Black and Hispanic U.S. men who have sex with men have higher rates of HIV diagnosis than whites, and they are more likely than whites to develop AIDS within three years after learning that they are infected with HIV.1 The study that produced these findings also revealed that blacks have the lowest survival rate three years after receiving an AIDS diagnosis. HIV diagnosis rates are increasing more rapidly among young men who have sex with men than among their older counterparts, but trends within age-groups do not vary by race or ethnicity.
The analysis of trends in HIV diagnoses was based on information provided by 33 states to the Centers for Disease Control and Prevention from 2001 to 2004; the data included all men who have sex with men who were at least 13 years old, except injection-drug users. To assess the burden of HIV infection, the researchers calculated diagnosis rates per 100,000 men in the general population, using the number of men who have sex with men and who received an HIV diagnosis in a given year as the numerator; for subgroup analyses, the denominator was age- or race-specific. Patterns of progression from HIV to AIDS were examined for men whose HIV was diagnosed in 1996–2002 and who were followed up through 2004. Likewise, to study survival among men with AIDS, the analysts used data covering diagnoses in 1996–2002 and follow-up through 2004.
Men who have sex with men and who received an HIV diagnosis represented 23.1 of every 100,000 men in the 33 reporting states in 2001. The rate then increased by 1–2% annually, to 24.3 per 100,000 in 2004. Diagnosis rates for black and Hispanic men in 2004 (70.8 and 39.0 per 100,000) were higher than the rate for whites (14.6). A similar pattern was observed in each age-group studied, but the racial and ethnic differentials varied. For teenagers, the rate among blacks (23.5) was about four times that among Hispanics (6.1) and 20 times the rate of whites (1.2). In older age-groups, blacks had 3–4 times the rate among whites, and Hispanic men’s rate lay between those of the other groups.
Between 2001 and 2004, the HIV diagnosis rate declined by 2–3% a year among men in their 30s, but it rose in most other age-groups, and the increases among the youngest men were dramatic. Teenagers’ rate of HIV diagnosis increased by 14% annually, and the rate among men in their early 20s climbed by 13%. By contrast, annual increases were 6% among men in their early 50s, 5% among those in their late 20s and those in their early 40s, and 3% among those aged 45–49; rates among men 55 and older did not change significantly during the study period. Changes within age-groups did not differ by race or ethnicity.
Overall, 71% of men in whom HIV was diagnosed between 1996 and 2002 did not receive an AIDS diagnosis by 2004. The proportion who did not progress to AIDS within three years was significantly higher among whites (75%) than among blacks (67%) or Hispanics (68%). It also was higher among younger than among older men; for example, 84% of teenagers and 78% of men in their 20s did not develop AIDS within three years of their HIV diagnosis, compared with 61% of men aged 50 or older. The year in which HIV had been diagnosed also was related to progression to AIDS, although the differences were not large; for example, the proportion remaining AIDS-free was 68% among men whose HIV was diagnosed in 1996 and 72% among those who learned they were infected in 2001.
Eighty-three percent of men who received an AIDS diagnosis were still alive three years later. The three-year survival rate was 85% for whites and Hispanics, but it was significantly lower for blacks (81%). Young men were more likely than older men to survive for three years: The proportion doing so was 86–88% among men in their teens, 20s or 30s, but it dropped to 81% among men in their 40s, 74% among those in their 50s and 61% among older men. The survival rate fell as men’s CD4+ T-cell count six months after AIDS diagnosis declined. Finally, whereas progression from HIV to AIDS declined only slightly over time, survival after an AIDS diagnosis improved markedly: Some 86% of men who received an AIDS diagnosis in 2001 were still alive three years later, compared with 79% of those who had learned of their illness in 1996.
The analysts caution that the 33 states on which their study was based may not be nationally representative and that the surveillance system lacks important information, such as data that could help determine the role of treatment in the progression of HIV to AIDS. Despite these and other limitations, however, they consider it clear that interventions targeting specific subgroups of men who have sex with men are needed to reduce HIV transmission, AIDS diagnoses, and racial and ethnic health disparities in this population. “In particular,” they conclude, “interventions need to be tailored to the needs and behavioral context of black and Hispanic youth.”—D. Hollander
1. Hall HI et al., Racial/ethnic and age disparities in HIV prevalence and disease progression among men who have sex with men in the United States, American Journal of Public Health, 2007, 97(6):248–253.