Half of gay men who have HIV don't know it

Aug 14 2005

A recent Centers for Disease Control and Prevention (CDC) study on HIV prevalence among men who have sex with men (MSM), found that a staggering 48% of gay and bi-sexual men who were found to be HIV positive during the study were previously unaware of their HIV infection, according to a report on the study published in the Journal of American Medical Association.

The JAMA report included HIV prevalence data from the study (which took place from June 2004 through April 2005 in five US cities) from the CDC's Morbidity and Mortality Weekly Report (MMWR). AIDS Healthcare Foundation (AHF), the nation's largest AIDS organization with AIDS treatment clinics in the US, Africa, Asia and Central America, expressed alarm over these high numbers and called for an immediate and far-reaching overhaul to the current "broken" HIV testing system in the US including widespread efforts to make HIV testing more accessible overall throughout the country.

"The fact that almost half of the gay men who tested HIV positive during this study had no idea they were infected with HIV underscores the sad reality that the HIV testing system in this country is broken and needs to fixed," said Michael Weinstein, President of AIDS Healthcare Foundation (AHF). "We need to normalize HIV testing and incorporate testing as a routine part of healthcare screenings in most healthcare settings. Testing and outreach also needs to become more easily accessible to the public, particularly to those in high-risk groups such as men who have sex with men."

During June 2004 -- April 2005, participants in five of seventeen National HIV Behavioral Surveillance (NHBS) system cities (Baltimore, Maryland; Los Angeles, California; Miami, Florida; New York, New York; and San Francisco, California) were tested for HIV infection after informed consent. A total of 2,261 men culled from 258 venues located throughout the five cities participated in the study, titled, "HIV Prevalence, Unrecognized Infection, and HIV Testing Among Men Who Have Sex With Men -- Five U.S. Cities, June 2004 -- April 2005."

Among the study's findings:

• ...of the MSM surveyed, 25% were infected with HIV, and 48% of those infected were unaware of their infection.
• In the five cities, 2,261 men sampled from 258 venues participated in NHBS. The participation rate among eligible men was 83% (range by city: 69%-99%). A total of 1,767 (78%) were men who had one or more male sex partners and agreed to the survey, HIV test, and STARHS test (range by city: 222-462). Of these 1,767 participants, the median age was 32 years (range: 18-81 years); 35% were white, 27% Hispanic, 25% black, 7% multiracial/other, and 6% Asian/Pacific Islander. Participants were recruited at bars (30%), street locations (20%), dance clubs (19%), cafes/retail stores (10%), Gay Pride events (6%), social organizations (5%), gyms (5%), sex establishments (3%), and parks (1%).
• Of the 450 HIV-infected MSM, 217 (48%) were unaware of their HIV infections. The proportion of unrecognized HIV infection was highest among MSM who were aged <30 years, nonwhite, and surveyed in the four cities other than San Francisco. Of the 217 MSM with unrecognized HIV infections, 64% were black, 18% Hispanic, 11% white, and 6% multiracial/other. The majority (184 [84%]) of the 217 MSM with unrecognized HIV infection had previously been tested for HIV; 145 (79%) reported that their most recent test result was negative, 33 (18%) were unknown, and six (3%) were indeterminate. Approximately 58% of MSM with unrecognized infections had not been tested during the preceding year.
• Nearly all participants (92%) reported previously being tested for HIV, and 64% reported being tested during the preceding year. MSM were more likely to have been tested during the preceding year if they had visited a health-care provider and their provider recommended an HIV test.

The study's authors concluded that to decrease HIV transmission, men who have sex with men 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.

"In June, the CDC reported that the number of people living with HIV/AIDS in the United States had reached 1 million for the first time ever," added AHF's Weinstein. "That number reflects a continued increase in new HIV infections -- about 40,000 new HIV cases per year and 18,000 AIDS deaths -- for a net gain of 22,000 cases each year. Sadly, that 40,000 figure has remained constant for more than a decade, despite a 2001 pledge by the CDC that it would strive to halve the rate. These startling numbers, both the one million overall living with HIV/AIDS and the 48% of MSM testing positive who were unaware of their infection, clearly show that we need to rethink and revamp our HIV testing and prevention strategies both on a local and national level."