Early Linkage to HIV Care and Antiretroviral Treatment among Men Who Have Sex with Men--20 Cities, United States, 2008 and 2011

Abstract

Early linkage to care and antiretroviral (ARV) treatment are associated with reduced HIV transmission. Male-to-male sexual contact represents the largest HIV transmission category in the United States; men who have sex with men (MSM) are an important focus of care and treatment efforts. With the release of the National HIV/AIDS Strategy and expanded HIV treatment guidelines, increases in early linkage to care and ARV treatment are expected. We examined differences in prevalence of early linkage to care and ARV treatment among HIV-positive MSM between 2008 and 2011. Data are from the National HIV Behavioral Surveillance System, which monitors behaviors among populations at high risk of HIV infection in 20 U.S. cities with high AIDS burden. MSM were recruited through venue-based, time-space sampling. Prevalence ratios comparing 2011 to 2008 were estimated using linear mixed models. Early linkage was defined as an HIV clinic visit within 3 months of diagnosis. ARV treatment was defined as use at interview. Prevalence of early linkage to care was 79% (187/236) in 2008 and 83% (241/291) in 2011. In multivariable analysis, prevalence of early linkage did not differ significantly between years overall (P = 0.44). Prevalence of ARV treatment was 69% (790/1,142) in 2008 and 79% (1,049/1,336) in 2001. In multivariable analysis, ARV treatment increased overall (P = 0.0003) and among most sub-groups. Black MSM were less likely than white MSM to report ARV treatment (P = 0.01). While early linkage to care did not increase significantly between 2008 and 2011, ARV treatment increased among most sub-groups. Progress is being made in getting MSM on HIV treatment, but more efforts are needed to decrease disparities in ARV coverage.

Fig 1. Adjusted prevalence^a of current ARV treatment by race/ethnicity among MSM—NHBS, 2008 and 2011.

Adjusted prevalences from a model adjusted for year, current age, annual household income, current insurance, venue type where recruitment occurred, and city (random effect) show that the percent of blacks currently on antiretroviral therapy is significantly less than the percent of whites currently on antiretroviral therapy in both years. ^aAdjusted prevalence estimated from the following model: current ARV = α + β1*race + β 2*age + β 3*current insurance + β 4*income + β 5*venue type + β 6*year + β 7*race*year + β 8*age*year + β 9*current insurance*year + β 10*income*year; city is included as a random effect; adjusted prevalence ratio based on combined 2008, 2011 data comparing whites to blacks was 1.09 (CI: 1.02–1.16); ^bHispanics can be of any race; ^cIncludes MSM reporting American Indian or Alaska Native, Asian, Native Hawaiian or Pacific Islander, other race, or multiple races.