Improvements in HIV, syphilis prevention measures needed in young, black MSM

Biedrzycki P. MMWR. 2011;60:99-102.

The significant increase in confirmed HIV and syphilis diagnoses in young, black men who have sex with men in Milwaukee county during 1999 and 2008 was not associated with increased testing methods, but due to increased transmission. Researchers therefore recommend improvements in prevention education programs and better entry to care for those with HIV or who are at risk for HIV in Milwaukee and across the US.

Officials at the CDC, Milwaukee Health Department and the Wisconsin Division of Public Health pooled data from publicly funded HIV testing sites and confidential HIV surveillance data reported in Milwaukee since 1985. New HIV diagnoses were considered as those not previously reported.

Researchers then compared trends in new HIV diagnosis, number of tests performed at publicly funded test sites, and the number of positive tests among black, white and Hispanic MSM. Data were stratified by age: 15 to 19 years; 20 to 24 years; 25 to 29 years; and 30 years and older. Aggregate data were compared between 1999 and 2001 and 2006 and 2008. Trends in primary or secondary syphilis diagnoses were also compared with trends in HIV diagnoses.

Increased HIV diagnoses

Between 2006 and 2008, the Wisconsin Division of Public Health increased HIV testing efforts statewide and implemented new social networks testing that encouraged MSM to recruit others for HIV testing within their social networks. Efforts were also aimed at increasing better target testing in publicly funded test sites.

New HIV diagnoses during 2006 and 2008 significantly increased by 143% among black MSM aged between 15 and 19 years; by 245% in those aged between 20 and 24 years; and by 78% in those aged between 25 and 29 years. Yet, new social networks testing accounted for only 11.8%, 5.3%, and 6.3% of new diagnoses, respectively.

Conversely, new HIV diagnoses decreased among black and nonblack MSM aged 30 years and older and increased less among nonblack MSM aged between 20 and 24 years (14%) and those aged between 25 and 29 years (45%).

The researchers noted that target testing in publicly funded test sites were initiated after increases in HIV diagnoses were confirmed.

Increased syphilis diagnoses

In a separate analysis, the researchers reviewed records of 22 black MSM aged between 15 and 29 years diagnosed with primary or secondary syphilis between 2006 and 2009.

Five of the 22 men had syphilis only; nine had HIV and syphilis co-infection; six contracted syphilis after HIV diagnosis; and two contracted HIV after syphilis diagnosis. Compared with 1999 and 2001, the number of syphilis diagnoses increased from one case to 19 cases in black MSM and from zero to four cases in nonblack MSM aged between 15 and 29 years during 2006 and 2008.

“During 2001-2006, HIV diagnoses among black MSM aged between 13 and 24 years across 33 states increased by 93%,” the researchers wrote. “Although some diagnoses were made because of intensified testing, an increase in HIV transmission likely occurred. Moreover, an increase in syphilis diagnoses among young black MSM in Milwaukee preceded the increase in HIV diagnoses, which suggests that changes in risk behavior or sexual networks might explain the increase.”

In an accompanying editorial, CDC researchers wrote that, “As a result of this investigation, [the Milwaukee Health Department] has developed, funded, and is implementing a peer-focused and community-based action plan to promote prevention education, early HIV detection, and entry into care among young black MSM. If evaluation shows these interventions to be effective, other jurisdictions should consider implementing similar measures.” – by Jennifer Henry

CDC's investigation found that reported increases in HIV diagnoses among young, black, gay and bisexual men in Milwaukee are due, at least in part, to increased transmission of HIV within this population. It also highlights the intersecting epidemics of STD and HIV infection among young black gay and bisexual men and points to the critical need for new or improved interventions for young at-risk gay and bisexual men in Milwaukee and across the country. HIV should not be a rite of passage for each new generation of young black gay men. It is critical that we understand the complex social and environmental factors — including homophobia, stigma, and poor access to healthcare — that place many young black gay and bisexual men at risk for HIV infection. It is equally critical that we reach these young men with the tools they need to protect themselves from this preventable disease.

–Kevin A. Fenton, MD, PhD, FFPH

Infectious Disease News Editorial Board member
Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC

Diclosure: Dr. Fenton reports no relevant financial disclosures.

Follow InfectiousDiseaseNews.com on Twitter.