1).
From 2001 to 2006, a 12.4% (EAPC = 1.9) increase in the number of HIV/AIDS diagnoses among all black MSM was observed; however, an increase of 93.1% (EAPC = 14.9) was observed among black MSM aged 13–24 years (Figure 2).
During 2001–2006, approximately twice as many (7,658) diagnoses occurred in black MSM aged 13–24 years as in their white counterparts (3,221).
The largest proportionate increase (255.6% [EAPC = 30.8]) was among Asian/Pacific Islander MSM aged 13–24 years.
Among MSM aged 13–24 years, statistically significant increases in diagnoses as measured by EAPC were observed in all racial/ethnic populations except American Indian/Alaska Natives. Among MSM of all ages, statistically significant increases as measured by EAPC were observed in blacks, Hispanics, and Asian/Pacific Islanders.¶
Reported by: A Mitsch, MPH, X Hu, MS, K McDavid Harrison, PhD, T Durant, PhD, Div of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC.
During 2001–2006, male-to-male sex remained the largest HIV transmission category in the United States and the only one associated with an increasing number of HIV/AIDS diagnoses. In this analysis, statistically significant decreases in HIV/AIDS diagnoses were observed for all other transmission categories (i.e., among persons likely to have been infected through high-risk heterosexual contact, IDU, MSM and IDU, and other routes). Among MSM aged 13–24 years, statistically significant increases in diagnoses were observed in nearly all racial/ethnic populations. These findings underscore the need for continued effective testing and risk reduction interventions for MSM, particularly those aged <25 years.
The data in this report indicate when persons were diagnosed with HIV infection, rather than when they became infected. This is an important distinction because a person might have been infected with HIV for years before receiving a diagnosis of HIV infection. Determining when persons who have been diagnosed were actually infected is difficult. Although HIV diagnosis data can provide some indication of underlying trends in HIV infection, this approach has limitations. A greater number of tests for HIV infection among MSM might partially explain the observed increase in HIV/AIDS diagnoses. However, available data suggest that these increases cannot be explained by increases in testing alone; the increase could be attributed to more targeted testing, increasing incidence, or some combination of these.** [27 June 2008, CDC, MMWR Weekly, 57(25);681-686, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5725a2.htm?s_cid=mm5725a2_e]