Trends in AIDS Incidence and Survival Among Racial/Ethnic Minority Men Who Have Sex With Men, United States, 1990-1999
February 20, 2003
This study describes trends in AIDS incidence, survival, and deaths among racial/ethnic minority men who have sex with men (MSM). In the United States, MSM still account for the largest number of reported AIDS cases each year. Through December 1999, 341,597 AIDS cases were reported among MSM, compared with 184,429 among male and female injection drug users (IDU) and 74,477 among men and women who acquired HIV through heterosexual contact. Racial/ethnic minorities account for an increasing proportion of AIDS cases, including cases among MSM, the authors reported.Adapted from:
The researchers pointed out there are "important economic, social, and cultural differences" distinguishing racial/ethnic minority MSM from white MSM. Such differences influence the context in which minority MSM live, and "have public health implications for providing culturally appropriate HIV/AIDS prevention efforts for each racial/ethnic community," according to the study.
The authors present trends in AIDS incidence among US MSM for 1990-1999 by race/ethnicity and a more detailed analysis of trends from 1996-1999, the era of HAART. They also examine survival trends among minority MSM with AIDS from 1993-1997.
From 1990 through 1999, the proportion of black MSM with AIDS increased from 19 percent to 34 percent. Hispanic MSM with AIDS increased from 12 percent to 18 percent. White MSM with AIDS declined from 67 percent to 46 percent. The proportion of Asian/Pacific Islander (A/PI) and American Indian/ Alaska Native (AI/AN) MSM with AIDS represented 1 percent and less than 1 percent, respectively.
After the introduction of HAART, from 1996 through 1999, racial/ethnic minority MSM comprised 50 percent of MSM with AIDS. All racial/ethnic MSM groups showed a 22 percent decline in AIDS incidence from 1996 to 1997, and a 15 percent decline in 1998 as compared to 1997. By group, the declines were 42 percent among A/PI MSM, 41 percent among white MSM, 28 percent among AI/AN MSM, 29 percent among Hispanic MSM, and 25 percent among black MSM. Smaller declines among all MSM and within racial/ethnic groups occurred from 1998 to 1999.
Deaths among MSM with AIDS declined 49 percent from 1996 through 1997, with the rate of decline slowing to 22 percent for 1998 compared with 1997. From 1996 to 1998, deaths declined 69 percent among A/PI MSM, 63 percent among white MSM, 61 percent among Hispanic MSM, 58 percent among AI/AN MSM, and 53 percent among black MSM. Smaller declines in deaths among all racial/ethnic MSM groups with AIDS occurred from 1998 to 1999.
The investigators found that 85 percent of MSM with AIDS lived in large metropolitan areas with populations of 500,000 or more. Five cities that accounted for the largest number of racial/ethnic minority MSM with AIDS from 1996 through 1999 were New York; Los Angeles; Miami; Washington, D.C.; and Chicago.
Blair and coauthors concluded that annual AIDS incidence among MSM remains high relative to other modes of HIV exposure, and stressed the need to prevent new infections among MSM. They noted that young black and Hispanic MSM remain at high risk for infection, and suggested that racial/ethnic minority community leaders promote dialogue about sexual orientation to overcome social barriers to HIV prevention. "Additionally," the report stated, "because of differences in social characteristics and HIV risk behaviors, prevention programs specifically geared toward bisexual men are needed ... Estimates of the proportion of men who also have sexual contact with women are also useful for prevention planning."
"... CDC will support additional behavioral and serologic surveys, including HIV seroincidence studies, HIV and AIDS case surveillance, and supplemental research and evaluation studies. In 1999, CDC funded a special program to enhance HIV prevention services for racial/ethnic minority MSM. These efforts will enhance the data that are available locally to better guide interventions and assess their impact in reducing HIV infection, disease, and death in the communities most severely affected by the epidemic," the authors concluded.
Journal of Acquired Immune Deficiency Syndromes
11.01.02; Vol. 31: P. 339-347; Janet M. Blair; Patricia L. Fleming; John M. Karon
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.