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Black, Hispanic Men Left Behind on Declining HIV Rates in the U.S.

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While the number of new HIV infections fell among white men who have sex with men (MSM) over the past decade, infection rates among Black and Hispanic/Latino MSM were less positive, according to the CDC.

In a new Vital Signs report, researchers highlighted racial disparities in HIV trends from 2010 to 2019, with new infections dropping by about 32% for white MSM (7,500 to 5,100, respectively; P<0.01), while remaining stable among Black MSM (9,000 to 8,900; P=0.90), and numerically ticking up for Hispanic/Latino MSM (6,800 to 7,900; P=0.10).

“The report shows that despite overall progress in reducing new infections among gay and bisexual men, the HIV epidemic continued and was more severe among Black and Hispanic/Latino … gay men and bisexual men in the decades leading up to the federal Ending the HIV Epidemic in the U.S. initiative, or EHE,” said CDC Director Rochelle Walensky, MD, on a press call Tuesday.

Overall, the number of MSM who were diagnosed with HIV in the U.S. dropped by about 8%, from 25,100 in 2010 to 23,100 (P=0.05) in 2019, according to the report.

Report co-author Demetre Daskalakis, MD, MPH, director of the CDC Division of HIV/AIDS Prevention, described infections among Black and Hispanic/Latino MSM as “high and relatively stable” throughout the study period, and blamed the “unequal reach of HIV prevention and treatment” for the disparities, along with greater HIV stigma among certain communities.

He noted that during 2019, about 83% of Black MSM and 80% of Hispanic/Latino MSM with HIV had received an HIV diagnosis compared with 90% of white MSM. Also, fewer Black MSM and Hispanic/Latino MSM with an HIV diagnosis — 62% and 67%, respectively — were virally suppressed compared to 74% of white MSM, Daskalakis stated.

As for prevention, data from 2017 showed that approximately 47% of Black MSM discussed pre-exposure prophylaxis (PrEP) with a healthcare provider, and about 27% used PrEP in the last 12 months. These rates were 45% and 31%, respectively, for Hispanic/Latino MSM, and 59% and 42% for white MSM.

The new report showed that age was a factor in infection rates, which were nearly halved during the study period for MSM ages 13-24, dropping from 10,400 in 2010 to 5,700 in 2019 (P<0.01). They also fell by about a third for those ages 45-54, dropping from 2,900 to 2,000 (P<0.01). But the number of HIV infections among MSM ages 25-34 jumped from 6,700 to 10,000 (P<0.01).

The report also noted that the lowest percentages of diagnosed infections were seen among MSM ages 13-24 and ages 25-34, at 55% and 71%, respectively.

In looking at National HIV Behavioral Surveillance (NHBS) data among 7,577 respondents who did not report a positive HIV tests within 12 months of their interview, 79% said they were tested for HIV in the previous 12 months. NHBS data were collected from 23 urban areas where the majority of people who frequent certain venues — including bars clubs and other street locations — are MSM.

Of the 1,181 MSM who saw a healthcare provider, but were not tested for HIV in the 12 months prior, 78% said they were not offered an HIV test. MSM ages 45-54 and ages ≥55 had the lowest rate of testing, according to the current report.

HIV-related stigma was also higher among Black MSM and Hispanic/Latino MSM compared with white MSM, the researchers noted.

The EHE initiative calls for concentrating HIV prevention and treatment efforts in the hardest-hit communities, including the 57 state and local jurisdictions that represent more than half of all new HIV infections, Walensky noted.

The EHE also aims to scale up diagnosis, treatment, prevention, and response efforts, as well as expand access to prevention strategies, such as PrEP, in clinics that treat sexually transmitted infections (STIs), and in syringe exchange programs. The EHE also aims to reduce new HIV infections by 90% from 2020 to 2030.

“It’s clear that persistent factors like discrimination, healthcare access and use, education, income, housing and transportation, are contributing to continuing HIV disparities and standing in the way of our goal,” said Daskalakis.

He outlined four key tenets, called “ROOT,” to guide and improve treatment and prevention efforts:

  • Provide “resources” for communities most in need because many do not currently have access to the latest advances
  • Help those “outside” traditional healthcare settings including HIV self-testing and mobile services
  • “Overcome” systemic racism, homophobia, transphobia, and other HIV-related stigma
  • Take a “total person” approach to care that acknowledges “interconnected epidemics” such as other STIs and the hepatitis virus

“Right now, with EHE and the effective prevention and treatment tools at our disposal, we have a decade-in-the-making opportunity to end our nation’s HIV epidemic and erase the glaring health disparities highlighted in this report,” he said.

  • Shannon Firth has been reporting on health policy as MedPage Today’s Washington correspondent since 2014. She is also a member of the site’s Enterprise & Investigative Reporting team. Follow

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