Trends in Diagnosis of HIV Infection, Linkage to Medical Care, and Viral Suppression Among Men Who Have Sex with Men, by Race/Ethnicity and Age — 33 Jurisdictions, United States, 2014–2018

During 2018, gay, bisexual, and other men who have sex with men (MSM) accounted for 69.4% of all diagnoses of human immunodeficiency virus (HIV) infection in the United States (1). Moreover, in all 42 jurisdictions with complete laboratory reporting of CD4 and viral load results,* percentages of MSM linked to care within 1 month (80.8%) and virally suppressed (viral load <200 copies of HIV RNA/mL or interpreted as undetected) within 6 months (68.3%) of diagnosis were below target during 2018 (2). African American/Black (Black), Hispanic/Latino (Hispanic), and younger MSM disproportionately experience HIV diagnosis, not being linked to care, and not being virally suppressed. To characterize trends in these outcomes, CDC analyzed National HIV Surveillance System† data from 2014 to 2018. The number of diagnoses of HIV infection among all MSM decreased 2.3% per year (95% confidence interval [CI] = 1.9-2.8). However, diagnoses did not significantly change among either Hispanic MSM or any MSM aged 13-19 years; increased 2.2% (95% CI = 1.0-3.4) and 2.0% (95% CI = 0.6-3.3) per year among Black and Hispanic MSM aged 25-34 years, respectively; and were highest in absolute count among Black MSM. Annual percentages of linkage to care within 1 month and viral suppression within 6 months of diagnosis among all MSM increased (2.9% [95% CI = 2.4-3.5] and 6.8% [95% CI = 6.2-7.4] per year, respectively). These findings, albeit promising, warrant intensified prevention efforts for Black, Hispanic, and younger MSM.

respectively). These findings, albeit promising, warrant intensified prevention efforts for Black, Hispanic, and younger MSM.
CDC used data reported to the National HIV Surveillance System by December 2019 to identify cases of HIV infection that met CDC's HIV infection case definition among MSM, including MSM aged ≥13 years who inject drugs (3). Multiple imputation was used to adjust for unknown or missing transmission category (15.6% of cases) (4). At the time of diagnosis, all MSM resided in one of 33 jurisdictions § with complete laboratory reporting for each year during 2014-2018. Linkage-to-care analyses included MSM with HIV infection diagnosed during the calendar year when the diagnosis was first made. Linkage to care was defined as one or more CD4 or viral load tests performed within 1 month of diagnosis. Viral suppression within 6 months of diagnosis was measured for MSM whose infection was diagnosed during the outcome year and who resided in any of the 33 jurisdictions at the time of diagnosis of HIV infection. Viral suppression was defined as a viral load result of <200 copies/mL or a viral load test interpretation value of undetected.
Results are presented by race/ethnicity (Black, Hispanic, other, and White) and age group (  Abbreviations: CI = confidence interval; EAPC = estimated annual percentage change. * Men who have sex with men were persons whose sex at birth was male and whose transmission category was either male-to-male sexual contact or male-to-male sexual contact and injection drug use.  Abbreviations: CI = confidence interval; EAPC = estimated annual percentage change; HIV = human immunodeficiency virus. * Men who have sex with men were persons whose sex at birth was male and whose transmission category was either male-to-male sexual contact or male-to-male sexual contact and injection drug use. † Data are based on residence at time of diagnosis of HIV infection.  (6,7). Addressing these factors might improve outcomes.
The findings in this report are subject to at least two limitations. First, only 33 of the 51 U.S. jurisdictions had complete laboratory reporting of CD4 and viral load results during 2014-2018. Therefore, data do not represent all diagnoses of HIV infection among MSM during 2014-2018. Second, using EAPCs with p-values <0.05 to identify trends might result in clinically meaningful temporal changes being deemed as having no significant change.
Providing antiretroviral therapy for both HIV preexposure prophylaxis and treatment can prevent HIV infection and, subsequently, the need for linkage to care and viral suppression among MSM (8,9). However, during 2017, Black and Hispanic MSM who had discussed preexposure prophylaxis with a medical provider were less likely than were White MSM to receive prescriptions for preexposure prophylaxis in 23 jurisdictions (8). Providers' implicit racial biases toward Blacks and Hispanics often promote treatment nonadherence (10), which inhibits viral suppression (9). Therefore, interventions might need to address systemic racism and concomitant racial biases within health care systems (7). CDC encourages use of interventions that address social determinants of health ¶ that underlie the high risk for HIV infection among MSM of all races/ethnicities and ages. Such interventions might help prevent HIV infection and eliminate racial/ethnic disparities in HIV infection among MSM.