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Black MSM in South underrepresented in HIV testing
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Black men who have sex with men who live in the southern United States are significantly underrepresented in HIV testing, according to data published in MMWR.
“The analysis of CDC-funded HIV testing from 20 health departments in the South found that 6% of HIV tests were provided to African American gay and bisexual men in 2016 and [they] accounted for 36% of the new diagnoses in non-health care facilities,” Mariette Marano, MPH, behavioral scientist in the CDC’s Division of HIV/AIDS Prevention, told Infectious Disease News.
Marano and colleagues noted that 63% of all U.S. black men who have sex with men (MSM) with diagnosed HIV infection live in the South. They reported that the CDC funded 20 health departments and 24 community-based organizations in 2016 for HIV testing and related services in the South. Marano and colleagues analyzed data from 2016, including the number of CDC-funded HIV tests, new HIV-positive diagnoses, if the person with a newly or previously identified HIV diagnosis was linked to medical care within 90 days of diagnosis and interviews about partners. MSM included in the study reported sex with a man within the prior 12 months and were aged 13 years or older.
There were 374,871 CDC-funded HIV tests provided in non-health care facilities in the reported jurisdictions in 2016, with black MSM receiving 22,183 (6%). Of the 2,304 new diagnoses among all people tested, black MSM accounted for 828 new diagnoses (36%).
Among black MSM, the highest percentage of tests were provided to patients aged 25 to 34 years (43%), those who lived in a metropolitan area (75%) and who had a previous test (81%). Overall, 1,471 black MSM received an HIV diagnosis, including 643 (44%) who had previously received an HIV-positive result.
Among the black MSM who had a recent HIV diagnosis, 67% were linked to HIV medical care, whereas 58% of black MSM who had a previous diagnosis were linked to care. Both percentages are below than the national goal of 85%, the researchers wrote.
A higher percentage of newly diagnosed black MSM aged 20 to 24 years (61%) were interviewed for partner services than those aged 25 to 34 years (50%).
The researchers wrote that racism, lower educational levels, stigma, income inequality and lack of access to health care are barriers for black MSM in the South for testing and HIV prevention and treatment.
“Results of [the analysis] suggest that efforts are needed to increase HIV testing of African American gay and bisexual men in non-health care facilities in the South,” Marano said.
She and colleagues concluded that through targeting risk-based testing in non-health care settings and routine screening in locations providing health care service to black MSM, the testing programs in the South can reach more black MSM. – by Bruce Thiel
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Greg Millett, MPH
This analysis underscores two things that may be happening simultaneously, both of which are related to stigma. The first is the stigma associated with HIV — particularly in the South, which likely dissuades many black MSM from testing for HIV in public health department facilities (for fear of their identities being compromised or the perception of less receptive services in these clinics). The second is the stigma associated with homosexuality in the South.
Despite the fact that MSM represent the greatest number of new HIV infections in every region of the country nationally, health departments do not target services to this population proportionate to their risk. The CDC previously released data showing that HIV testing and prevention services disproportionately target heterosexuals. I am sure that health departments in the South are just as prone to this same bias, which of course is only compounded by race for black MSM.
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