New Faces of HIV Infection: Age, Race, and Timing of Entry into HIV Care in the Southeastern United States

Abstract

Among younger men who have sex with men (MSM), the incidence of HIV is rising nationally. Of the 281 persons who entered into care at a large HIV clinic in the southeastern United States in 2010 to 2012, 78 (27.8%) were <25 years old at the time of diagnosis. Those in the younger group were more likely than those aged ≥25 to be black (59.0% versus 37.4%), MSM (78.2% versus 55.2%), and to have a longer median time from diagnosis to entry into care (71 versus 53 days; P < .05 each). In adjusted survival analysis, persons of black race were less likely to enter care after diagnosis than those of nonblack race (hazard ratio = 0.75, P = .02). Young MSM represent an important target population for prevention and HIV testing interventions, and there is a need to shorten the time from diagnosis to linkage to care, particularly in persons aged <25 and of black race.

Keywords: HIV; care continuum; entry into care; race; young adults.

Figure 1

Adjusted survival curves for time from HIV diagnosis (Dx) to first clinic visit, by age category, accounting for race, sex, HIV risk factor, and active substance abuse.

Figure 2

Diagnosis of the proportionality assumption in a Cox regression model, using the scaled Schoenfeld residuals. The horizontal line at 0 on the Y-axis indicates that hazards are proportional by exposure of interest (age) across the study period.

Figure 3

Adjusted survival curves for time from HIV diagnosis to first clinic visit, with age by race interactions, accounting for sex, HIV risk factor, and active substance abuse.

Figure 4

Adjusted survival curves for time from HIV diagnosis to first clinic visit, with age by risk interactions, accounting for sex, race, and active substance abuse.