MedicalResearch.com Interview with:
Sonia Singh, PhD, Epidemiologist
Division of HIV/AIDS Prevention
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: HIV infection is a persistent health concern in the United States, particularly for people at high risk of infection such as gay and bisexual men. We used data from the National HIV Surveillance System to estimate HIV incidence and prevalence and the percentage of undiagnosed HIV infections overall and among gay and bisexual men.
Estimated HIV incidence declined nearly 15% overall in the U.S. from an estimated 45,200 infections in 2008 to 38,500 in 2015. Estimated HIV incidence declined for both males (9%) and females (33%) over this period. Estimated HIV incidence declined 32% among heterosexuals, 42% among people who inject drugs and 20% among gay and bisexual men who also inject drugs. Estimated HIV incidence remained relatively stable among gay and bisexual men; however, it increased over 25% among Latino gay and bisexual men, almost 45% among gay and bisexual men ages 25 to 34 and 30% among gay and bisexual men ages 55 and older.
The percentage of undiagnosed HIV infections decreased nearly 20%, from 18.1% in 2008 to 14.5% in 2015. The percentage of undiagnosed HIV infections among gay and bisexual men declined 21.6%, from 21.3% in 2008 to 16.7% in 2015. In 2015, the percentage of undiagnosed HIV infections was highest among gay and bisexual males ages 13-24 (52.2%) compared to other age groups and higher among Latino (20.1%) and African American (19.6%) gay and bisexual men, as well as Asian gay and bisexual men (20.5%), compared to white gay and bisexual men (11.9%).
MedicalResearch.com: What should readers take away from your report?
Response: Though overall decreases in HIV incidence are encouraging, there is lack of progress in reducing HIV incidence among Latino and African American gay and bisexual men, as well as gay and bisexual men ages 25 to 44 and ages 55 and up.
Many young gay and bisexual men with HIV do not know that they are infected. Routine HIV screening in health care settings, targeted testing, and linkage to care should occur so that persons with HIV can access treatment as soon as they are diagnosed and retained in care to achieve viral suppression, protecting themselves and their partners. Support is needed for persons with HIV to keep them engaged in care and promote treatment adherence. Gay and bisexual men, people who inject drugs, and heterosexually active adults at increased risk for HIV infection also may benefit from preexposure prophylaxis (PrEP).
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: To address the large percentage of undiagnosed infections among Asian, Latino, and African American gay and bisexual men, HIV testing must be expanded for these groups. Barriers to accessing testing services include lack of health insurance, stigma, fear, discrimination, and homophobia, as well as immigration issues and language barriers for Asian and Latino gay and bisexual men should be considered.
High-impact prevention strategies must continue to be developed and implemented at the state and local levels to accelerate progress in decreasing HIV incidence for persons at high risk of infection.
Singh S, Song R, Johnson AS, McCray E, Hall HI. HIV Incidence, HIV Prevalence, and Undiagnosed HIV Infections in Men Who Have Sex With Men, United States. Ann Intern Med. [Epub ahead of print 20 March 2018] doi: 10.7326/M17-2082
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