Men who have sex with men (MSM) living with HIV in major urban areas are increasingly promptly linked to medical care and on antiretroviral (ARV) treatment for the virus. However, troubling racial disparities persist, with HIV-positive Black MSM less likely to be on ARVs than whites.
Publishing their findings in The Journal of Infectious Diseases, researchers analyzed data from the 2008, 2011 and 2014 National HIV Behavioral Surveillance (NHBS) studies, examining HIV-positive MSM’s responses to survey questions.
The NHBS survey is conducted every three years among MSM in 20 major urban areas. It is not a nationally representative sample, however, and so its findings are not generalizable across the United States or even for all MSM in the participating cities. But by comparing changes between survey years, researchers can identify certain trends nevertheless.
To conduct their analysis of the rates of linkage to medical care, the researchers looked at data on a respective 236, 291 and 358 HIV-positive men in the 2008, 2011 and 2014 surveys. Each group of men was restricted to those diagnosed with the virus between three months and three years prior to being surveyed.
Defining linkage to care as an HIV-related medical appointment within three months of diagnosis, the researchers found that the proportion linked to care increased from 79 percent in 2008 to 87 percent in 2014. This translated to a 5 percent increase in the linkage rate every three years. Most subgroups had a similar rate of increase.
The researchers found that the proportion of those who were linked to care within one month of diagnosis increased from 75 percent in 2008 to 78 percent in 2014, or a 4 percent rise in the rate per three year-period.
Across time, men were more likely to be linked to care if they had more education, a higher income and health insurance. There were no regional differences in the linkage rates.
To determine the proportion of MSM with HIV who were on ARVs, researchers looked at a respective 1,142; 1,336; and 1,714 men in the three years of the NHBS survey. The proportion on ARVs increased from 69 percent in 2008 to 88 percent in 2014, an increase of 15 percent per three-year period. Treatment rates increased across subgroups.
Throughout the surveys, a higher proportion of whites, older individuals, those with more education, those with a higher income and those with health insurance were on ARVs. In 2014, the ARV use rate was 9 percentage points higher among white MSM compared with Black MSM. This difference persisted even when the researchers adjusted the data for other factors that tend to predict poorer access to health care, including less education, lower income and a lack of health insurance.
In 2011 and 2014, the South had the lowest rate of ARV use compared with other regions. When the data was adjusted by race and ethnicity, this difference disappeared. The researchers concluded that the higher rates of HIV-positive African-American MSM in the South compared with other regions drove the difference in ARV use rates.
To read the study, click here.
To read an accompanying commentary about the study, click here.