Care Continuum Improvements Needed for Sexual Minority Men Living With HIV

Men who have sex with men (MSM), or sexual-minority men, living with HIV continue to suffer from unequal care outcomes and inadequate access to care and HIV-related services, according to the CDC’s latest Morbidity and Mortality Weekly Report.

The report details analyses on overall and race/ethnicity data on HIV prevention services among MSM from the National HIV Surveillance System, National HIV Behavioral Surveillance, and Medical Monitoring Project.

Adding to these already troubling results is that total new HIV infections among MSM did not vary significantly between 2010 and 2019—either as a decrease or increase in total infections—dropping from 25,100 to 23,100 (8%). Also, two-thirds of new HIV infections in the United States in 2019 were among this 2% of the country’s adult population.

“Gay, bisexual, and other MSM have been disproportionately affected by HIV since the onset of the epidemic and have been a priority population for HIV prevention and treatment,” the authors wrote. Ending the HIV epidemic in the United States cannot be achieved without substantial reductions in HIV infections among MSM, they noted.

Looking at the findings by race/ethnicity and age, the analyses on estimated new HIV infections show the following:

• Infections dropped among White MSM by 32% vs a 1.1% decrease among Black MSM and a 16% increase among Hispanic/Latino MSM
• Infections rose 49% among MSM aged 25 to 34 years but dropped 45.2% and 31% among MSM aged 13 to 24 and 45 to 54 years, respectively
• 85% of MSM overall received an HIV diagnosis, but compared with White MSM (90%), fewer Black MSM (83%) and Hispanic/Latino MSM (80%) received an HIV diagnosis
• MSM aged 25 to 34 years had the fewest HIV diagnoses (55%)

In addition, the results on treatment and prevention barriers show that 79% of MSM were tested for HIV within the past year (as of 2017 data examining a subset of MSM in 23 urban areas). But out of 1181 MSM who visited a health care provider (HCP) in the past year but had not been tested, 78% were not offered an HIV test at their visit. The lowest testing percentages were among MSM aged 45 to 54 and at least 55 years old.

Pre-exposure prophylaxis (PrEP) was discussed with their HCP by just over half (52%) with likely PrEP indications, and the lowest usage rates were seen among those at least 55 years old (24%) and Black MSM (27%).

Among the MSM on antiretroviral treatment (ART), a majority (58%) were 100% adherent over the past 30 days and 68% were virally suppressed. Adherence was lowest among 18-to-24-year-olds (45%) and Black MSM (48%), and viral suppression rates were lowest among 25-to-24-year-olds (65%) and Black MSM (62%).

On a stigma scale of 0 to 100 (no stigma to highest stigma), MSM aged 18 to 24 had the highest scores (39), while compared with White MSM (26), Black (33) and Hispanic/Latino MSM (32) reported greater stigma.

Citing the findings that show persistent care inequities within the HIV space despite targeted efforts among Black and Hispanic MSM, the authors called for prevention and treatment strategies that address the root causes of these ongoing care gaps, “including systemic racism, stigma, discrimination, homophobia, poverty, homelessness, and unequal access to care and prevention services.”

The low rates of testing for HIV are contrary to the CDC’s recommendation of annual HIV testing among all sexually active MSM.

“Intensified and innovative efforts to expand access to HIV testing, prevention, and treatment services for MSM, particularly Black MSM, Hispanic/Latino MSM, and younger MSM, are required to decrease health disparities and reduce new HIV infections,” the authors concluded. “All programs should implement a status neutral approach to reduce barriers to prevention, testing, and treatment by breaking down institutional barriers and reducing HIV-related stigma.”

Reference

Pitasi MA, Beer L, Cha S, et al. Vital signs: HIV infection, diagnosis, treatment, and prevention among gay, bisexual, and other men who have sex with men—United States, 2010–2019. MMWR Morb Mortal Wkly Rep. 2021;70(48):1669-1675. doi:10.15585/mmwr.mm7048e