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HIV/AIDS Among Men Who Have Sex With Men

June 2007


In the United States, HIV infection and AIDS have had a tremendous effect on men who have sex with men (MSM). MSM accounted for 71% of all HIV infections among male adults and adolescents in 2005 (based on data from 33 states with long-term, confidential name-based HIV reporting), even though only about 5% to 7% of male adults and adolescents in the United States identify themselves as MSM.1,2

The number of HIV diagnoses for MSM decreased during the 1980s and 1990s, but recent surveillance data show an increase in HIV diagnoses for this group.3,4 Additionally, racial disparities exist with regard to HIV diagnoses within the MSM population. A recent study, conducted in 5 large US cities, found that HIV prevalence among black MSM (46%) was more than twice that among white MSM (21%).5

The recent overall increase in HIV diagnoses for MSM, coupled with racial disparities, strongly points to a continued need for appropriate prevention and education services tailored for specific subgroups of MSM, especially those who are members of minority races/ethnicities.


Statistics

HIV/AIDS in 2005

(The following bullets refer to the 33 states with long-term, confidential name-based HIV reporting. See the box, before the References section, for a list of the 33 states.)

Transmission Categories of Male Adults and Adolescents With HIV/AIDS Diagnosed During 2005

Transmission Categories of Male Adults and Adolescents With HIV/AIDS Diagnosed During 2005

Note. Based on data from 33 states with long-term, confidential name-based HIV reporting. Because of rounding, percentages may not equal 100.

Race/Ethnicity of MSM Living With HIV/AIDS, 2005

Race/Ethnicity of MSM Living With HIV/AIDS, 2005

Race/Ethnicity of MSM Living With HIV/AIDS, 2005 -- MSM who inject drugs

Note. Based on 33 states with long-term, confidential name-based HIV reporting.

AIDS in 2005

(See the box, before the References section, for AIDS definition. The following data are from 50 states and the District of Columbia.)


Risk Factors and Barriers to Prevention

Sexual Risk Factors

Sexual risk factors account for most HIV infections in MSM. These factors include unprotected sex and sexually transmitted diseases (STDs).

Unknown HIV Serostatus
Approximately 25% of people in the United States who are infected with HIV do not know they are infected.14

Research has shown that many people who learn that they are infected with HIV alter their behaviors to reduce their risk of transmitting the virus.16,17 Therefore, increasing the proportion of people who know their HIV serostatus can help decrease HIV transmission.

Substance Use

The use of alcohol and illegal drugs continues to be prevalent among some MSM and is linked to risk factors for HIV infection and other STDs.18 Substance use can increase the risk for HIV transmission through the tendency toward risky sexual behaviors while under the influence and through sharing needles or other injection equipment. Reports of increased use of the stimulant drug methamphetamine are also a concern because methamphetamine use has been associated both with risky sexual behaviors for HIV infection and other STDs and with the sharing of injection equipment when the drug is injected.19 Methamphetamine and other "party" drugs (such as ecstasy, ketamine, and GHB [gamma hydroxybutyrate]) may be used to decrease social inhibitions and enhance sexual experiences.20 These drugs, along with alcohol and nitrate inhalants ("poppers"), have been strongly associated with risky sexual practices among MSM.21

Complacency About Risk

More than 25 years into the HIV epidemic, there is evidence of an underestimation of risk, of difficulty in maintaining safer sex practices, and of a need to sustain prevention efforts for all gay and bisexual men.

MSM Who Are HIV-Positive

HAART has enabled HIV-infected MSM to live longer. However, HAART's success means there are more MSM living with HIV who have the potential to transmit the virus to their sex partners. This emphasizes the importance of focusing prevention efforts on those who are living with HIV.

Although many MSM reduce their risk behaviors after learning that they have HIV, most remain sexually active.17 Most HIV-infected MSM believe that they have a personal responsibility to protect others from HIV, but some engage in risky sexual behaviors that may result in others' contracting HIV.30-32 Interventions to reduce the risk for transmission, some of which were tested with MSM, are available for persons living with HIV.33,34

The Internet

During the past decade, the Internet has created new opportunities for MSM to meet sex partners.35 Internet users can anonymously find partners with similar sexual interests without having to leave their residence or having to risk face-to-face rejection if the behaviors they seek are not consistent with safer sex.36 The Internet may also normalize certain risky behaviors by making others aware of these behaviors and creating new connections between those who engage in them. At the same time, however, the Internet has the potential to be a powerful tool for use with HIV prevention interventions.

Social Discrimination and Cultural Issues

MSM are members of all communities, all races and ethnicities, and all strata of society. To reduce the rate of HIV infection, prevention efforts must be designed with respect for the many differences among MSM and with recognition of the discrimination against MSM and other persons infected with HIV in many parts of the country.

Combinations of Risk Factors

There is growing recognition that combinations of individual, sociocultural, and biomedical factors affect HIV risk behavior among MSM.46 Childhood sexual abuse, substance use, depression, and partner violence have been shown to increase the practice of risky sexual behaviors. Further research has shown that the combined effects of these problems may be greater than their individual effects.47 Therefore, MSM with more than 1 of these problems may have additional risk factors for HIV infection. The expansion and wider awareness of this type of research, which shows the additive effect of various psychosocial problems, will result in more precise prevention efforts.

Differences Within the MSM Population

Even though MSM constitute a group at risk for HIV, not all MSM are at risk for HIV. Analyzing the context within which individuals of the larger MSM community live and socialize may be a promising method for developing and focusing HIV interventions. A recent large-scale HIV vaccine efficacy trial looked at combinations of demographic characteristics and risk behaviors to help identify MSM at greatest risk.48 This study of more than 5,000 HIV-negative MSM found that older men with large numbers of sex partners, young men who used "party" drugs, and older men who used nitrate inhalants were most likely to contract HIV.

The appreciation of differences within the MSM community will aid in the development of successful HIV prevention interventions.


Prevention

To reduce the incidence of HIV, CDC released the Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings in 2006. These recommendations include the routine HIV screening of adults, adolescents, and pregnant women in health care settings in the United States. They also include reducing barriers to HIV testing. In 2003, CDC announced Advancing HIV Prevention. This initiative comprises 4 strategies: making HIV testing a routine part of medical care, implementing new models for diagnosing HIV infections outside medical settings, preventing new infections by working with HIV-infected persons and their partners, and further decreasing perinatal HIV transmission.

Given that a large number of HIV-infected MSM are unaware of their infection, HIV testing is an important strategy for this population. Many of these men have previously tested HIV-negative, so CDC recommends that all sexually active MSM be tested for HIV at least once a year.49 MSM who engage in high-risk behaviors (e.g., unprotected anal sex with casual partners) should be tested more frequently.

MSM as a group continues to be the population most affected by HIV infection and AIDS. However, research shows that HIV prevention efforts can reduce sexual risk factors: one review found that among men who received an HIV prevention intervention, the proportion who engaged in unprotected sex decreased, on average, 26%.50

CDC offers effective interventions for MSM (www.effectiveinterventions.org). These interventions can be tailored to various audiences, such as African American or Hispanic MSM. For example,

In 2006, CDC provided 54 awards to community-based organizations that focus primarily on MSM. CDC also provides funding through state, territorial, and local health departments. Of these 54 awards, 63% focus on African Americans, 43% on Hispanics, 13% on Asians and Pacific Islanders, and 20% on whites (the percentages do not add to 100% because some of the organizations focus on more than one racial/ethnic group). For example,


Understanding HIV and AIDS Data

AIDS surveillance: Through a uniform system, CDC receives reports of AIDS cases from all US states and dependent areas. Since the beginning of the epidemic, these data have been used to monitor trends because they are representative of all areas. The data are statistically adjusted for reporting delays and for the redistribution of cases initially reported without risk factors. As treatment has become more available, trends in new AIDS diagnoses no longer accurately represent trends in new HIV infections; these data now represent persons who are tested late in the course of HIV infection, who have limited access to care, or in whom treatment has failed.

HIV surveillance: Monitoring trends in the HIV epidemic today requires collecting information on HIV cases that have not progressed to AIDS. Areas with confidential name-based HIV infection reporting requirements use the same uniform system for data collection on HIV cases as for AIDS cases. A total of 33 states (Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming) have collected these data for at least 5 years, providing sufficient data to monitor HIV trends and to estimate risk behaviors for HIV infection.

HIV/AIDS: This term is used to refer to 3 categories of diagnoses collectively: (1) a diagnosis of HIV infection (not AIDS), (2) a diagnosis of HIV infection and a later diagnosis of AIDS, and (3) concurrent diagnoses of HIV infection and AIDS.


References

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