An increasing number of men who have sex with men (MSM) are taking HIV tests, and more of those living with HIV are taking antiretrovirals (ARVs). However, another key figure remains unchanged: the rate of those MSM who are linked promptly into medical care following an HIV diagnosis.

Looking at recent data from the U.S. Centers for Disease Control and Prevention (CDC), one group of researchers found that MSM testing rates rose from 63 percent to 67 percent between 2008 and 2011. For African-American MSM, that figure jumped from 63 percent to 71 percent.

In another study, investigators examined the same data pool from the CDC and found that about three-quarters of MSM were promptly linked to care in both 2008 and 2011. However, during that time frame, the rate of MSM living with HIV who were taking ARVs jumped from 68 percent to 77 percent.

Edward Gardner, MD, is an infectious disease specialist at Denver Public Health who in 2010 created the famed notion of the “treatment cascade,” which is a descending bar graph charting those who know their HIV status, those who are linked to care, those retained in care, and on down to those who are virally suppressed. He says that the linkage and long-term retention steps are especially challenging for people.

“Dealing with the emotion and stress of a new diagnosis of HIV and then trying to follow through with all those steps that are required—it’s not just getting an appointment and going,” he says, “it’s really a fairly complex management issue.”