CDC: 1/3 of gay, bisexual men with HIV don’t even know it

The Centers for Disease Control (CDC) has just issued a report on HIV/AIDS treatment in the US, finding that half of gay and bisexual men with HIV go untreated.

And about 1/3 of gay and bisexual men in the US who are infected, don’t even know it.

The report was released in time for National Gay Men’s HIV/AIDS Awareness Day (which falls on Saturday, September 27th this year.) Much of the reported data is NOT good news, especially for some subgroups of gay and bisexual men.

An important note is that this data is drawn from a segment of the US population, not the whole US population with HIV/AIDS. So there is a chance that the numbers may be somewhat different if data from the whole population were used.

HIV/AIDS ribbon via Shutterstock

HIV/AIDS ribbon via Shutterstock

The first bit of bad news is that of all new cases of HIV, almost 2/3 of that total were found in MSMs (Men who have Sex with Men, primarily composed of gay and bisexual men.) That means that in spite of efforts by the CDC and other scientific, medical and social organizations, many gay and bisexual men are still getting infected with HIV.

The CDC is trying to use additional methods of outreach to limit the spread of HIV. Promoting safer sex methods on social media is one method.  Another is encouraging men to use PrEP (Truvada), a daily pill that has been show to significantly decrease the transmission of the HIV virus.

To try to improve treatment, and decrease the viral load (the quantity of virus in the bloodstream) of those already infected, the CDC has targets that it will try to reach by 2015 in regards to the treatment of HIV patients. The targets are:

  • 85% of MSMs who are diagnosed with HIV should be linked to care. That is, after diagnosis, they should be given a follow up appointment with a doctor, clinic or hospital where they can get appropriate care including being started on appropriate anti-HIV medications. [Some patients are always lost to follow up. They may refuse treatment, die, become incarcerated, move or in some other manner be lost.]
  • 80% should be retained in care. That is, steps should be taken to make sure that patients continue in treatment. This can be done via case management services, appointment reminders and other means to encourage them to continue treatment.
  • The proportion of patients with an undetectable viral load should be increased by 20%.

Most recent data shows that (for all MSM demographic groups):

  • 78% of newly diagnosed HIV patients were linked to care.
  • 51% were retained in care.
  • 42% achieved viral suppression.

What is disturbing here is that almost 80% of patients are linked to care, but ALMOST 30% OF THOSE LINKED TO CARE FAIL TO REMAIN IN TREATMENT.

That’s 30% who don’t keep appointments, get prescriptions for medications,or have blood tests done.

Obviously, a key issue here will be keeping these men in treatment. That will mean taking a look at why they either never take the opportunity to start treatment, or why many leave treatment.

More bad news. The above data were for all MSM demographics. When the data is digested and broken down into subsets, the results are even worse for two particular groups. Young MSMs and black MSMs.

The number of men successfully linked to care increases with patient age. In general, older patients are more compliant and get into treatment after diagnosis. Men aged 45-54 years link to care at a rate of 84%. But the males in the 13-24 year old age range only got linked to care at about 70% — almost 15% lower than older men.

Breakdown by race shows that African-American males had the lowest percentage linked to care at 71%, while whites and Hispanics/Latinos were linked to care at about a 10% higher rate than African-American men.

For these groups (young MSMs and African-American MSMs) retention in care was also low.

The authors of the report state that it is critical to improve all three areas (linking, retention and suppression) in order to help decrease the number of new cases of HIV in MSMs.

They suggest that perhaps social stigma, lack of easy access to care, lack of health insurance and discrimination might be reasons that young MSMs and black MSMs are not being enrolled and maintained in treatment.

The authors of the CDC report conclude:

CDC has adopted a high-impact prevention approach to reduce the number of new HIV infections by using a combination of scientifically proven, cost-effective, and scalable interventions targeted to relevant populations and geographic areas for increasing the impact of HIV prevention efforts and achieving the goals of the National HIV/AIDS Strategy.*** CDC currently funds prevention, surveillance, research, and evaluation programs for a diverse range of MSM, including young racial/ethnic minority MSM.††† The findings in this report highlight the need for continued expansion of prevention, care, and treatment efforts for achieving improvement in linkage to care, retention in care, and viral suppression for MSM, particularly MSM aged <25 years and black/African-American MSM. Given that MSM account for more than half of new infections and comprise approximately half of persons living with HIV infection, to reduce HIV incidence, improve health outcomes, and reduce HIV-related health disparities in the United States, the prevention and care needs of MSM must be addressed.

I’d like to add that there is more that can be done. We can act to spread the word about HIV testing, treatment, safer sex, PrEP to friends and relatives. If you don’t feel that you don’t have enough knowledge about HIV to talk to someone about HIV, HIV prevention and treatment, you can at least direct them to a site that would be a beginning.

Some places for you (or them) to start are:

CDC
AIDS.gov
NIH


Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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