3. Promoting HIV Testing in Diverse Populations
Men Who Have Sex With Men Populations
Since the beginning of the US
HIV epidemic, MSM have consistently represented the largest percentage of AIDS diagnoses and deaths. In 2006, MSM accounted for more than 30,000 (53%) of all new US HIV infections, and MSM with a history of IDU (MSM-IDU) accounted for an additional 4%. [CDC 2008]
A 2008 CDC study found that 1 in 5 (19%) MSM in 21 major cities were HIV-positive, and nearly half (44%) were unaware of their status. In addition, the study reported that 28% of African American MSM were HIV-infected vs 18% of Latino MSM and 16% of white MSM. Infection rates in other racial/ethnic groups of MSM included 20% of American Indian/Alaska Native MSM and 18% of Native Hawaiian/Pacific Islander MSM.
In 2007, MSM were 44 to 86 times as likely to be diagnosed with HIV as other men and 40 to 77 times as likely as women.
Prevention and Access to Care Issues
Due to the high prevalence of HIV infection among MSM, each sexual encounter can be associated with greater risk of transmission. Young MSM who did not appreciate the severity of the early HIV epidemic may be complacent about their risk for acquiring HIV infection, out of the erroneous belief that treatment advances have made HIV no longer a serious health threat. Access to care among this population also varies, with race/ethnicity, education, and socioeconomic status playing important roles.
Risk factors for MSM overlap with other populations:
- Sexual risks include engaging in unprotected sex and the presence of STIs.
- Alcohol and illicit drug use—by increasing the likelihood of risky sexual behaviors—contributes to increased risk for HIV infection and other STIs.
- Many HIV-infected MSM are unaware of their status, especially MSM of color and young MSM. A 2008 CDC study reported that among urban MSM in 21 cities who were unaware of their HIV infection, 55% had not been tested in the previous 12 months. In addition, stigma and homophobia can negatively affect the mental and sexual health of MSM, potentially resulting in unhealthy choices regarding sexual activity and substance use. Stigma and homophobia may limit the willingness of MSM to access HIV prevention and care, isolate them from family and community support, and pose cultural barriers to integrating into social networks.
For racial/ethnic minority MSM racism, poverty, and lack of acces to healthcare can impede use of HIV prevention services. A recent CDC study, National HIV Behavorial Surveillance System, 2008, found a strong link between socioeconomic status and HIV among MSM: prevalence increased as education and income decreased; and awareness of HIV status was higher among MSM with greater education and income.
