Behavioral and Clinical Characteristics of Persons with Diagnosed HIV Infection—Medical Monitoring Project, United States 2020 Cycle (June 2020–May 2021): Figures

Figure 2a. An estimated 75% of persons were male, 23% were female, and 2% were transgender (defined as either self-identifying as transgender or reporting a gender identity that was different from their reported sex assigned at birth). Data presented were from the 2020 cycle of the Medical Monitoring Project, a surveillance system monitoring clinical outcomes and behaviors of adults with diagnosed HIV infection in the United States. Demographic data were collected using in-person or telephone interviews. For more details on MMP methods, see here: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-special-report-number-29.pdf.

Note. Transgender persons defined as those who self-identified as transgender or who reported a gender identity different from sex assigned at birth.

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Figure 2d. An estimated 42% of persons were Black or African American and 29% were White. Additionally, 24% of all persons were Hispanic or Latino (Hispanics and Latinos can be of any race) and 6% were American Indian/Alaska Native, Asian, Native Hawaiian/Other Pacific Islander, or multiracial. Data presented were from the 2020 cycle of the Medical Monitoring Project, a surveillance system monitoring clinical outcomes and behaviors of adults with diagnosed HIV infection in the United States. Demographic data were collected using in-person or telephone interviews. For more details on MMP methods, see here: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-special-report-number-29.pdf.

Note. “Other” race/ethnicity defined as persons who were American Indian/Alaska Native, Asian, Native Hawaiian/Other Pacific Islander, or multiracial. Hispanics or Latinos can be of any race.

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Figure 3b: An estimated 15% received Supplemental Security Income (SSI) benefits, and 19% received Social Security Disability Insurance (SSDI) benefits during the 12 months prior to interview.  Data presented were from the 2020 cycle of the Medical Monitoring Project, a surveillance system monitoring clinical outcomes and behaviors of adults with diagnosed HIV infection in the United States. Data on SSI benefits and SSDI benefits were collected using in-person or telephone interviews. For more details on MMP methods, see here:  https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-special-report-number-29.pdf.

Note. *SSI, Supplemental Security Income; SSDI, Social Security Disability Insurance.

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Figure 3c: 47% of persons had health insurance or coverage for care or medications (including antiretroviral medications) through the Ryan White HIV/AIDS Program (RWHAP), 43% had Medicaid, 28% had Medicare, and 40% had private health insurance. People could report more than one type of health insurance or coverage.  Data presented were from the 2020 cycle of the Medical Monitoring Project, a surveillance system monitoring clinical outcomes and behaviors of adults with diagnosed HIV infection in the United States. Data on types of health insurance or coverage for care or antiretroviral medications were collected using in-person or telephone interviews. For more details on MMP methods, see here:  https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-special-report-number-29.pdf.

Note. Healthcare insurance/coverage types not mutually exclusive; people could report >1 type of coverage.
*RWHAP, Ryan White HIV/AIDS Program

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Figure 4. An estimated 63% of persons had an undetectable HIV viral load (<200 copies/mL or undetectable) at the most recent test, and 59% of persons had sustained viral suppression, defined as having all viral load tests in the past 12 months <200 copies/mL or undetectable in the 12 months prior to the interview. Data presented were from the 2020 cycle of the Medical Monitoring Project, a surveillance system monitoring clinical outcomes and behaviors of adults with diagnosed HIV infection in the United States. HIV viral load data were collected using medical record abstractions. Abstraction of medical records occurred at the facility where the participant received most of their HIV care in the 12 months prior to the interview. Medical records were only abstracted at one clinic regardless of how many clinics the participant visited. For more details on MMP methods, see here: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-special-report-number-29.pdf.

*Viral load <200 copies/mL or undetectable based on most recent test in the past 12 months.
†Sustained viral suppression defined as having all viral load tests in the past 12 months <200 copies/mL or undetectable.

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Figure 5. In all, 95% of persons received some form of outpatient HIV care in the 12 months prior to the interview. Outpatient HIV care was defined as any documentation of the following: encounter with an HIV care provider, viral load test result, CD4 test result, HIV resistance test or tropism assay, ART prescription, PCP prophylaxis, or MAC prophylaxis. Approximately 72% were retained in care in the 12 months prior to the interview. Retention in care was defined as at least two elements of outpatient HIV care at least 90 days apart in each 12-month period. Overall, an estimated 79% of persons had an antiretroviral therapy prescription documented in the medical record. Data presented were from the 2020 cycle of the Medical Monitoring Project, a surveillance system monitoring clinical outcomes and behaviors of adults with diagnosed HIV infection in the United States. Clinical care data were collected using medical record abstractions. Abstraction of medical records occurred at the facility where the participant received most of their HIV care in the 12 months prior to the interview. Medical records were only abstracted at one clinic regardless of how many clinics the participant visited. Additionally, a self-reported encounter with an HIV care provider met the criteria for receipt of outpatient HIV care. For more details on MMP methods, see here: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-special-report-number-29.pdf.

*Outpatient HIV care was defined as any documentation of the following at the most frequent source of HIV care: encounter with an HIV care provider (could be self-reported), viral load test result, CD4 test result, HIV resistance test or tropism assay, ART prescription, PCP prophylaxis, or MAC prophylaxis.
†Two elements of outpatient HIV care at least 90 days apart during the 12 months prior to interview.

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Figure 8. Among persons who were currently taking antiretroviral therapy (ART) and ever missed a dose, 65% reported that the reason for their most recently missed dose was because they forgot, 39% reported it was because of a change in daily routine or being out of town, 37% reported the reason was because they fell asleep early or overslept, 17% had a problem getting a prescription or refill for HIV medicine, and 16% because they felt depressed or overwhelmed. Data presented were from the 2020 cycle of the Medical Monitoring Project, a surveillance system monitoring clinical outcomes and behaviors of adults with diagnosed HIV infection in the United States. Adherence data were collected using in-person or telephone interviews. For more details on MMP methods, see here: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-special-report-number-29.pdf.

*Participants may report more than one reason for last missed dose.

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Figure 9a. 7% of adults with diagnosed HIV reported symptoms of major depression, and 7% reported symptoms of other depression, during the past 2 weeks. Responses to the items on the PHQ-8 were used to define "major depression" and "other depression", according to criteria from the DSM-IV. "Major depression" was defined as having at least 5 symptoms of depression; "other depression" was defined as having 2–4 symptoms of depression. The PHQ-8 classification "other depression" comprises the DSM-IV categories of dysthymia and depressive disorder, not otherwise specified, which includes minor or subthreshold depression. Data presented were from the 2020 cycle of the Medical Monitoring Project, a surveillance system monitoring clinical outcomes and behaviors of adults with diagnosed HIV infection in the United States. Data on symptoms of depression were collected using in-person or telephone interviews. For more details on MMP methods, see here: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-special-report-number-29.pdf.

Note. *Responses to the items on the PHQ-8 were used to define “major depression” and “other depression” according to criteria from the DSM-IV. “Major depression” was defined as having at least 5 symptoms of depression; “other depression” was defined as having 2–4 symptoms of depression. The PHQ-8 classification “other depression” comprises the DSM-IV categories of dysthymia and depressive disorder, not otherwise specified, which includes minor or subthreshold depression.

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Figure 9b. Of all adults with diagnosed HIV, 5% reported symptoms of mild anxiety, 7% reported symptoms of moderate anxiety, and 6% reported symptoms of severe anxiety in the past 2 weeks. Responses to the GAD-7 were used to define "mild anxiety", "moderate anxiety", and "severe anxiety", according to criteria from the DSM-IV. "Severe anxiety" was defined as having a score of >=15; "moderate anxiety" was defined as having a score of 10–14; and "mild anxiety" was defined as having a score of 5–9. Data presented were from the 2020 cycle of the Medical Monitoring Project, a surveillance system monitoring clinical outcomes and behaviors of adults with diagnosed HIV infection in the United States. Anxiety data were collected using in-person or telephone interviews. For more details on MMP methods, see here: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-special-report-number-29.pdf.

Note. †Responses to the GAD-7 were used to define “mild anxiety,” “moderate anxiety,” and “severe anxiety,” according to criteria from the DSM-IV. “Severe anxiety” was defined as having a score of ≥ 15; “moderate anxiety” was defined as having a score of 10–14; and “mild anxiety” was defined as having a score of 5–9.

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Figure 10b. The estimated prevalence of any alcohol use in the past 12 months was 63%. An estimated 7% of persons reported drinking alcohol daily, 19% weekly, 12% monthly, and 25% reported less than monthly in the 12 months before the interview. An estimated 15% of persons engaged in binge drinking, defined as 5 or more alcoholic beverages in one sitting (4 or more alcoholic beverages for women), during the past 30 days. Data presented were from the 2020 cycle of the Medical Monitoring Project, a surveillance system monitoring clinical outcomes and behaviors of adults with diagnosed HIV infection in the United States. Alcohol use data were collected using in-person or telephone interviews. For more details on MMP methods, see here: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-special-report-number-29.pdf.

*Persons who drank ≥ 5 alcoholic beverages in a single sitting (≥ 4 for women) during the 30 days before interview.

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Figure 12. Among cisgender men who had sex with cisgender men (MSM), an estimated 9% engaged in sex without using an HIV prevention strategy, compared with 8% for cisgender men who only had sex with cisgender women (MSW), and 7% for cisgender women had sex with cisgender men (WSM). Sex without using an HIV prevention strategy was defined as having vaginal or anal sex in the past 12 months with at least 1 partner with an HIV-negative or unknown status while not having sustained viral suppression (all viral load tests in the past 12 months <200 copies/mL or detectable), when a condom was not used, and the partner was not known to be taking pre-exposure prophylaxis (PrEP). Data presented were from the 2020 cycle of the Medical Monitoring Project, a surveillance system monitoring clinical outcomes and behaviors of adults with diagnosed HIV infection in the United States. Data on sex without using an HIV prevention strategy were collected using in-person or telephone interviews. For more details on MMP methods, see here: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-special-report-number-29.pdf.

Note. MSM, cisgender men who have sex with cisgender  men; MSW, cisgender men who have sex only with cisgender women; WSM, cisgender women who have sex with cisgender men.
*Vaginal or anal sex with at least 1 HIV-negative or unknown status partner while not having sustained viral suppression (all viral load measurements in the past 12 months undetectable or < 200 copies/mL), when a condom was not used, and the partner was not known to be taking preexposure prophylaxis (PrEP)

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Figure 13. During the past 12 months, an estimated 62% of sexually active cisgender men with diagnosed HIV who had sex with cisgender men engaged in sex and had viral suppression. An estimated 55% of persons had condom-protected sex; 22% had condomless sex with a partner on PrEP; and 54% had sex with a person with HIV. During the past 12 months, an estimated 50% of sexually active cisgender men with diagnosed HIV who only had sex with cisgender women engaged in sex and had viral suppression. An estimated 57% of persons had condom-protected sex; 5% had condomless sex with a partner on PrEP; and 24% had sex with a person with HIV. During the past 12 months, an estimated 58% of sexually active cisgender women with diagnosed HIV who had sex with cisgender men engaged in sex and had viral suppression. An estimated 51% of persons had condom-protected sex; 4% had condomless sex with a partner on PrEP; and 28% had sex with a person with HIV. Data presented were from the 2020 cycle of the Medical Monitoring Project, a surveillance system monitoring clinical outcomes and behaviors of adults with diagnosed HIV infection in the United States. Prevention services data were collected using in-person or telephone interviews. For more details on MMP methods, see here: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-special-report-number-29.pdf.

Note. MSM, cisgender men who have sex with cisgender men; MSW, cisgender men who have sex only with cisgender women; WSM, cisgender women who have sex with cisgender men.

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Figure 14a. For HIV support services, an estimated 52% of persons received HIV case management services, 48% received medicine through Ryan White/ADAP, 30% received ART adherence support services, 14% received patient navigation services, and 10% received HIV peer support services. In total, 6% of persons had unmet needs for HIV case management, 3% had unmet needs for medicine through Ryan White or ADAP, 1% had unmet needs for adherence support services, 4% had unmet needs for patient navigation services, and 6% had unmet needs for HIV peer support services. Data presented were from the 2020 cycle of the Medical Monitoring Project, a surveillance system monitoring clinical outcomes and behaviors of adults with diagnosed HIV infection in the United States. Data on unmet needs for ancillary services were collected using in-person or telephone interviews. For more details on MMP methods, see here: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-special-report-number-29.pdf.

*ADAP, AIDS Drug Assistance Program
†ART, Antiretroviral therapy

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Figure 14c. For subsistence services, an estimated 37% received SNAP or WIC, 24% received meal or food services, 20% received transportation assistance, and 15% received shelter or housing services. In total, 10% had unmet needs for SNAP or WIC, 5% had unmet needs for meal or food services, 6% had unmet needs for transportation assistance, and 8% had unmet needs for shelter or housing services. Data presented were from the 2020 cycle of the Medical Monitoring Project, a surveillance system monitoring clinical outcomes and behaviors of adults with diagnosed HIV infection in the United States. Data on unmet needs for ancillary services were collected using in-person or telephone interviews. For more details on MMP methods, see here: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-special-report-number-29.pdf.

*SNAP: Supplemental Nutrition Assistance Program; WIC: Special Supplemental Nutrition Program for Women, Infants, and Children
†Includes services such as soup kitchens, food pantries, food banks, church dinners, or food delivery services.

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