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Rates of Starting Care and Treatment Rise Among HIV-Positive Gay and Bisexual Men

May 23, 2017

From 2008 through 2014, rates of entering HIV care and starting antiretroviral therapy rose significantly among gay and bisexual men in a 20-city study by the U.S. Centers for Disease Control and Prevention (CDC). But black gay and bisexual men started treatment less often than white men.

The U.S. National HIV/AIDS Strategy emphasizes the importance of beginning care soon after testing positive for HIV, and by 2020 aims to get 85% of HIV-positive people into care within 1 month of diagnosis. The plan also aims to have at least 80% of people diagnosed with HIV reach an undetectable viral load through antiretroviral therapy. The CDC conducted this study to determine rates of entering care and starting treatment among gay and bisexual men, who account for the highest proportion of people with newly detected HIV in the United States.

The study involved gay and bisexual men at least 18 years old and interviewed in 2008, 2011 or 2014 in one of 20 cities across the United States. All men had tested positive for HIV within the three years before their interview. Men reported how soon they entered care after testing positive and whether they started antiretroviral therapy. The researchers determined the rate of change in entering care and starting treatment for two periods, 2008-2011 and 2011-2014. The analysis of change in starting therapy used a statistical method that adjusts for the impact of age, race, current insurance, and the interaction between age and year.

The entry-to-care analysis included 236 men in 2008, 291 in 2011, and 358 in 2014. When the researchers defined entering care as starting care within three months of testing positive, the rate of entering care rose from 79% in 2008 to 87% in 2014. When the researchers figured the rate of entering care within 1 month of testing positive, the rate increased from 75% in 2008 to 78% in 2014.

The starting-therapy analysis included 1,142 men in 2008, 1,336 in 2011, and 1,714 in 2014. The proportion of men starting antiretroviral therapy rose from 69% in 2008 to 88% in 2014. In each of the three study years, proportions starting treatment were higher among whites, older men, those with health insurance, and those with more education and income. The proportions of black, Hispanic and white participants starting treatment were 60.8%, 70.0%, and 73.8% in 2008; 71.0%, 79.1%, and 85.8% in 2011; and 83.3%, 88.7%, and 92.1% in 2014.

The CDC investigators note that the rate of entering care did not differ much between blacks and whites over the two study periods, but lower proportions of blacks started antiretroviral therapy than whites. This difference between blacks and whites in starting treatment is particularly great in southern states. The researchers point out that many men became eligible for Medicaid coverage of antiretrovirals through the Affordable Care Act (Obamacare), but many southern states did not take advantage of that option to expand Medicaid.

Mark Mascolini writes about HIV infection.

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