HIV/AIDS Diagnoses Rising from Male-Male Sex


By Michael Smith
ATLANTA, 27 JUNE 2008-- The number of HIV/AIDS diagnoses among men who have sex with men grew 8.6% from 2001 through 2006, the CDC said today. Over the same period, there were significant declines (P<0.05) in new diagnoses in all other risk categories, the agency said in the June 27 issue of Morbidity and Mortality Weekly Report. The finding -- released on National HIV Testing Day -- came from an analysis of trends in the 33 states that have had confidential, name-based HIV case reporting since at least 2001, the agency said.
At the same time, New York announced a three-year plan to test all adults in the Bronx, which has the highest rate of AIDS deaths of the city's five boroughs.
The CDC said that in the 33 states, the estimated average annual percentage increase in new diagnoses among men who have sex with men was 1.5%.
In contrast, new diagnoses among injection drug users fell by an estimated 9.5% annually, while those among people with high-risk heterosexual contact fell by an estimated 4.4% a year.
Among men who have sex with men who were also injection drug users -- treated by the agency as a separate category from MSM -- the annual percentage decrease was 5.2%.
Among men who have sex with men, the increase in diagnoses was more marked in men ages 13 to 24 of all racial/ethnic groups and in black men, the agency said:
The number of HIV/AIDS diagnoses among all black men who have sex with men was 12.4% over the six-year period, for an estimated annual percentage change of 1.9%.
But for black men who have sex with men ages 13 through 24, the increase was 93.1%, with an estimated annual percentage change of 14.9%.
There were 7,658 diagnoses in black men who have sex with men ages 13 through 24, compared with 3,221 in their white counterparts.
The agency pointed out that the 33-state case surveillance data are not representative of all HIV-positive people in the U.S., and added that an estimated 25% of all HIV-positive people have not yet been diagnosed.
National HIV Testing Day "focuses on the importance" of people knowing their HIV infection status, the agency said, adding that getting a diagnosis is the first step to getting treatment.
In New York, city officials said their plan to test all adults in the 1.3-million-population Bronx will require making HIV tests a part of routine medical care.
"Routine would mean if you came into the emergency room for asthma or a broken leg, we test everyone for HIV, if they're willing," city health commissioner Thomas Frieden, M.D., told the New York Times.
The city estimated that 40% of the 830,000 Bronx residents ages 18 to 64 have been tested in the past year and another 250,000 people who have never been tested would be targeted for early testing.
The city plans to offer tests at about 40 clinics, community centers, churches and emergency rooms and will cover the $12 cost of each test, city officials said.
In New York, the rate of AIDS cases is 82 per 100,000 people in Manhattan, compared with 75 in the Bronx, 46 in Brooklyn, 26 in Queens, and 16 on Staten Island.
But 37 people die annually from AIDS for every 100,000 people in the Bronx, compared with 21 for Manhattan, 19 for Brooklyn, eight for Staten Island, and six for Queens.
The higher death rate in the Bronx was attributed to the relative poverty of the population, which may tend to delay testing until later in the process.
One obstacle to wider testing has been New York State's strict consent laws, which doctors have viewed as too onerous for settings such as emergency rooms.
For this push, doctors will be using a script that follows state law but squeezes the consent process into five minutes, according to Donna Futterman, M.D., of Montefiore Medical Center, who developed the script.
An experienced physician can deliver the script in three minutes, Dr. Futterman told the Times, and her own record is one minute.
Additional source: Morbidity and Mortality Weekly ReportSource reference: Centers for Disease Control and Prevention "Trends in HIV/AIDS diagnoses among men who have sex with men -- 33 States, 2001-2006." MMWR 2008; 57: 681-686.