Almost one in every 5 sexually active gay/bisexual men, also known as MSM (men who have sex with men) is HIV positive, and 44% of them do not know they are infected, according to a CDC report – Morbidity and Mortality Weekly Report (MMWR) – published yesterday. According to the study involving 21 major cities in the United States, those most likely to be unaware of their HIV positive status are African-American and young individuals. To estimate and monitor risk behaviors, CDC’s National HIV Behavioral Surveillance system (NHBS) collects data from metropolitan statistical areas (MSAs) using an anonymous cross-sectional interview of men at venues where MSM congregate, such as bars, clubs, and social organizations.

Kevin Fenton, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said:

This study’s message is clear: HIV exacts a devastating toll on men who have sex with men in America’s major cities, and yet far too many of those who are infected don’t know it. We need to increase access to HIV testing so that more MSM know their status, and we all must bring new energy, new approaches, and new champions to the fight against HIV among men who have sex with men.

These findings add weight to President Obama’s recent drive for a National HIV/AIDS Strategy for the United States, which stressed that:

The United States cannot reduce the number of HIV infections nationally without better addressing HIV among gay and bisexual men.

The President’s strategy listed MSM as one of the few priority groups to focus HIV prevention endeavors. Lowering the number of HIV positive people who are unaware of their infection is one of its key targets, the CDC (Centers for Disease Control and Prevention) writes.

The study tested 8,153 sexually active gay/bisexual males in 21 cities for HIV who had taken part in the 2008 National HIV Behavioral Surveillance (NHBS) system. They calculated HIV awareness as well as prevalence among men who have sex with men.

NHBS tracks risk behaviors, access to medical and prevention services, and HIV testing among populations deemed to be of high risk in cities were the numbers of people living with AIDS is known to be high.

The report reveals that:

  • 28% of African-American sexually active gay/bisexual men were infected
  • 18% of Hispanic sexually active gay/bisexual men were infected (In the USA the term “Hispanic” tends to refer to people either from Latin America or with Latin American ancestry and not including Spain, while in the UK it means people from Spanish speaking countries, including Spain but not including Brazil)
  • 16% of Caucasian sexually active gay/bisexual men were infected

There was a clear difference in HIV infection rates across socioeconomic groups. Rates were higher among people with lower income and academic levels, while awareness of their HIV status was higher as education and income increased. The report adds that previous studies had found similar statistics in heterosexual populations.

The authors also reveal that:

  • 59% of African-American MSM who were HIV infected were unaware of their HIV status
  • 46% of Hispanic MSM who were HIV infected were unaware of their HIV status
  • 26% of Caucasian (white) MSM who were HIV infected were unaware of their HIV status
  • MSM under the age of thirty were less likely to be HIV positive than older sexually active gay/bisexual men
  • 63% of MSM under the age of 30 years who were HIV positive were unaware of their HIV status
  • 30% of MSM over the age of 30 years who were HIV positive were unaware of their HIV status
  • 71% of African-American MSM under the age of 30 years who were HIV positive were unaware of their HIV status
  • 63% of Hispanic MSM under the age of 30 years who were HIV positive were unaware of their HIV status
  • 40% of Caucasian MSM under the age of 30 years who were HIV positive were unaware of their HIV status

The following factors are most likely linked to low HIV status awareness among MSM, the authors write:

  • Infections occurred recently
  • They may have miscalculated their personal risk
  • There were not enough opportunities to get tested
  • A belief that the HIV threat is becoming less serious because of advances in treatment

Poverty, stigma, homophobia and limited health-care access will definitely make the Strategy more challenging, the report points out.

Jonathan Mermin, M.D., director of CDC’s Division of HIV/AIDS Prevention, said:

For young men who have sex with men – including young men of color who are least likely to know they may be infected – the future is truly on the line. It is critical that we reach these young men early in their lives with HIV prevention and testing services and continue to make these vital services available as they become older.

The study authors believe that most new sexually transmitted infections occur among individuals who do not know they are infected, and that they take steps to protect their sexual partners as soon as they do know. Therefore, unawareness of HIV status is most likely a key factor in HIV transmission. Regular HIV testing among MSM, especially the younger ones is crucial.

The CDC recommends that MSM of all age and socioeconomic groups be tested at least once a year, and more frequently if they have multiple partners, anonymous partners, or use drugs during sex.

Less than half of the HIV positive MSM who did not know about their status had been tested during the previous 12 months.

Even though HIV prevention for sexually active gay/bisexual men is a priority, the CDC believes a lot more needs to be done to reduce the burden of HIV on MSM, as well as increasing access to prevention.

AIDS stands for Acquired ImmunoDeficiency Syndrome.

  • Acquired – means that the disease develops after birth, is not hereditary, from contact with a disease causing agent (in this case, HIV).
  • Immunodeficiency – means that the disease is characterized by a weakening of the immune system.
  • Syndrome – refers to a group of symptoms that collectively indicate or characterize a disease. In the case of AIDS this can include the development of certain infections and/or cancers, as well as a decrease in the number of certain cells in a person’s immune system.

HIV (human immunodeficiency virus) is the virus that causes AIDS. This virus may be passed from one person to another when infected blood, semen, or vaginal secretions come in contact with an uninfected person’s broken skin or mucous membranes.

In addition, infected pregnant women can pass HIV to their baby during pregnancy or delivery, as well as through breast-feeding. People with HIV have what is called HIV infection. Some of these people will develop AIDS as a result of their HIV infection.

Put simply: HIV is the virus, while AIDS is the illness.

“Prevalence and Awareness of HIV Infection Among Men Who Have Sex With Men – 21 Cities, United States”
CDC MMWR September 24, 2010 / 59(37);1201-1207

Written by Christian Nordqvist