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HIV Testing Among Men Who Have Sex With Men -- 21 Cities, United States, 2008

June 3, 2011

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Editorial Note

The findings from this analysis suggest that adherence to annual HIV testing recommendations for MSM is low and that even among MSM who reported being tested during the past 12 months, a substantial proportion were newly infected. Because persons often reduce their risk behaviors when they receive a diagnosis of HIV infection and persons who do not know they are infected are estimated to account for more than half of sexually transmitted HIV infections,10 increasing the frequency of HIV testing for MSM can reduce the time from HIV infection to diagnosis and reduce HIV transmission.

Current CDC guidelines identify MSM who should be tested more frequently according to their risk behaviors.8 However, among MSM in this analysis, those who had high-risk behaviors were not more likely to be newly infected than those without high-risk behaviors, suggesting that self-reported risk behaviors might not determine which MSM should be tested more frequently. The 7% prevalence of new HIV infection detected through NHBS among MSM who had been tested for HIV during the past year and the similar prevalence of new HIV infection among MSM with and without high-risk behaviors suggests that more frequent testing, perhaps as often as every 3 to 6 months, might be warranted among all sexually active MSM, regardless of their risk behaviors. In considering revising guidelines regarding frequency of testing among MSM, public health officials also should weigh other factors, including the acceptability and cost effectiveness of testing MSM more frequently and the sensitivity of tests in the early stages of infection.

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That MSM with less education and income were less likely to have been tested suggests that efforts to expand access to and use of HIV testing among MSM should concentrate on these populations. Additionally, although recent HIV testing did not vary by race/ethnicity, the high proportion of HIV-infected persons among minority MSM, particularly black MSM, who had not previously received a diagnosis of HIV infection and were tested during the past year underscores that testing among these populations should be a priority for HIV testing programs.

The findings in this report are subject to at least three limitations. First, positive HIV status might have been underreported, and recent HIV testing might have been overreported during this interviewer-administered survey, thereby inflating estimates of the proportion of MSM in the sample with new HIV infections. Likewise, MSM might have underreported high-risk behaviors, resulting in some MSM being miscategorized as not having high-risk behaviors. This social-desirability bias also can influence response in HIV testing settings, which suggests that identifying persons for more frequent testing based on self-reported risk might not be effective because it might miss those at risk who underreport risk behaviors. Second, MSM with high-risk behaviors who were tested in the past 12 months might have been more likely to receive a positive HIV test result and be excluded from this analysis compared with MSM without high-risk behaviors, which might have resulted in an underestimation of HIV risk among those with high-risk behaviors. Finally, participants were recruited at venues, most of which were bars and clubs, in 21 cities with high AIDS prevalence and might not represent all MSM; data have not been weighted to account for the unequal selection probabilities of venues or frequency of venue attendance.

This analysis demonstrates that MSM remain a key population for expanded HIV testing efforts. Efforts to increase the proportion of HIV-infected MSM who are aware of their infection should include 1) enhanced outreach of HIV testing to sexually active MSM, particularly populations with higher HIV incidence, in clinical and nonclinical settings, and 2) reexamination of existing recommendations and consideration of HIV testing every 3 to 6 months for all sexually active MSM regardless of self-reported risk behaviors.


Acknowledgments

National HIV Behavioral Surveillance System staff members, including Jennifer Taussig, Robert Gern, Tamika Hoyte, Laura Salazar, Atlanta, Georgia; Colin Flynn, Frangiscos Sifakis, Baltimore, Maryland; Deborah Isenberg, Maura Driscoll, Elizabeth Hurwitz, Boston, Massachusetts; Nik Prachand, Nanette Benbow, Chicago, Illinois; Sharon Melville, Richard Yeager, Aaron Sayegh, Jim Dyer, Alicia Novoa, Dallas, Texas; Mark Thrun, Alia Al-Tayyib, Ralph Wilmoth, Denver, Colorado; Emily Higgins, Vivian Griffin, Eve Mokotoff, Detroit, Michigan; Marcia Wolverton, Jan Risser, Hafeez Rehman, Houston, Texas; Trista Bingham, Ekow Sey, Los Angeles, California; Marlene LaLota, Lisa Metsch, Dano Beck, David Forrest, Gabriel Cardenas, Miami, Florida; Chris Nemeth, Carol-Ann Watson, Nassau-Suffolk, New York; William T. Robinson, DeAnn Gruber, New Orleans, Louisiana; Chris Murrill, Alan Neaigus, Samuel Jenness, Holly Hagan, Travis Wendel, New York, New York; Helene Cross, Barbara Bolden, Sally D'Errico, Newark, New Jersey; Kathleen Brady, Althea Kirkland, Philadelphia, Pennsylvania; Vanessa Miguelino, Al Velasco, San Diego, California; H. Fisher Raymond, Willi McFarland, San Francisco, California; Sandra M. De León, Yadira Rolón-Colón, San Juan, Puerto Rico; Maria Courogen, Hanne Thiede, Nadine Snyder, Richard Burt, Seattle, Washington; Michael Herbert, Yelena Friedberg, Dale Wrigley, Jake Fisher, St. Louis, Missouri; Tiffany West-Ojo, Manya Magnus, Irene Kuo, District of Columbia.


References

  1. Purcell DW, Johnson C, Lansky A, et al. Calculating HIV and syphilis rates for risk groups: estimating the national population size of men who have sex with men. Presented at 2010 National STD Prevention Conference; Atlanta, GA. Abstract no. 22896.
  2. CDC. HIV surveillance report, 2009. Atlanta, GA: US Department of Health and Human Services, CDC; 2011. Accessed May 26, 2011.
  3. CDC. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR 2006;55(No. RR-14).
  4. CDC. Prevalence and awareness of HIV infection among men who have sex with men -- 21 cities, United States, 2008. MMWR 2010;59:1201-7.
  5. Gallagher KM, Sullivan PS, Lansky A, et al. Behavioral surveillance among people at risk for HIV infection in the U.S.: the National HIV Behavioral Surveillance System. Public Health Rep 2007;122(Suppl 1):32-8.
  6. MacKellar DA, Gallagher KM, Finlayson T, et al. Surveillance of HIV risk and prevention behaviors of men who have sex with men -- a national application of venue-based, time-space sampling. Public Health Rep 2007;122(Suppl 1):39-47.
  7. Allen DR, Finlayson T, Abdul-Quadar A, et al. The role of formative research in the National HIV Behavioral Surveillance System. Public Health Rep 2009;124:26-33.
  8. CDC. Sexually transmitted diseases treatment guidelines, 2010. MMWR 2010;59(No. RR-12).
  9. Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 2004;159:702-6.
  10. Marks G, Crepaz N, Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS 2006;20:1447-50.

* The 21 MSAs included in this analysis were Atlanta-Sandy Springs-Marietta, GA; Baltimore-Towson, MD; Boston-Cambridge-Quincy, MA-NH: Boston-Quincy Division; Chicago-Joliet-Naperville, IL: Chicago-Joliet-Naperville Division; Dallas-Fort Worth-Arlington, TX: Dallas-Plano-Irving Division; Denver-Aurora-Broomfield, CO; Detroit-Warren-Livonia, MI: Detroit-Livonia-Dearborn Division; Houston-Sugar Land-Baytown, TX; Los Angeles-Long Beach-Santa Ana, CA: Los Angeles-Long Beach-Glendale Division; Miami-Ft. Lauderdale-Pompano Beach, FL: Miami Division; New Orleans-Metairie-Kenner, LA; New York-Northern New Jersey-Long Island, NY-NJ-PA: New York-White Plains-Wayne Division; New York-Northern New Jersey-Long Island, NY-NJ-PA: Nassau-Suffolk Division; New York-Northern New Jersey-Long Island, NY-NJ-PA: Newark-Union Division; Philadelphia-Camden-Wilmington, PA-NJ-DE-MD: Philadelphia Division; San Diego-Carlsbad-San Marcos, CA; San Francisco-Oakland-Fremont, CA: San Francisco-San Mateo-Redwood City Division; San Juan-Caguas-Guaynabo, PR; Seattle-Tacoma-Bellevue, WA: Seattle-Bellevue-Everett Division; St. Louis, MO-IL; and Washington-Arlington-Alexandria, DC-VA-MD-WV: Washington-Arlington-Alexandria Division.


What is already known on this topic?

The greatest numbers of human immunodeficiency virus (HIV) infections in the United States occur among men who have sex with men (MSM). CDC recommends that sexually active MSM be tested for HIV infection at least annually.

What is added by this report?

Data from MSM recruited by the National HIV Behavioral Surveillance System (NHBS) for interviews and HIV testing at venues in 21 U.S. cities indicated that 61% of MSM reported an HIV test during the preceding year; among these, 7% had a new, positive HIV test result.

What are the implications for public health practice?

Given the 7% prevalence of HIV infection among MSM who had not previously received a diagnosis of HIV infection and were tested for HIV during the preceding 12 months, sexually active MSM might benefit from more frequent HIV testing (e.g., every 3 to 6 months).

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This article was provided by U.S. Centers for Disease Control and Prevention. It is a part of the publication Morbidity and Mortality Weekly Report. Visit the CDC's website to find out more about their activities, publications and services.
 

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