Trends in racial/ethnic disparities of new AIDS diagnoses in the United States, 1984-2013.

PURPOSE: In the United States, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) disproportionately impacts racial/ethnic minorities. We describe and evaluate trends in the Black-White and Hispanic-White disparities of new AIDS diagnoses from 1984 to 2013 in the United States. METHODS: AIDS diagnosis rates by race/ethnicity for people ≥13 years were calculated using national HIV surveillance and Census data. Black-White and Hispanic-White disparities were measured as rate ratios. Joinpoint Regression was used to identify time periods across which to estimate rate-ratio trends. We calculated the estimated annual percent change in disparities for each time period using log-normal linear regression modeling. RESULTS: Black-White disparity increased from 1984 to 1990, followed by a large increase from 1991 to 1996, and a smaller increase from 1997 to 2001. Black-White disparity moderated from 2002 to 2005 and rose again from 2006 to 2013. Hispanic-White disparity increased from 1984 to 1997 but declined after 1998. Black-White and Hispanic-White disparities increased for men who have sex with men during 2008 to 2013. CONCLUSIONS: Recent increases in racial/ethnic disparities of AIDS diagnoses were observed and may be due in part to care continuum inequalities. We suggest assessing disparities in AIDS diagnoses as a high-level measure to capture changes at multiple stages of the care continuum collectively. Future research should examine determinants of racial/ethnic differences at each step of the continuum to better identify characteristics driving disparities.

Rates of Prevalent HIV Infection, Prevalent Diagnoses, and New Diagnoses Among Men Who Have Sex With Men in US States, Metropolitan Statistical Areas, and Counties, 2012-2013.

BACKGROUND: In the United States, men who have sex with men (MSM) increasingly represent the majority of people living with and acquiring human immunodeficiency virus (HIV) infection. Local and federal surveillance programs estimate the number of persons living with an HIV diagnosis, persons living with HIV infection, and new diagnoses. Given the absence of population-based estimates of the number of MSM for US states, metropolitan statistical areas (MSAs), or counties, it is not possible to accurately estimate rates using these indicators at these levels, inhibiting the ability to understand HIV burden and to direct prevention efforts. OBJECTIVE: To synthesize recently published estimates of MSM population size with publicly available HIV surveillance data, in order to estimate the prevalence of HIV diagnosis and infection and the rate of new diagnoses, at the national, state, MSA, and county levels. METHODS: The number of MSM living with HIV infection in 2012 (prevalence), living with an HIV diagnosis in 2012 (diagnosed prevalence), and newly diagnosed with HIV infection in 2013 (new diagnosis), at state, MSA, and county levels, were obtained from publicly available data from AIDSVu.org and the US Centers for Disease Control and Prevention. The estimated number of MSM living in every US county was calculated using recently published methodology that utilized data from the National Health and Nutrition Examination Survey and American Community Survey. Estimated county-level MSM counts were aggregated to form MSA- and state-level totals. From this, we estimated HIV prevalence, diagnosed prevalence, and new diagnosis rates. RESULTS: The estimated HIV prevalence among MSM in the United States in 2012 was 15.0% (666,900/4,452,772), the diagnosed HIV prevalence in 2012 was 11.1% (493,453/4,452,772), and the new diagnosis rate for 2013 was 0.7 per 100 MSM. For diagnosed prevalence at the state level, 6 states had both <15,000 cases and diagnosed prevalence rates of ≥15%, all in the South. Five highly populated states had ≥15,000 cases and rates between 10% and 15%. Georgia was the only state with ≥15,000 cases and ≥15% diagnosed prevalence rate. Of the 25 MSAs with the highest diagnosed prevalence rates in the United States, 21 were in the South and 6 had diagnosed prevalence of ≥25%. County-level data showed high diagnosed prevalence rates in both urban and rural counties of the South. CONCLUSIONS: HIV infection is hyperendemic among MSM in many areas of the United States, particularly in the South. Our data emphasize the priorities for HIV prevention and care set forth in the United States National HIV/AIDS Strategy (NHAS) and provide updatable local estimates of NHAS indicators. Jurisdictions can use these results to direct resources, programs, and policies to optimally benefit the health of MSM.

Disassortative Age-Mixing Does Not Explain Differences in HIV Prevalence between Young White and Black MSM: Findings from Four Studies.

OBJECTIVE: Age disassortativity is one hypothesis for HIV disparities between Black and White MSM. We examined differences in age mixing by race and the effect of partner age difference on the association between race and HIV status. DESIGN: We used data from four studies of MSM. Participants reported information about recent sexual partners, including age, race, and sexual behavior. Two studies were online with a US sample and two focused on MSM in Atlanta. METHODS: We computed concordance correlation coefficients (CCCs) by race across strata of partner type, participant HIV status, condom use, and number of partners. We used Wilcoxon rank-sum tests to compare Black and White MSM on partner age differences across five age groups. Finally, we used logistic regression models using race, age, and partner age difference to determine the odds ratio of HIV-positive serostatus. RESULTS: Of 48 CCC comparisons, Black MSM were more age-disassortative than White MSM in only two. Furthermore, of 20 comparisons of median partner age, Black and White MSM differed in two age groups. One indicated larger age gaps among the Black MSM (18-19). Prevalent HIV infection was associated with race and age. Including partner age difference in the model resulted in a 2% change in the relative odds of infection among Black MSM. CONCLUSIONS: Partner age disassortativity and partner age differences do not differ by race. Partner age difference offers little predictive value in understanding prevalent HIV infection among Black and White MSM, including diagnosis of HIV-positive status among self-reported HIV-negative individuals.