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HIV Testing Programs Needed in Southern US to Improve Black MSM Linkage to Care

A new CDC analysis underscores the need for HIV testing programs in the southern part of the United States to improve linkage medical care among HIV-positive black men who have sex with men (MSM).

The Joint United Nations Programme on HIV/AIDS estimates that about 36.7 million individuals are living with HIV worldwide and about 30% of these individuals are unaware of their status. When it comes to HIV prevention, identifying these individuals, linking them to care, and reducing any health disparities are imperative.

A new analysis from the US Centers from Disease Control and Prevention (CDC) which evaluated HIV testing for black men who have sex with men (MSM) in 20 southern US jurisdictions in 2016 found that although this population received only 6% of the tests that were provided, they accounted for 36% of new diagnoses in non-health care facilities. Furthermore, about two-thirds of black MSM reside in the southern United States, underscoring the need for targeted preventive activities for this population in this region.

In 2016, the CDC funded 20 different health departments and 24 community-based organizations throughout the southern United States to provide HIV testing and services in the region. Data pertaining to HIV tests, new HIV-positive diagnoses, linkage of those newly diagnosed to medical care within 90 days, and interviews for partner services were submitted through a secure system supported by the CDC. The data were stratified by age group, first-time tested, and urbanicity.

Out of the 374,871 documented HIV tests that were given in non-health care facilities throughout the 20 southern jurisdictions, 22,183 (6%) were found to have been provided to black MSM, a population that accounted for 828 (36%) of 2,304 new diagnoses. Of the black MSM who received a test, the highest percentage (43%) of tests were provided to men between the ages of 25 and 34 residing in metropolitan areas (75%) who had been tested previously (81%).

The CDC reports that a total of 1471 black MSM had positive tests for HIV infection with 828 (56%) receiving a new diagnosis and 643 (44%) having previously received an HIV diagnosis. The authors of the analysis noted that new diagnoses were highest in black MSM between the ages of 20 and 24 years, followed by those between 13 and 19 years.

Furthermore, the analysis revealed that among the 828 black MSM in the southern United States who had been newly diagnosed with HIV, 552 (67%) were linked with medical care within the first 90 days of diagnosis and 451 (55%) had been interviewed for partner services.

“The findings from this study highlight the value of CDC’s HIV testing program for reaching black MSM in the southern United States who are at highest risk for acquiring or transmitting HIV infection,” CDC authors write. “Among black MSM in 20 southern US jurisdictions, the percentage of HIV-positive results was highest among men aged <35 years (4.3%), highlighting the critical importance of prioritizing this population.”

They add that because black MSM only accounted for about 6% of HIV tests, but 36% of the new diagnoses, efforts are needed to encourage HIV testing in this population. The fact that almost half of the positive HIV test results were among black MSM with previously diagnosed infections is indicative that testing among black MSM who have never been tested for the virus should also be a priority.

Authors of the analysis also highlight that about two-thirds (67%) of black MSM with HIV in the southern United States who were newly diagnosed and 58% who were previously diagnosed with the infection, had been linked with medical care—both of these estimates do not meet the national goal of 85%. As such, HIV testing programs should be developed to reach more of this population and conduct targeted risk-based testing.

“Increasing awareness of HIV status through HIV testing, especially among black MSM in the southern United States, is essential for reducing the risk of transmission and addressing disparities,” the authors conclude. “HIV testing programs in the southern United States can reach more black MSM by conducting targeted risk-based testing in non-health care settings and by routine screening in agencies that also provide health care services to black MSM.”