Linkage to HIV Care, Viral Suppression Continue to Vary Among Racial, Ethnic Groups, CDC Reports

Minority men who have sex with other men (MSM), especially Hispanic/Latino and African American/Black men, account for most new HIV diagnoses, despite total diagnoses actually decreasing 2.3% (95% CI, 1.9%-2.8%) annually, according to the CDC’s most recent Morbidity and Mortality Weekly Report.

In 2015 alone, the HIV diagnosis rate was 9.3 times higher in Black MSM compared with White MSM. This group also accounted for more diagnoses compared with the other racial/ethnic MSM groups evaluated.

Overall, by the end of the study period, just over two-thirds (68.3%) were able to achieve viral suppression (viral load < 200 copies/mL) within 6 months and only 80.8% were linked to care in the month following their diagnosis. Both of these results came in “below target during 2018.”

Using data reported as of December 2019 to the National HIV Surveillance System for MSM who received their diagnoses from 2014 to 2018, this examination of race/ethnicity and age data from 2014 through 2018 shows that new HIV diagnoses increased each year by 2.2% (95% CI, 1.0%-3.4%) among Black MSM and 2.0% (95% CI, 0.6%-3.3%) among Hispanic MSM aged 25 to 34 years. For younger MSM (aged 13-19 years), no significant change for either group was seen.

All MSM lived in 1 of 33 jurisdictions reporting complete lab data on CD4 counts and viral load for the study period.

“These findings, albeit promising, warrant intensified preventions efforts for Black, Hispanic, and younger MSM,” the report noted.

Although additional analyses reveal disparities in the results among the racial groups (Black, Hispanic, White, other) and age ranges (13-19, 20-24, 25-34, 35-44, 45-54, > 55 years) evaluated, there were similarities as well:

• Among Black MSM, diagnoses decreased 1.3% annually overall compared with no significant change for Hispanic MSM and 4.8% for White MSM
• For those aged 20 to 24 years, diagnoses decreased 6.0%, 3.7%, and 5.6% among Black, Hispanic, and White MSM, respectively
• For all groups evaluated, diagnoses did not significantly change among Black, Hispanic, and White MSM for those 13 to 19 or at least 55 years old
• White MSM aged 45 to 54 and 25 to 34 years had the largest and smallest age-related decreases, respectively, in new HIV diagnoses: 9.3% and 2.1%
• Linkage to care increased the most among Black MSM and the least among White MSM: 3.8% vs 1.8%
• Linkage to care increased among all groups for those 20 to 24 and 25 to 34 years old
• Viral suppression did not significantly increase in any of the groups for MSM at least 55 years old
• Viral suppression increased the most for Black MSM and the least for White MSM: 9.4% vs 4.4%
• Preexposure prophylaxis prescriptions were more often provided to White MSM in 23 of the jurisdictions in 2017 than they were to Black and Hispanic MSM.

The report stresses the need to intensify prevention efforts Black and Hispanic/Latino MSM, especially those in the youngest age range evaluated (13-19 years), as well as increasing the overall linkage to care and viral suppression.

“CDC encourages use of interventions that address social determinants of health that underlie the high risk for HIV infection among MSM of all races/ethnicities and ages,” the authors concluded. “Such interventions might help prevent HIV infection and eliminate racial/ethnic disparities in HIV infection among MSM.”

Limitations to their findings are 2-fold:

• Incomplete data—just 33 of 51 US jurisdictions reported complete CD4 and viral loads for the study period—mean that not all HIV diagnoses among MSM are represented in the study findings.
• Estimated annual percentage change used a P value of < .05, so that temporal trend changes might be deemed insignificant.

Reference

Jeffries WL 4th, Dailey AF, Jin C, Carter JW Jr, Scales L. Trends in diagnosis of HIV infection, linkage to medical care, and viral suppression among men who have sex with men, by race/ethnicity and age — 33 jurisdictions, United States, 2014–2018. MMWR Morb Mortal Wekly Rep. 2020;69(38):1337-1342. doi:10.15585/mmwr.mm6938a1