HIV transmission among black women--North Carolina, 2004

In 2003, women constituted 28% of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) cases in the United States; approximately 69% of those cases were among non-Hispanic black women. Heterosexual transmission is now the most commonly reported mode of HIV transmission among women. In North Carolina, black women make up a growing proportion of newly reported HIV infections and, in 2003, the HIV-infection rate for black women in North Carolina was 14 times higher than that for white women. Despite this disparity, few epidemiologic studies have examined HIV transmission among black women in the United States, particularly those residing in southern states. In August 2004, the North Carolina Department of Health (NCDOH) invited CDC to assist in an epidemiologic investigation of HIV transmission among black women in North Carolina. This report summarizes the results of that investigation, which indicated that the majority of HIV-positive and HIV-negative sexually active black women in North Carolina reported HIV sexual risk behaviors. These findings underscore the need for enhanced HIV-prevention strategies in this population.     

Public Health Responses to the HIV Epidemic Among Black Men Who Have Sex With Men: A Qualitative Study of US Health Departments and Communities

In the United States, Black men who have sex with men (MSM) are disproportionately affected by HIV/AIDS. Thus, there is a need to understand the challenges facing health departments and community-based organizations responding to the HIV epidemic among this population. We interviewed 71 AIDS program directors, health department staff, and leaders of community-based organizations in 9 states and the District of Columbia. Participants identified psychosocial factors, a lack of capacity-building efforts, and stigma as barriers to HIV prevention responses targeting Black MSM. Participants identified culturally competent staff and culturally sensitive interventions as facilitating prevention responses. To ensure that HIV/AIDS interventions targeting Black MSM are effective, it is imperative to solicit the perceptions of frontline workers in health departments and community-based organizations.Black men who have sex with men (MSM) exhibit an extremely high and disproportionate rate of HIV infection in the United States relative to other groups. Three epidemiologic studies conducted within the past 10 years highlight this point. First, the Young Men''s Study employed a multisite, cross-sectional, venue-based survey methodology to collect behavioral and seroprevalence data from more than 3400 MSM between the ages of 15 and 22 years.¹ Findings from the study, released in 2000, showed that 14% of the Black MSM in the sample were HIV positive—the highest prevalence among the 5 ethnic groups represented by the sample. The study also showed that Black MSM were more than 6 times more likely than White MSM to be HIV positive.Second, a study conducted by the North Carolina Department of Health involved a retrospective review of North Carolina men aged 18 to 30 years who were diagnosed with HIV between 2000 and 2003.² The study reported an increase in HIV cases among male college students from 2 in 2000 to 56 in 2003. Of the 56 cases in 2003, 88% were Black, and almost all were MSM.Finally, the most disheartening seroprevalence data were published in 2005, from the Centers for Disease Control and Prevention''s 5-city study of MSM.³ The study, which used a methodology similar to that of the Young Men''s Study, showed an HIV prevalence of 46% among Black MSM, compared with 21% and 17% for White MSM and Latino MSM, respectively. Of the Black MSM who were HIV positive, 64% were unaware of their infection.Given the high and increasing rates of HIV infection among Black MSM, researchers have begun to place a greater emphasis on understanding the psychological, behavioral, sociocultural, and historical factors that may place these men at greater risk of becoming infected with HIV or transmitting the virus to sexual partners. For example, Millett et al.,⁴ in a seminal literature review, noted that rates of HIV risk behavior (e.g., unprotected anal intercourse, injection drug use, and substance use during sex) were no higher among Black MSM than among White or Latino MSM. However, their research suggested that the higher HIV incidence observed among Black MSM might be explained by the higher rates of sexually transmitted infections among this population. Sexually transmitted infections cause decreased immune-system functioning, thus making men more susceptible to the acquisition and transmission of HIV. The literature review also suggested that a lack of HIV testing and late HIV diagnosis among Black MSM could be linked to heightened risk for HIV among this group. Other work by Millett et al.^5,6 points toward characteristics of the sexual partners of Black MSM (e.g., older age, Black race, HIV-positive status) as important factors in explaining heightened HIV risk.Likewise, Malebranche,⁷ in pointing out steps for public health researchers and practitioners to take in thwarting the growth of the HIV/AIDS epidemic among Black MSM, suggested that a comprehensive understanding of HIV risk among Black MSM will require an examination of sexual networks, men''s understandings of masculinity and sexuality, health care access, and increased susceptibility related to social and environmental stressors, among other issues. Other researchers have noted that homophobia and AIDS stigma within the families and communities of Black MSM may also explain heightened HIV/AIDS risk.⁸ Homophobia and stigma may operate to reduce HIV testing and other protective behaviors among Black MSM and may impede HIV-status disclosure among HIV-positive Black MSM. These findings represent just a few of the myriad risk factors that may undergird the high rates of HIV infection and AIDS among Black MSM, highlighting the increased attention that needs to be focused on this public health crisis.     

HIV prevalence, unrecognized infection, and HIV testing among men who have sex with men--five U.S. cities, June 2004-April 2005

Well into the third decade of the human immunodeficiency virus (HIV) epidemic, rates of HIV infection remain high, especially among minority populations. Of newly diagnosed HIV infections in the United States during 2003, CDC estimated that approximately 63% were among men who were infected through sexual contact with other men, 50% were among blacks, 32% were among whites, and 16% were among Hispanics. Studies of HIV infection among young men who have sex with men (MSM) in the mid to late 1990s revealed high rates of HIV prevalence, incidence, and unrecognized infection, particularly among young black MSM. To reassess those findings and previous HIV testing behaviors among MSM, CDC analyzed data from five of 17 cities participating in the National HIV Behavioral Surveillance (NHBS) system. This report summarizes preliminary findings from the HIV-testing component of NHBS, which indicated that, of MSM surveyed, 25% were infected with HIV, and 48% of those infected were unaware of their infection. To decrease HIV transmission, MSM should be encouraged to receive an HIV test at least annually, and prevention programs should improve means of reaching persons unaware of their HIV status, especially those in populations disproportionately at risk.     

HIV incidence among young men who have sex with men--seven U.S. cities, 1994-2000

Twenty years after the first report on human immunodeficiency virus (HIV) infection in the United States, studies of sexually transmitted diseases (STDs) and sexual behaviors suggest a resurgent HIV epidemic among men who have sex with men (MSM). However, few recent studies have measured HIV incidence in this population. To determine HIV incidence among young MSM, CDC analyzed data from the Young Men's Survey (YMS), a study that found a high prevalence of HIV and associated risks among MSM aged 15-22 years sampled in seven U.S. cities. This report confirms high HIV incidence among these young men.     

HIV/AIDS among racial/ethnic minority men who have sex with men--United States, 1989-1998

In the United States, racial/ethnic minority populations account for an increasing proportion of acquired immunodeficiency syndrome (AIDS) cases, including cases among men who have sex with men (MSM) (1). This report presents recent trends in AIDS incidence and deaths among MSM who belong to racial/ethnic minority populations, and compares data on human immunodeficiency virus (HIV) diagnoses with AIDS diagnoses during 1996-1998 among racial/ethnic minority MSM in the 25 states that have conducted confidential HIV surveillance and AIDS case surveillance since 1994. The findings indicate that among MSM, non-Hispanic black and Hispanic men accounted for an increasing proportion of AIDS cases and had smaller proportionate declines in AIDS incidence and deaths from 1996 to 1998. Of HIV and AIDS diagnoses among racial/ethnic minority MSM, the proportion who are young (aged 13-24 years) is higher than among white MSM.     

Primary and secondary syphilis--United States, 2003-2004

In 2000, the rate of primary and secondary (P&S) syphilis in the United States was 2.1 cases per 100,000 population, the lowest since reporting began in 1941. From 2001 to 2004, the P&S syphilis rate increased to 2.7, primarily as a result of increases in cases among men who have sex with men (MSM). To characterize the recent epidemiology of syphilis in the United States, CDC analyzed national notifiable disease surveillance data for 2000-2004, focusing on 2003-2004. This report describes the results of that analysis, which indicated that the disparity between syphilis rates among blacks and whites in 2004 increased for the first time since 1993 and is associated with a substantial increase of syphilis among black men. Syphilis rates continue to increase among MSM. After declining for 13 years, the rate of P&S syphilis in 2004, compared with 2003, increased in the South and remained the same among women. The findings underscore the need for enhanced prevention measures among blacks and MSM. In addition, enhanced surveillance is needed to detect any early increases in P&S syphilis among women.     

A comparison of HIV seropositive and seronegative young adult heroin- and cocaine-using men who have sex with men in New York City, 2000–2003

The purpose of this analysis was to determine the prevalence and correlates of HIV infection among a street-recruited sample of heroin-and cocaine-using men who have sex with men (MSM). Injection (injecting ≦3 years) and non-injection drug users (heroin, crack, and/or cocaine use<10 years) between 18 and 40 years of age were simultaneously street-recruited into two cohort studies in New York City, 2000–2003, by using identical recruitment techniques. Baseline data collected among young adult men who either identified as gay/bisexual or reported ever having sex with a man were used for this analysis. Nonparametric statistics guided interpretation. Of 95 heroin/ cocaine-using MSM, 25.3% tested HIV seropositive with 75% reporting a previous HIV diagnosis. The majority was black (46%) or Hispanic (44%), and the median age was 28 years (range 18–40). HIV-seropositive MSM were more likely than seronegatives to be older and to have an HIV-seropositive partner but less likely to report current homelessness, illegal income, heterosexual identity, multiple sex partners, female partners, and sex for money/drug partners than seronegatives. These data indicate high HIV prevalence among street-recruited, drug-using MSM compared with other injection drug use (IDU) subgroups and drug-using MSM; however, lower risk behaviors were found among HIV seropositives compared with seronegatives. Large-scale studies among illicit drug-using MSM from more marginalized neighborhoods are warranted.     

Increase in newly diagnosed HIV infections among young black men who have sex with men--Milwaukee County, Wisconsin, 1999-2008

During 2001-2006, new human immunodeficiency virus (HIV) diagnoses among black men aged 13-24 years who have sex with men (MSM) in 33 states increased by 93%. The Wisconsin Division of Public Health (WDPH) recently reported to CDC a 144% increase during 2000-2008 in HIV diagnoses among black MSM aged 15-29 years in Milwaukee County. In October 2009, the City of Milwaukee Health Department (MHD), WDPH, and CDC investigated whether the increase in HIV infections among young black MSM in Milwaukee represented increased HIV transmission or simply better identification of prevalent infections. This report describes the results of that investigation, which indicated that a new "social networks" HIV testing strategy and the recent expansion of better targeted HIV testing efforts accounted for few diagnoses among young black MSM and occurred after HIV diagnoses increased, respectively. Therefore, although some diagnoses were made because of intensified testing, an increase in HIV transmission likely occurred. Moreover, an increase in syphilis diagnoses among young black MSM in Milwaukee preceded the increase in HIV diagnoses, which suggests that changes in risk behavior or sexual networks might explain the increase. These findings highlight the need for new or improved interventions promoting prevention education, early HIV detection, and entry to care for young HIV-infected and at-risk black MSM in Milwaukee.     

高校大学生男男性行为人群中HIV传播相关因素分析

大学生男男性行为人群急速增加,男男性行为人群已成为艾滋病传播的纽带人群,学生男男性行为的人类免疫缺陷病毒(HIV)感染增加表现出明显的趋势,对大学生男男性行为人群中HIV传播因素进行分析,为更好的开展学生艾滋病预防和控制提供重要依据。     

High-risk sexual behavior by HIV-positive men who have sex with men--16 sites, United States, 2000-2002

The majority of persons living with human immunodeficiency virus (HIV) in the United States are men who have sex with men (MSM). High-risk sexual behavior by HIV-positive MSM exposes sex partners to HIV. The risk for transmitting HIV from an infected partner to an uninfected partner through unprotected insertive anal intercourse (UIAI) is greater than the risk for transmission through receptive anal intercourse or oral sex. Differences in sexual risk behavior might be associated with the perceived HIV serostatus of the partner (i.e., HIV positive, HIV negative, or unknown serostatus), as well as with the sex partner type (i.e., steady or nonsteady). During May 2000-December 2002, HIV-positive MSM were interviewed in a behavioral surveillance survey at surveillance sites in 16 states. This report describes insertive anal intercourse practices reported by these MSM; findings indicated that a large percentage of HIV-positive MSM were sexually abstinent, practiced safer sexual behavior by having protected insertive anal intercourse, or had UIAI with an HIV-positive partner. However, a small percentage of HIV-positive MSM reported UIAI with partners who were HIV negative or whose serostatus was unknown; for this group, more intensive and comprehensive HIV-prevention efforts are needed to eliminate this risk behavior.     

Trends in human immunodeficiency virus diagnoses among men who have sex with men in North America,Western Europe,and Australia, 2000–2014

PurposeThe aim of the article was to investigate recent trends in human immunodeficiency virus (HIV) diagnosis rates among men who have sex with men (MSM) in high-income countries in North America, Western Europe, and Australia.MethodsData on annual rates of HIV diagnoses among MSM aged 15 to 65 years from 2000 to 2014 were collected from 13 high-income countries. Joinpoint regression software was used to empirically determine country-specific trend periods. Trends in HIV diagnosis rates and in the proportion of diagnoses occurring in young MSM aged 15 to 24 years were analyzed using Poisson regression and log-binomial regression, respectively.ResultsSix countries experienced an increasing trend from 2000 to 2007-08 followed by either a stable or declining trend through 2014. Five countries had recently increasing trends, and two countries had one stable trend from 2000 to 2014. All 13 countries experienced increases in the proportion of diagnoses occurring in young MSM.ConclusionsSince 2008, half of the 13 high-income countries examined experienced stable or decreasing trends. Still, some countries continue to experience increasing HIV trends, and young MSM are increasingly represented among new diagnoses. Efforts to support early sexual health promotion, reduce barriers to pre-exposure prophylaxis, and improve care engagement for young MSM are critical to addressing current HIV trends.     

宁夏大学生2010-2015年艾滋病知信行调查

目的 了解宁夏青年学生艾滋病知识掌握和相关危险性行为情况,为制定防制措施提供依据.方法 收集2010-2015年青年学生艾滋病哨点监测结果,进行整理分析.结果 2010-2015年共调查宁夏青年学生4 800人.宁夏青年学生对艾滋病基本知识掌握较好,2010-2015年知晓率均高于80％,但各相关知识掌握水平不均衡.青年学生共382人发生过性行为,比例逐年增加(x2趋势=31.428,P＜0.01);男生发生过性行为的比例为12.87％,高于女生的3.91％,且存在一定比例的同性性行为.青年学生发生性行为时使用安全套比例均低于80％,坚持使用安全套比例均低于60％.结论 宁夏青年学生艾滋病防治知识知晓率仍有待提高,学生中存在不安全性行为.今后亟需加强大学生人群健康教育,针对学生男男性行为人群开展行为干预措施,阻止HIV在大学生人群中的传播.     

Rates of prevalent and new HIV diagnoses by race and ethnicity among men who have sex with men,U.S. states, 2013–2014

PurposeMen who have sex with men (MSM) bear a disproportionate burden of new and existing HIV infections in the United States, with black and Hispanic MSM facing the highest rates. A lack of data on MSM population sizes has precluded the understanding of state-level variations in these rates.MethodsUsing a recently developed model for estimating state-level population sizes of MSM by race that synthesizes data from the American Community Survey and the National Health and Nutrition Examination Survey, in conjunction with Centers for Disease Control and Prevention–based HIV diagnosis data, we estimated rates of living with an HIV diagnosis (2013) and new diagnosis among MSM (2014) by state and race.ResultsNationally, state-level median prevalence of living with an HIV diagnosis was 10.6%. White MSM had lower prevalence in all but five states; black MSM were higher in all but three. Hispanic MSM had highest concentrations in Northeast and Mississippi Delta states. Patterns were similar for new diagnoses rates.ConclusionsResults suggest that racial disparities in HIV infection among MSM are more prominent than geographic ones. Interventions should be differentially tailored to areas of high proportionate and absolute burden. Continued efforts to understand and address racial differences in HIV infection are needed.     

Human papillomavirus vaccination coverage among men who have sex with men—National HIV Behavioral Surveillance,United States, 2017

Men who have sex with men (MSM) are at high risk for infections and diseases caused by human papillomavirus (HPV), many of which are vaccine-preventable. In the United States, routine HPV vaccination has been recommended for adolescent males since 2011. This analysis evaluated self-reported receipt of ≥ 1 HPV vaccine dose by age group and HIV status among adult MSM using 2017 data from National HIV Behavioral Surveillance (NHBS) and compared the proportion vaccinated to prior years. Among 10,381 MSM aged ≥ 18 years, 17.9% of MSM overall and 28.4% of MSM living with HIV reported any HPV vaccination. Among 2,482 MSM aged 18–26 years, 32.8% overall and 51.3% living with HIV reported HPV vaccination. Since 2011, the proportion of MSM aged 18–26 years reporting HPV vaccination has increased over six-fold. As vaccinated adolescents age into young adults, coverage will continue to increase overall, including among MSM.     

Stigma in place: Black gay men's experiences of the rural South

Black gay men (MSM) in the rural United States South are inequitably burdened by stigmatization and the HIV epidemic. Drawing from twelve oral history interviews with middle-aged and older Black gay narrators from rural North Carolina, this research explores the impact of sexual marginalization and the HIV epidemic on lived experiences of the rural South. Despite describing increasingly empowered views of HIV and sexual health, narrators expressed persistent difficulty managing social determinants of HIV vulnerability—sexual stigma and disconnection from LGBTQ collectivity. Narrators reported better managing sexual marginalization over their lifetimes in urban settings and places outside of the South such as New York (NY). This research suggests stressful structural and interpersonal experiences of stigma may define lived experiences of particular settings.     

Subpopulation estimates from the HIV incidence surveillance system--United States, 2006

CDC has created an HIV incidence surveillance system in selected areas of the United States as a component of its national human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) reporting system. The purpose of the new system is to estimate the number of new HIV infections occurring each year in the United States. Initial results published recently for 2006 showed that 73% of new infections were in males, 45% were in blacks, and 53% were in men who have sex with men (MSM). To provide additional subpopulation estimates by age group, race/ethnicity, and HIV transmission category, CDC conducted a more detailed analysis of data from the new surveillance system. The results indicated that, in 2006, of new HIV infections among males, 72% were in MSM. Among MSM with new infections, 46% were white, 35% were black, and 19% were Hispanic. Among MSM aged 13-29 years, the number of new HIV infections in blacks (5,220) was 1.6 times the number in whites (3,330) and 2.3 times the number in Hispanics (2,300). Among females, the predominant HIV transmission category was high-risk heterosexual contact, which accounted for 80% of new infections. The HIV incidence rate for black females was 14.7 times the rate for white females, and the rate for Hispanic females was 3.8 times the rate for white females. MSM (of all races), blacks, and Hispanics were represented disproportionately in 2006 among those with new HIV infections. The new incidence data will help guide local, state, and national intervention measures tailored to those populations at greatest risk for HIV infection.     

杭州市使用社交网络大学生MSM人群规模评估研究

了解杭州市三大高教园大学生使用同性社交软件情况并估计使用社交网络学生男男性行为人群(men who have sex with men,MSM)规模,为开展针对MSM大学生的艾滋病防控工作提供依据.方法 2017年4月15日,选取杭州市滨江、下沙、小和山三大高教园区合适的地点,分3组开展调研,并对登陆同性社交软件的男同性恋大学生开展计数,7d以后重复此过程,通过对比个人信息,确定2次计数均被计入的调查对象,采用捕获—再捕获法计算使用社交网络学生MSM人群规模.结果 杭州市使用社交网络学生MSM人群规模约为2 636人(95%CI=2 522~2 750),平均年龄为(20.75±2.00)岁,平均体重为(63.58±11.82) kg,平均身高为(175.86±8.89) cm.在性角色分类中,插入和被插入均可的有400人(21.11%),被插入方405人(21.39%),插入方280人(14.78%),保密或未填809人(42.72%).结论 同性社交软件为应用捕获—再捕获方法估计男同性恋学生人群基数提供了新手段,也为高校开展对男同性恋青年学生的宣教工作提供了载体.新媒体技术在高校艾滋病防控工作中的作用值得深入研究.     

天津市青年学生男男性行为者新型毒品使用现状及影响因素分析

  目的  了解天津市青年学生男男性行为者(men who have sex with men,MSM)的基本特征、性行为情况以及新型毒品的使用情况,并探究使用新型毒品青年学生MSM的特征,为高校艾滋病防控相关政策制定提供参考依据。  方法  于2018年1月1日至12月31日,在天津市通过滚雪球抽样的方式在同性浴池、同性酒吧和社交软件等途径招募青年学生MSM。通过面对面访谈的方式与参与者沟通。通过调查问卷收集826名参与者基本人口学信息、性行为情况、新型毒品使用等信息。使用Logistic回归分析青年学生MSM中新型毒品使用者的特征。  结果  经实验室确证的HIV感染者32人,总体感染率为3.87%。其中新型毒品使用者为371人(44.92%)。Rush是使用率最高(98.65%)的新型毒品。在使用新型毒品的青年学生MSM中,306人(82.48%)使用过多种毒品,65人(17.52%)仅使用过一种毒品。多种毒品使用者的HIV感染率(16.92%)高于单一毒品使用者(4.57%)。年龄、首次性行为年龄、户籍、性取向、教育程度、性伴寻找方式、无保护性肛交和HIV检测史对青年学生MSM新型毒品使用影响均有统计学意义(OR值分别为3.70,5.51,0.51,0.60,4.64,0.40,0.52,1.98,2.29,P值均 < 0.05)。  结论  天津市青年学生男男性行为者中新型毒品使用率偏高。相关部门应加强高校禁毒防艾宣传,提高青年学生性健康意识,建立长效的HIV和毒品预防机制。     

青岛市2016年部分高校学生男男性行为者性伴状况研究

目的 了解高校学生MSM性伴相关状况,分析其寻找性伴的相关因素,为开展高校艾滋病预防干预工作提供参考。方法 依托青岛市MSM民间组织的艾滋病自愿咨询检测点,2016年10月采用滚雪球法招募青岛市部分高校学生MSM,按照现况调查估算样本量为267人,采用自填式问卷调查,收集其人口学特征、性伴状况等信息,采用SPSS 17.0软件统计分析调查内容。结果 共招募304名高校学生MSM,完成调查300名,来自24所高校,平均年龄20.7岁,同性性伴主要为熟人,第1个同性性伴和最近1个同性性伴为熟人的分别占58.7%（176/300）和62.3%（187/300）。通过互联网来寻找性伴占86.0%（258/300）。喜欢选择男性作为性伴占88.3%（265/300）,喜欢选择在校就读学生作为性伴占42.7%（128/300）。结论 高校学生MSM主要通过互联网寻找性伴,同性性伴主要为熟人,喜欢选择男性在校学生作为同性性伴。艾滋病防治工作应该关注高校学生人群MSM及其性健康。     

Outbreak of syphilis among men who have sex with men--Southern California, 2000

Syphilis is a sexually transmitted disease (STD) caused by infection with the spirochete Treponema pallidum, and like other genital ulcer diseases, syphilis enhances the transmission of human immunodeficiency virus (HIV). During the 1990s, syphilis occurred predominantly among heterosexual blacks in the South and in large cities. However, recent outbreaks of syphilis have occurred among men who have sex with men (MSM). A large syphilis outbreak occurred among MSM during January-July 2000 in southern California. During the outbreak period, the proportion of primary and secondary (P&S) syphilis cases among MSM increased to 51% from 26% for the same period in 1999. This report summarizes the findings of an investigation of this syphilis outbreak, which indicate a substantial increase in the number of syphilis cases among MSM, many of whom are HIV-positive. These data suggest that concern about HIV infection may be declining among MSM and emphasize the importance of strengthening efforts to prevent HIV infection in this population in the United States.