Prevalence and Awareness of HIV Infection Among Men Who Have Sex With Men --- 21 Cities, United States, 2008

Prevalence and Awareness of HIV Infection Among Men Who Have Sex With Men --- 21 Cities, United States, 2008
Weekly
September 24, 2010 / 59(37);1201-1207


Men who have sex with men (MSM) are at increased risk for infection with human immunodeficiency virus (HIV). In 2006, 57% of new HIV infections in the United States occurred among MSM (1). To estimate and monitor risk behaviors, CDC's National HIV Behavioral Surveillance system (NHBS) collects data from metropolitan statistical areas (MSAs) using an anonymous cross-sectional interview of men at venues where MSM congregate, such as bars, clubs, and social organizations. This report summarizes NHBS data from 2008, which indicated that, of 8,153 MSM interviewed and tested in the 21 MSAs participating in NHBS that year, HIV prevalence was 19%, with non-Hispanic blacks having the highest prevalence (28%), followed by Hispanics (18%), non-Hispanic whites (16%), and persons who were multiracial or of other race (17%). Of those who were infected, 44% were unaware of their infection. Men who know their current HIV infection status can be linked to appropriate medical care and prevention services. Once linked to prevention services, men can learn ways to avoid transmitting the virus to others. Young MSM (aged 18--29 years) (63%) and minority MSM (other than non-Hispanic white) (54%) were more likely to be unaware of their HIV infection. Efforts to ensure at least annual HIV testing for MSM should be strengthened, and HIV testing and prevention programs should increase their efforts to reach young and minority MSM.

NHBS is a behavioral surveillance system used to monitor prevalence and trends in 1) HIV-related risk behaviors, 2) HIV testing, and 3) use of HIV prevention services among populations at high risk for acquiring HIV, including MSM, injection-drug users, and heterosexuals at increased risk for HIV infection. Data are collected in annual cycles from one risk group per year so that each group is surveyed once every 3 years. The first cycle of NHBS (among MSM) was conducted in 15 MSAs during 2004--2005; behavioral surveys were conducted in 10 MSAs, and HIV testing in conjunction with the behavioral survey was conducted in five MSAs (2). In 2008, NHBS staff members in 21 MSAs collected cross-sectional behavioral risk data and conducted HIV testing among MSM. MSAs were selected based on high prevalence of acquired immunodeficiency syndrome (AIDS); the 21 MSAs included approximately 60% of all prevalent urban U.S. AIDS cases in 2006. MSM were sampled using venue-based, time-space sampling methods. Health department staff members first identified appropriate venues (e.g., bars, clubs, organizations, and street locations) and days and times when men frequented those venues (3). Venues and the corresponding day/time periods (VDTs) were chosen randomly each month. Staff members then systematically approached men at the venues (2). Men eligible for being interviewed were aged ≥18 years, residents of the MSAs, and able to complete the interview in English or Spanish. After participants gave informed consent, trained interviewers administered a standardized, anonymous questionnaire using a handheld computer. The interview consisted of questions about sex, drug use, HIV testing behaviors, and use of HIV prevention services. All respondents were offered anonymous HIV testing, regardless of self-reported HIV infection status, given the opportunity to receive their test results, and anonymously referred to care when appropriate. HIV testing was performed by collecting blood or oral specimens for either Western blot (WB) or immunofluorescence assay (IFA) confirmatory testing in a laboratory or rapid testing at venues using Food and Drug Administration (FDA)--approved tests for use in nonlaboratory settings. A nonreactive rapid test was considered a definitive negative result; reactive (preliminary positive) rapid test results were considered definitive positive only when confirmed by WB or IFA. MSM unaware of their HIV infection were defined as those who tested HIV-positive at the time of the interview but reported that the result of their most recent HIV test was negative, indeterminate, or unknown, or that they had never been tested. Men were compensated both for their time participating in the interview and for taking an HIV test.

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Prevalence and Awareness of HIV Infection Among Men Who Have Sex With Men --- 21 Cities, United States, 2008