New study highlights inequities in HIV care among MSM
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A study published Tuesday on the eve of World AIDS Day described continuing inequities in HIV care among gay and bisexual men in the United States.
According to the study published in MMWR, there was no overall change in the estimated number of new HIV infections among men who have sex with men (MSM) between 2010 and 2019, the year the U.S. announced a new 10-year plan to end the HIV epidemic.
Infections decreased significantly among white MSM during this period, in fact, but not among Black or Hispanic/Latino MSM, researchers reported.
“Throughout my career, I have witnessed a transformation for those living with and at risk for HIV,” CDC Director Rochelle P. Walensky, MD, MPH, said in a press release. “We have the scientific tools to end the HIV epidemic, however, to achieve this end we must acknowledge that inequities in access to care continue to exist and are an injustice. We must address the root causes of these ongoing disparities and make proven HIV prevention and treatment intervention available to all.”
During a press briefing, Walensky said the new Vital Signs report was timed to coincide with World AIDS Day, which is observed annually on Dec. 1.
“It is an opportunity for people worldwide to unite against HIV, to show their support for people at risk for or with HIV and to remember those who have succumbed to an HIV-related illness,” Walensky said.
The report aimed to assess changes in estimated HIV infections and determine trends among HIV prevention and treatment services, such as HIV testing, PrEP use, ART adherence and viral suppression. To do so, the CDC analyzed national surveillance data from the National HIV Surveillance System, National HIV Behavioral Surveillance and Medical Monitoring Project.
According to Demetre C. Daskalakis, MD, who leads the CDC’s Division of HIV/AIDS Prevention, nearly two-thirds of all new HIV infections occur among MSM. Speaking during the press briefing, Daskalakis said there was a roughly 8% decrease in new HIV infections among MSM, but further assessment revealed the disparities between Black and Hispanic/Latino MSM and white MSM.
The analysis showed that from 2010 to 2019, the number of new HIV infections remained mostly stable among Black MSM (from 9,000 to 8,900), increased among Hispanic/Latino MSM (from 6,800 to 7,900) and declined among white MSM (from 7,500 to 5,100).
According to the study, in 2019, approximately 83% of Black MSM, 80% of Hispanic/Latino MSM and 90% of white MSM with HIV had received an HIV diagnosis, with the lowest percentage of diagnosed infections occurring among MSM aged 13 to 24 years (55%). These are below the 95% threshold needed to reach the U.S. plan’s goal of reducing new infections by 90% by 2030.
Additionally, among MSM with a likely PrEP indication, discussions about PrEP with a provider and PrEP use were less likely to occur among Black MSM (47% and 27%, respectively) and Hispanic/Latino MSM (45% and 31%) than among white MSM (59% and 42%). Similar disparities were reported for ART adherence and viral suppression, with rates of 48% and 62%, respectively, among Black MSM and 59% and 67% among Hispanic/Latino MSM compared with 64% and 74% among white MSM.
According to the report, HIV-related stigma may contribute to these disparities, leading researchers to assess experiences of stigma based on each participant’s reports. Experiences of HIV-related stigma among MSM with an HIV diagnosis were higher among Black MSM (median = 33 on a scale of 0 to 100) and Hispanic/Latino MSM (median = 32) when compared with white MSM (median = 26).
Based on these findings, the authors concluded that improving access to and use of HIV services for MSM — especially Black MSM, Hispanic/Latino MSM, and younger MSM — and addressing social determinants of health that contribute to unequal outcomes “will be essential to end the HIV epidemic in the United States.”
“HIV continues to disproportionately harm the health and well-being of certain groups, including Black and Hispanic/Latino gay and bisexual men,” Daskalakis said. “To end the HIV endemic, we will need to address the systemic factors that turn health differences into public health injustice. It starts with recognizing that HIV disparities are not inevitable. We have a decades-in-the-making opportunity to end our nation’s HIV epidemic and erase the glaring health disparities outlined in this report.”
References:
New CDC Vital Signs report reveals a decade of continuing HIV inequities on eve of World AIDS Day. Published Nov. 30, 2021. Accessed Nov. 30, 2021. https://www.cdc.gov/nchhstp/newsroom/2021/2021-HIV-vital-signs.html.
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