State Data Show Racial/Ethnic Disparities in HIV, Syphilis Diagnoses Among MSM
Since the start of the HIV epidemic, disparities in both incidence and mortality among men who have sex with men (MSM) have remained prevalent as a result of several health inequalities at play, including access to care. Related to HIV in its susceptible populations, behavioral risks, and biology, syphilis typically affects similar patient populations. Due to their similarities, HIV and syphilis are often linked when considering sexual health outcomes among MSM.
According to a new study that examined disparities in the 2 infections in US states, there is a widely disparate impact of HIV and syphilis among black and Hispanic MSM compared with white MSM.
Between-state variation suggests that states should tailor and focus prevention efforts to best address state data, explained the study researchers who used state-level surveillance data of reported HIV and syphilis cases in 2015 and 2016. Using those data, as well as estimates of MSM population size, they estimated HIV and syphilis prevalence by race/ethnicity and rate ratios (RRs).
“MSM made up roughly 2% of the population but 54% of people living with HIV in the United States in 2015,” wrote the researchers. “Of the 27,814 syphilis cases that were reported in 2016, 3049 were among women, 24,724 were among men, and about 58% of all cases were among MSM.”
In 2016, rates of prevalent HIV diagnoses and new HIV diagnoses were higher among black MSM (prevalent: RR, 3.29; new diagnoses: RR, 5.87) and Hispanic MSM (prevalent: RR, 1.72; new diagnoses: RR, 2.97) compared with white MSM. In all states with reportable data, the state-specific black–white and Hispanic–white RRs for HIV diagnoses were greater than 1.
However, disparity varied by state, with the highest disparity in prevalent HIV infections among black MSM seen in North Dakota (RR, 7.14) and the lowest in Hawaii (RR, 1.20). Among Hispanic MSM, the highest disparity was seen in Vermont (RR, 5.17); similar to black MSM, the lowest disparity was seen in Hawaii (RR, 0.73). For new HIV diagnoses, the highest state-specific disparity among black MSM was in Wisconsin (RR, 10.12) and the lowest was in Rhode Island (RR, 2.35). Among Hispanic MSM, the greatest disparity was seen in Pennsylvania (RR, 5.78) and the lowest was seen in Tennessee (RR, 1.50).
Three of the 6 highest state-specific black–white RRs for HIV diagnoses were in the South, and 5 of the 7 highest Hispanic–white disparities for HIV diagnoses occurred in Northeastern states.
Meanwhile, for syphilis diagnoses in black MSM, the highest state-specific disparity was in Alaska (RR, 17.11) and the lowest was in the District of Columbia (RR, 0.80). For black–white syphilis disparities, 6 of the 7 states with the lowest disparity were Western states.
“Our analysis allows the discussion of disparities to move beyond national-level disparity measures and allows us to examine the data that are most relevant to state programs, which have primary public health responsibility and authority for disease control and treatment programs,” wrote the researchers.
For states like Arkansas, with high diagnosis rates among both black and white MSM, they might consider focusing their response for all MSM, while states with high Hispanic-specific rates and low white-specific rates might consider focusing their efforts on that patient population, they explained.
Sullivan P, Purcell D, Grey J, et al. Patterns of racial/ethnic disparities and prevalence in HIV and syphilis diadgnoses among men who have sex with men, 2016: a novel data visualization [published online November 1, 2018]. Am J Public Health. doi: 10.2105/AJPH.2018.304762.