As CDC reported [PDF 2.3 MB] in December, our nation is making substantial but uneven progress on HIV prevention for gay, bisexual, and other men who have sex with men (MSM). Over the past decade, new HIV diagnoses declined significantly among white MSM, but increased among Latino MSM. Among black MSM, the sharp increases we saw just a few years ago have since leveled off – a sign of progress and cause for optimism, even if the numbers remain unacceptably high.
Making HIV prevention work for all MSM is among CDC’s highest priorities. MSM are a core focus of nearly all of our major HIV prevention grant programs for health departments and community-based organizations (CBOs). We recently worked with state and local partners to launch innovative new prevention programs for MSM, especially men of color. And last year, we called on states to take a hard look at their own programs, to make sure they are making full use of the latest prevention tools and holding themselves to the highest standards of success.
But HIV prevention for MSM has long been complicated by a lack of complete data. We have known how many MSM were diagnosed with HIV. And a few years ago, CDC reported on national rates – relative to population size –, which showed rates of HIV diagnoses at least 40 times higher than for heterosexual men or women. But until now, we did not have comprehensive data on the rates among MSM for specific states, counties, and cities.
Now, Emory University researchers, in collaboration with CDC, have provided that crucial information . The researchers estimated HIV rates for MSM in every state, and in most counties and cities nationwide.
What they found is critically important for HIV prevention—chiefly, that MSM are more severely affected in the South than in any other region. This is true even in places where the absolute number of cases may be relatively low. In 2012, at least one in four MSM were estimated to be living with an HIV diagnosis in each of the following cities: Jackson, Mississippi; Columbia, South Carolina; El Paso, Texas; Augusta, Georgia; and Baton Rouge, Louisiana. Among metropolitan statistical areas, the South accounted for 21 of the top 25 in terms of rates of MSM living with diagnosed HIV in the same year. The researchers also estimated rates of new HIV diagnoses and came to similar conclusions.
Of course, these findings don’t negate the rates of HIV in MSM beyond the South. The largest numbers of HIV diagnoses still occur in major coastal states and cities such as New York and Los Angeles. The data also don’t reflect the reasons that southern MSM are so disproportionately affected.
What the new analyses do tell us is that MSM in the South are in need of better access to HIV prevention, care, and treatment. This is especially true for MSM men of color, whom other data clearly show to be most affected.
Better access begins with making sure financial resources are directed where they’re most needed. At the national level, CDC has improved allocation of its HIV prevention funding to better align with the rates of HIV in the South. Between 2010 and 2015, CDC increased its total funding to southern health departments and CBOs by 22 percent, from $165 million to $201 million.
But allocation within individual states is just as crucial. The new estimates provide important information that health departments can use – along with standard surveillance data and local knowledge of community needs and resources – to identify and support MSM communities that are most affected.
We also need to focus on the most effective prevention strategies. CDC’s state partners, especially in the South, might consider taking aggressive steps to improve prevention and care outcomes for MSM, and all others at risk. This means linking individuals with newly diagnosed HIV to care and treatment the same day they receive their test results. It means improving early diagnosis of HIV infection by speeding the adoption of the latest testing technologies. It means promoting pre-exposure prophylaxis, or PrEP, as well as other prevention and support services for people who are at very high risk for HIV. And it requires doing a better job of ensuring that every person living with HIV has unfettered access to quality health care, no matter where he or she lives.
More information about these priorities is available in CDC’s Issue Brief: HIV in the Southern United States [PDF 274 KB].
We have the prevention tools to dramatically reduce new HIV infections among MSM in every community. These new data highlight the importance of using those proven tools in the most optimal ways to address the dramatic disparities in HIV rates seen among MSM in this country, and particularly in the South. If we stay focused on the biggest needs and the most effective solutions, I am confident we will succeed.
Resource: CDC Graphic HIV Prevention Funding in the South [PDF 3,503 KB]