HIV/AIDS Trends Among U.S. Men Who Have Sex With Men (MSM*)

The AIDS rate for men who have sex with men (MSM) continues to rise, but more slowly than earlier in the epidemic. Due to behavior changes which began in the 1980s, there has been a slowing in the overall rate of new AIDS cases among MSM and declines in new HIV infections have occurred in many areas. Although the overall numbers of AIDS cases among MSM have leveled, cases have steadily risen in some populations of MSM. Racial/ ethnic minority MSM have had large increases in AIDS rates, whereas AIDS rates have decreased slightly for white MSM. AIDS rates also have continued to rise among MSM in small cities and rural areas.

The statistics and trends analyzed in this fact sheet pertain to men whose primary risk factor for acquiring HIV infection was sex with other men. Therefore, this analysis does not include MSM who inject drugs.

This fact sheet is presented in a question-and-answer format that includes current statistics and trends and addresses the changing face of HIV/AIDS among MSM.

How many reported AIDS cases in the United States have been among MSM?

From June 1982 through December 1996, the Centers for Disease Control and Prevention (CDC) received reports of 581,429 cases of AIDS in the United States. Of these cases, 287,576, or 49%, were among MSM. The same 287,576 cases accounted for 59% of all reported AIDS cases among adolescent/adult men.

Through December 1996, the breakdown of AIDS cases reported among MSM by race/ ethnicity shows:

• 65% of cases were among white MSM.

• 20% were among African-American MSM.

• 13% were among Hispanic MSM.

• 1% were among Asian/Pacific Islander MSM.

• <1% were among American Indian/Alaska Native MSM.

The breakdown by age for all reported AIDS cases among MSM shows:

• AIDS Cases Reported Among MSM by Age -- Through December 1996

What was the reported number of new AIDS cases among MSM in 1996?

In 1996, there were 27,316 new cases of AIDS reported among MSM. This represented 40% of all reported AIDS cases in 1996. The same 27,316 represented 50% of reported AIDS cases among adolescent/adult males in 1996. The breakdown in new reported AIDS cases in 1996 among MSM by race/ethnicity is shown in the chart below.

How has the racial/ ethnic distribution of AIDS cases among MSM changed between 1990 and 1996?

The proportion of African-American and Hispanic MSM among new AIDS cases has increased. In 1990, African-American and Hispanic MSM accounted for 19% and 11%, respectively, of new AIDS cases among MSM. In 1996 the proportions grew to 24% for African-American MSM and 15% for Hispanic MSM. In contrast, the proportion for MSM with AIDS who were Asian/Pacific Islander or American Indian/Alaska Native did not differ substantially between 1990 and 1996, and the proportion who were white decreased from 69% to 59%.

What is the AIDS prevalence among MSM?

Prevalence refers to the number of people living with a particular disease. In June of 1996, MSM accounted for the largest number of persons living with AIDS (approximately 98,000), and from July 1995 to June 1996, MSM accounted for the largest absolute increase (5,100) in the number of persons living with AIDS.

What were the trends in AIDS OI among MSM in the 1990s?

Current Trends
CDC uses a statistical technique** to analyze trends in the epidemic. This technique estimates when people with HIV are likely to become ill. These illnesses are known as AIDS-related opportunistic infections (AIDS-OI). Some of the trends among MSM described in this section were analyzed using this technique.

By Geographic Region
AIDS-OI rates in the West decreased slightly (-2%), but rates increased in all other regions. Although racial/ethnic rate differences were fairly consistent within regions, the highest race/ region-specific increase in AIDS-OI rates occurred among African-American MSM in the South (59%) and the Midwest (59%). The only race/region-specific decrease was among white MSM in the West (-8%); in all other regions, rates among white MSM were stable.

Among All MSM
From 1990 through 1992, the estimated AIDS-OI incidence among MSM increased 17%. Annual increases in incidence then began to slow, and from 1994 through 1995, estimated cases among MSM remained relatively constant at 29,500 each year.

Among Young MSM
Between 1990 and 1995, estimated AIDS-OI incidence among MSM aged 13 to 25 years declined 29%. However, trends in incidence varied greatly by race/ethnicity. While AIDS- OI incidence decreased 50% among young white MSM during this period, incidence fell just 2% among young black MSM and rose 5% among young Hispanic MSM. AIDS-OI incidence rate refers to the number of AIDS-OI cases per 100,000 population for a specific time period. For regional analysis in this section of the fact sheet, only data from the 50 states and the District of Columbia were used. National analysis also included Puerto Rico and other U.S. dependencies, possessions, and associated nations. This section will compare AIDS-OI rate data among MSM from 1990 through 1995.

By Age
AIDS-OI rates over the 5-year period increased for men age 30 and older, but decreased for men ages 13 to 29. The largest increase was for men over 59 years old (32%); however, the rates in this age group were low.

AIDS-OI Rates + Among MSM in 1990 and 1995, by Region

What were the trends in AIDS incidence rates among MSM from 1990 through 1995?

By Metropolitan Area
Larger increases in AIDS-OI rates occurred in rural areas and areas with 50,000 to 249,000 residents; however, these smaller metropolitan areas had lower rates than large metropolitan areas in 1990. The largest race/metropolitan area-specific increases in rates occurred among African-American (132%) and Hispanic (100%) MSM in rural areas, African-American (83%) MSM in metropolitan areas between 50,000 and 249,000 resi- dents, and African-American (100%) and American Indian/Alaska Native (100%) MSM in metropolitan areas of 250,000 to 999,999 residents. The only decrease in rates occurred among white MSM (-9%) in metropolitan areas of more than 2.5 million residents. In the 10 metropolitan areas with the largest cumulative numbers of AIDS-OI cases among MSM, the AIDS-OI rates and changes in the rates have differed. Rates for African- American MSM increased in all 10 areas, and rates for Hispanic MSM increased in 6 of 8 metropolitan areas with enough data for analysis. In contrast, rates for white MSM decreased in 7 of the 10 metropolitan areas. The largest decrease in AIDS-OI rates occurred in Houston (-21%), and the largest increase occurred in Miami (34%) and was associated with a large increase among African-American MSM (110%)

What are the trends in AIDS mortality among MSM?

The estimated number of deaths among MSM reported with AIDS rose steadily in the 1980s and early 1990s, and then leveled at approximately 25,000 deaths in 1994 and 1995. In the first 6 months of 1996, overall AIDS deaths declined for the first time. Compared with the first half of 1995, AIDS deaths among MSM fell 19% in the first half of 1996. While AIDS deaths among MSM have shown a decline, AIDS remains the leading cause of death among all men ages 25-44.

References

Centers for Disease Control and Prevention (CDC). HIV/AIDS Surveillance Report 1996;8(2):1-39.

CDC. Update: Trends in AIDS incidence, deaths, and prevalence -- United States, 1996. MMWR 1997;46(8):165-172.

Denning PH, Jones JL, Ward JW. Recent trends in the HIV epidemic among adolescent and young adult gay and bisexual men. J Acquir Immune Defic Syndr. In press.

Sullivan PS, Chu SY, Fleming PL, Ward JW. Changes in AIDS incidence for men who have sex with men, United States, 1990 through 1995. AIDS. In press.

Notes

* The term MSM is meant to identify men whose primary reported risk category for HIV infection is unprotected sex with other men. The MSM term is not intended to imply that all sex between men is inherently risky, but that unprotected sex between men of discordant or unknown serostatus may pose a risk for HIV transmission. Also, the term MSM includes all men who have had unprotected sex with men, whether they identify themselves as gay, bisexual, heterosexual, or other.

** To more accurately analyze trends, CDC uses estimates based on when people will develop opportunistic infections (OIs). Most HIV-infected people become severely immunosuppressed before the onset of one of the numerous illnesses indicative of AIDS. The estimates of when these AIDS-related opportunistic illnesses (AIDS-OIs) will occur are used to determine the annual AIDS incidence (or the number of people diagnosed each year with AIDS.) The use of this technique adjusts for reporting delays and changes in the reporting system over time.

For further analysis of surveillance and trends in HIV/AIDS, consult the HIV/AIDS Surveillance Report. The most recent issue of the report, as well as many other resources, can be obtained from the sources shown below.

For more information. . .

CDC National AIDS
Clearinghouse
PO Box 6003
Rockville, MD 20849-6003
1-800-458-5231
CDC National AIDS Hotline: 1-800-342-AIDS
CDC National STD Hotline: 1-800-227-8922