Men's Risk for Newly Diagnosed HIV and Syphilis
Men's Risk for Newly Diagnosed HIV and Syphilis
Objectives: To describe the population of men who have sex with men (MSM) in New York City, compare their demographics, risk behaviors, and new HIV and primary and secondary (P&S) syphilis rates with those of men who have sex with women (MSW), and examine trends in infection rates among MSM.
Design: Population denominators and demographic and behavioral data were obtained from population-based surveys during 2005–2008. Numbers of new HIV and P&S syphilis diagnoses were extracted from city-wide disease surveillance registries.
Methods: We calculated overall, age-specific and race/ethnicityspecific case rates and rate ratios for MSM and MSW and analyzed trends in MSM rates by age and race/ethnicity.
Results: The average prevalence of male same-sex behavior during 2005–2008 (5.0%; 95% CI: 4.5 to 5.6) differed by both age and race/ethnicity (2.3% among non-Hispanic black men; 7.4% among non- Hispanic white men). Compared with MSW, MSM differed significantly on all demographics and reported a higher prevalence of condom use at last sex (62.9% vs. 38.3%) and of past-year HIV testing (53.6% vs. 27.2%) but also more past-year sex partners. MSM HIV and P&S syphilis rates were 2526.9/100,000 and 707.0/100,000, each of which was over 140 times MSW rates. Rates were highest among young and black MSM. Over 4 years, HIV rates more than doubled and P&S syphilis rates increased 6-fold among 18-year-old to 29-year-old MSM
Conclusions: The substantial population of MSM in New York City is at high risk for acquisition of sexually transmitted infections given high rates of newly diagnosed infections and ongoing risk behaviors. Intensified and innovative efforts to implement and evaluate prevention programs are required.
The successful targeting of resources for the prevention and treatment of sexually transmitted diseases (STD), including HIV, benefits from knowledge of the population size and demographic and behavioral characteristics of those at highest risk for infections. Although national and local data have shown that men who have sex with men (MSM) comprise the majority of new HIV and new syphilis cases in the United States, understanding the full burden of disease among the MSM population has been challenging given that, until recently, direct estimates of MSM numbers in the general population were unavailable.
Several recent population-based studies using MSM denominator estimates from behavioral surveillance have quantified point prevalence of HIV or primary and secondary (P&S) syphilis and HIV rates among MSM. Our analysis adds to this body of work by examining trends in newly diagnosed HIV and P&S syphilis among sexually active MSM in New York City (NYC), an epicenter of the US HIV epidemic. In NYC, the proportion of reported male HIV diagnoses that were among MSM increased by 19% in just 5 years. MSM have also been disproportionately affected by P&S syphilis since the outbreak began in 1999. In 2008, 87% of male P&S syphilis cases in NYC reported sex with other men. To effectively plan, implement, and evaluate programs aimed at preventing transmission of HIV and other STDs, we describe the population of MSM in NYC, compare demographic and behavioral characteristics of MSM and men who have sex with women (MSW), estimate rates of disease in both groups, and examine disparities among MSM by race/ethnicity and age using 3 population-based data sources.
Abstract and Introduction
Abstract
Objectives: To describe the population of men who have sex with men (MSM) in New York City, compare their demographics, risk behaviors, and new HIV and primary and secondary (P&S) syphilis rates with those of men who have sex with women (MSW), and examine trends in infection rates among MSM.
Design: Population denominators and demographic and behavioral data were obtained from population-based surveys during 2005–2008. Numbers of new HIV and P&S syphilis diagnoses were extracted from city-wide disease surveillance registries.
Methods: We calculated overall, age-specific and race/ethnicityspecific case rates and rate ratios for MSM and MSW and analyzed trends in MSM rates by age and race/ethnicity.
Results: The average prevalence of male same-sex behavior during 2005–2008 (5.0%; 95% CI: 4.5 to 5.6) differed by both age and race/ethnicity (2.3% among non-Hispanic black men; 7.4% among non- Hispanic white men). Compared with MSW, MSM differed significantly on all demographics and reported a higher prevalence of condom use at last sex (62.9% vs. 38.3%) and of past-year HIV testing (53.6% vs. 27.2%) but also more past-year sex partners. MSM HIV and P&S syphilis rates were 2526.9/100,000 and 707.0/100,000, each of which was over 140 times MSW rates. Rates were highest among young and black MSM. Over 4 years, HIV rates more than doubled and P&S syphilis rates increased 6-fold among 18-year-old to 29-year-old MSM
Conclusions: The substantial population of MSM in New York City is at high risk for acquisition of sexually transmitted infections given high rates of newly diagnosed infections and ongoing risk behaviors. Intensified and innovative efforts to implement and evaluate prevention programs are required.
Introduction
The successful targeting of resources for the prevention and treatment of sexually transmitted diseases (STD), including HIV, benefits from knowledge of the population size and demographic and behavioral characteristics of those at highest risk for infections. Although national and local data have shown that men who have sex with men (MSM) comprise the majority of new HIV and new syphilis cases in the United States, understanding the full burden of disease among the MSM population has been challenging given that, until recently, direct estimates of MSM numbers in the general population were unavailable.
Several recent population-based studies using MSM denominator estimates from behavioral surveillance have quantified point prevalence of HIV or primary and secondary (P&S) syphilis and HIV rates among MSM. Our analysis adds to this body of work by examining trends in newly diagnosed HIV and P&S syphilis among sexually active MSM in New York City (NYC), an epicenter of the US HIV epidemic. In NYC, the proportion of reported male HIV diagnoses that were among MSM increased by 19% in just 5 years. MSM have also been disproportionately affected by P&S syphilis since the outbreak began in 1999. In 2008, 87% of male P&S syphilis cases in NYC reported sex with other men. To effectively plan, implement, and evaluate programs aimed at preventing transmission of HIV and other STDs, we describe the population of MSM in NYC, compare demographic and behavioral characteristics of MSM and men who have sex with women (MSW), estimate rates of disease in both groups, and examine disparities among MSM by race/ethnicity and age using 3 population-based data sources.
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