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HIV INCIDENCE, PREVALENCE, AND UNDIAGNOSED INFECTIONS IN MEN WHO HAVE SEX WITH MEN
Sonia Singh1, Ruiguang Song1, Anna S. Johnson1, Eugene McCray1, Irene Hall1
1CDC, Atlanta, GA, USA
Gay, bisexual, and other men who have sex with men (MSM) represent approximately 2% of the United States population, yet they represent 67% of persons with HIV diagnoses in 2014. There are differences in HIV diagnoses by race/ethnicity and age, but few data are available on incidence and prevalence. We estimated HIV incidence, prevalence and percent of undiagnosed infections among MSM to better guide prevention efforts.
Data from the National HIV Surveillance System on HIV diagnoses among MSM and the first CD4 test result after diagnosis were used to estimate HIV incidence, prevalence and the percentage of undiagnosed infection by racial/ethnic and age groups for 2008-2014 using a method based on a well-characterized CD4 depletion model.
Estimated annual HIV infections among Hispanic/Latino MSM increased from 6,100 in 2008 (95% confidence interval [CI]: 5,800, 6,500) to 7,200 (95% CI: 6,200, 8,300) in 2014, but decreased among black and white MSM, from 10,100 (95% CI: 9,600, 10,600) to 10,000 (95% CI: 8,800, 11,200) and 8,900 (95% CI: 8,500, 9,300) to 7,400 (95% CI: 6,600, 8,300), respectively. HIV prevalence increased for all racial/ethnic groups from 2008-2014. In 2014, the percentage of undiagnosed infections among black, Hispanic/Latino and white MSM were 20.4% (95% CI: 18.5%, 22.2%), 20.9% (95% CI: 18.6%, 23.1%) and 12.5% (95% CI: 11.0%, 14.0%), respectively. The percentage of undiagnosed infections decreased for all racial/ethnic groups from 2008-2014. Among MSM 13-24 years old, the estimated annual number of HIV infections (9,400 in 2008 to 7,700 in 2014) decreased (p<0.05), and prevalence decreased after 2010 (2010, 57,000; 2014, 48,000). Among MSM 25-34 years old, both the estimated annual number of HIV infections (7,100 in 2008 to 9,700 in 2014) and prevalence (84,300 in 2008 to 128,000 in 2014) increased (p<0.05). The percentage of undiagnosed infections decreased for MSM 13-24 years old (70.1% in 2008 to 52.0% in 2014) and 25-34 years old (32.3% in 2008 to 30.1% in 2014)(p<0.05).
Decreases in HIV infections among black, white, and young (13-24 year old) MSM are encouraging, but there was an increase in HIV incidence among Hispanic/Latino MSM and MSM 25-34 years old from 2008-2014. Though there were decreases in undiagnosed HIV infections for all race/ethnic groups, expansion of HIV testing and treatment, particularly among Hispanic/Latino and MSM 13-24 and 25-34 years old, are needed to achieve the goals of the National HIV/AIDS Strategy.