Gaps in Care Among Gay Men with HIV

Only half of gay and bisexual men diagnosed with HIV received care and treatment in 2010

To support the goals of the National HIV/AIDS Strategy, CDC is focused on improving outcomes

Among gay and bisexual men in the United States who have been diagnosed with HIV, only half are receiving care and treatment for their infection, according to a new analysis by the Centers for Disease Control and Prevention. And just 42 percent have achieved viral suppression – meaning their virus is under control at a level that helps keep them healthy and also greatly reduces their risk of transmitting HIV to others.

Published today in CDC’s Morbidity and Mortality Weekly Report, the new analysis of the proportion of men who have sex with men (MSM) diagnosed with HIV who were engaged at each stage of care in the U.S. in 2010 also indicates that young MSM and African-American MSM were the least likely to receive care and treatment.

“It’s unacceptable that treatment, one of our most powerful tools for protecting people’s health and preventing new HIV infections, is reaching only a fraction of gay men who need it,” said Jonathan Mermin, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention. “A top prevention priority at CDC is making sure every gay man with HIV knows his status and receives ongoing medical care – otherwise, we will never tackle the HIV epidemic in the country.”

To help achieve the goals of the National HIV/AIDS Strategy, during 2010 to 2014, CDC:

• Realigned prevention and surveillance funding to better match the burden of disease
• Restructured prevention strategies and programs to increase the focus on people living with HIV – 75 percent of prevention funding to health departments must be focused on HIV testing, condom distribution, policy initiatives, and comprehensive prevention with HIV-positive individuals
• Funded, in collaboration with the Health Resources and Services Administration, the Retention in Care Study – a randomized controlled trial of a clinic-based retention intervention showing improvements in retention

Revised in March 2012, U.S. clinical guidelines now recommend that everyone with HIV begin therapy upon diagnosis, regardless of their CD4 immune cell count or viral load. Authors note that although the data presented in today’s analysis were collected before that revision, they do underscore critical gaps at every stage of care for gay and bisexual men diagnosed with HIV – particularly when it comes to keeping them engaged in medical care.

Across-the-board gaps, marked by stark disparities, challenge HIV prevention efforts

Overall, among MSM diagnosed with HIV, three-quarters (77.5 percent) were linked to care within three months of diagnosis, but only half (50.9 percent) were retained in care. In large part because many were not in care, fewer than half of MSM diagnosed with HIV (49.5 percent) were prescribed antiretroviral therapy and only 42 percent achieved viral suppression.

While 71 percent of young (aged 13-24) MSM diagnosed with HIV were linked to care, only 45.7 percent were retained in care. Largely as a result, fewer than one-third (30.5 percent) of those aged 18-24 (the most comparable age group for which data are available) were prescribed antiretroviral therapy, and just one-quarter (25.9 percent) achieved viral suppression (vs. 42 percent of MSM overall).

While 72 percent of black MSM diagnosed with HIV had been linked to care, only 46 percent were retained in care. Largely as a result, fewer than half (47.1 percent) of black MSM were prescribed antiretroviral therapy and just 37 percent achieved viral suppression (vs. 44 and 42 percent of white and Hispanic MSM, respectively).

The findings suggest that age- and race-related disparities in care and treatment may play a key role in the disproportionate burden of new HIV infections among young and African-American gay and bisexual men. High prevalence of HIV within these communities, coupled with low rates of viral suppression, means people in these groups are at higher risk of infection with every sexual encounter.

“To stop the epidemic among gay and bisexual men in its tracks, we must tackle the disparities that persist at every stage of HIV care and treatment,” said Eugene McCray, M.D., director of CDC’s Division of HIV/AIDS Prevention. “And we have to better reach the youngest generation – particularly young African-American men, who have experienced a surge in new HIV infections in recent years.”

To address these disparities, CDC:

• Launched 11-city MSM Testing Initiative to identify best practices for delivering HIV testing to gay and bisexual men
• Provided $55 million to community-based organizations to test an additional 90,000 young gay, bisexual, and transgender youth of color
• Launched the Care and Prevention in the United States project – a three-year $44.2 million pilot program that is helping eight state health departments increase the number of people with HIV who receive ongoing medical care and treatment
• Released national communications campaigns, including several designed to increase testing among gay and bisexual men of color and, most recently, Start Talking. Stop HIV., which encourages all gay and bisexual men to talk openly with their sexual partners about HIV risk and how to identify the prevention strategies that are right for them

For the new analysis, data from CDC’s National HIV Surveillance System (NHSS) provided estimates of the number of MSM diagnosed with HIV. Additional NHSS data from 19 U.S. jurisdictions with complete reporting of CD4 immune cell count and viral load test results were used to assess linkage to care within three months after diagnosis and retention in care. And data from the Medical Monitoring Project, which captures a nationally representative sample of people in HIV care, were used to assess prescription of antiretroviral therapy and viral suppression.

Critical to close gaps in HIV testing and retention in care

Today’s analysis highlights the need for improvements at each stage of care for men who have already been diagnosed. But it is equally important to reach the estimated 19 percent of gay and bisexual men who don’t yet know they’re infected. HIV testing is the gateway into care – a person cannot get treatment without first knowing they have HIV. Fully capitalizing on the benefits of antiretroviral therapy – both for individual health and for prevention – will require significant investment in closing gaps across the board, from testing to retention in care and adherence to treatment.

Data indicate that diagnosing individuals living with HIV, engaging them in ongoing care and prevention services, and ensuring they can stay on treatment are among the most cost-effective ways to prevent new infections. CDC has responded by refocusing its prevention strategy to include a primary focus on people living with HIV, while at the same time maximizing all available strategies for protecting HIV-negative individuals who are at high risk for infection, particularly gay and bisexual men. Specifically, CDC is working with health departments across the nation to use their surveillance data to identify and connect with those who have fallen out of care in order to re-engage and retain them in care. CDC is also funding community-based organizations across the nation to provide both peer-to-peer support and evidence-based interventions in order to help those diagnosed with HIV access and stay in care.

For additional resources on today’s analysis, visit www.cdc.gov/nchhstp/newsroom.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES