July 11, 2016

Rates of HIV Among MSM Vary Widely By Region

READ TIME: 6 MIN.

By Eric Brus

Eli Rosenberg and colleagues from Emory University's Rollins School of Public Health have used recent estimates of the number of gay, bisexual, and other men who have sex with men (MSM) and publicly available HIV surveillance data to estimate, for U.S. MSM, the prevalence of HIV diagnosis and infection and the rate of new diagnoses, at the national, state, Metropolitan Statistical Area (MSA), and county levels.

Their calculations indicate that, overall, HIV prevalence among MSM in the U.S. during 2012 was 15 percent, the diagnosed HIV prevalence among MSM in 2012 was 11.1 percent, and the new diagnosis rate for 2013 was 0.7 per 100 MSM. The diagnosed HIV prevalence rate among MSM was 57.5 times greater than among other U.S. men.

The bulleted list below highlights geographic patterns in HIV prevalence among MSM at the state, MSA, and county level in 2012. Please note that the HIV prevalence rates and HIV case figures cited refer specifically to diagnosed cases of HIV infection among MSM only. Though not summarized here, the paper also contains estimates of the total HIV cases (both diagnosed and undiagnosed) among MSM, as well as HIV prevalence estimates that include undiagnosed cases.

  • Georgia, with about 24,100 diagnosed HIV cases among MSM and a diagnosed HIV prevalence rate of 18.5 percent, was the only state with both more than 15,000 diagnosed HIV cases and a diagnosed prevalence rate above 15percent.
  • Five states, all in the South, and the District of Columbia (D.C.) had diagnosed HIV prevalence rates above 15 percent but fewer than 15,000 total diagnosed HIV cases among MSM. These states and their associated HIV prevalence rates were: Mississippi (23.3 percent); Louisiana (21.7 percent), South Carolina (21.6 percent), D.C. (21.0 percent), Alabama (15.8 percent), and Arkansas (15.0 percent).
  • Five high-population states had more than 15,000 diagnosed HIV cases among MSM and diagnosed HIV prevalence rates between 10-15 percent. These states and their associated HIV prevalence rates were: New York (14.6 percent), Florida (14.4 percent), Texas (11.8 percent), California (10.9 percent), and Illinois (10.2 percent).
  • Of the 25 MSAs with the highest diagnosed HIV prevalence rates in the U.S., 21 were in the South, and 6 had diagnosed HIV prevalence rates above 25 percent among MSM.
  • County-level data showed high diagnosed HIV prevalence rates in both urban and rural counties of the South.
  • The five states with the lowest diagnosed HIV prevalence rates were: North Dakota (3.3 percent), South Dakota (3.6 percent), Montana (3.7 percent), Vermont (4.0 percent), and Wyoming (4.0 percent).

    "Surveillance data have been described as the conscience of the HIV epidemic, and the new insights provided here on the rates of HIV prevalence and new diagnoses for U.S. MSM constitute a call of conscience for heightened responses and improved monitoring of HIV epidemics among MSM, especially in the South. Across the U.S., MSM are affected by HIV at rates that are orders of magnitude higher than for other Americans. This health disparity is even more pronounced in the South. There is a need for increased resources for HIV prevention, treatment, and care for MSM," conclude researchers. "In the South, this must include expansion of access to health care through Medicaid expansion under the Affordable Care Act; increased access to comprehensive HIV prevention services, including for pre-exposure prophylaxis (PrEP); and increased resources for programs to support immediate referrals for antiretroviral therapy for those who are newly diagnosed with HIV."

    CDC Finds Reduced Risk Among Youth

    The newly released national Youth Risk Behavior Survey (YRBS) for 2015 indicates that progress continues to be made in reducing some sexual risk behaviors among U.S. high school students. Every two years, the YRBS monitors the following six main categories of priority health-risk behaviors among youth and young adults nationwide in grades 9 through 12: 1) sexual behaviors related to unintended pregnancy and sexually transmitted infections (STIs), including HIV; 2) behaviors that contribute to unintentional injuries and violence; 3) tobacco use; 4) alcohol and other drug use; 5) unhealthy dietary behaviors; and 6) physical inactivity. In this brief feature, we focus on the YRBS report's findings on sexual behavioral risks, HIV/AIDS education, and HIV testing.

    Sexual Risk Behaviors and HIV Testing

    According to the 2015 YRBS report, for 9th through 12th grade students:

  • about 41 percent had ever had sexual intercourse -- decreasing from about 47 percent in 2013 and 54 percent in 1991 (the year when the YRBS was first conducted);
  • about 30 percent were currently sexually active -- decreasing from about 34 percent in 2013 and 37.5 percent in 1991;
  • about one in nine (11.5 percent) had had sexual intercourse with four or more people during their life -- decreasing from about 15 percent in 2013 and 19 percent in 1991;
  • about one in 25 (3.9 percent) had sexual intercourse for the first time before age 13 -- decreasing from 5.6 percent in 2013 and 10.2 percent in 1991; and
  • about one in 10 (10.2 percent) had ever been tested for HIV, compared to 12.9 percent in 2013 and 11.9 percent in 2005 (the first year for which this information was compiled in the YRBS).

    Health Education, Health Services, and Supportive Environments

    A related survey, the School Health Policies and Practices Study 2014, indicates that, among U.S. high school students:

  • 75 percent had been taught in school about preventing HIV infection;
  • 76 percent had been taught about preventing STIs;
  • 65 percent had been taught how to find valid information or services related to HIV or HIV testing;
  • 70 percent were taught how to find valid information or services related to STIs or STI screening;
  • 50 percent were taught how to obtain condoms; and
  • 35 percent were taught how to correctly use a condom.

    Further, among U.S. high schools:

  • 50 percent provided HIV or STI prevention services at school in one-on-one or small-group sessions;
  • 7 percent made condoms available to students at school;
  • 40 percent provided HIV counseling, testing, and referral services at school;
  • 54 percent provided identification, treatment of, or referral for STIs at school;
  • 16 percent provided identification, treatment of, or referral for STIs to students through arrangements with providers not located on school property;
  • 35 percent provided services specifically for gay, lesbian, or bisexual students at school; and
  • 38 percent had a gay/straight alliance.

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