HIV Testing Experience Before HIV Diagnosis Among Men Who Have Sex with Men — 21 Jurisdictions, United States, 2007–2013

Weekly / September 23, 2016 / 65(37);999–1003

Laurie Linley, MPH¹; Qian An, PhD¹; Ruiguang Song, PhD¹; Eduardo Valverde, DrPH¹; Alexandra M. Oster, MD¹; Xiaona Qian, MS¹; Angela L. Hernandez, MD¹ (View author affiliations)

Gay, bisexual, and other men who have sex with men (MSM) continue to be the population most affected by human immunodeficiency virus (HIV) in the United States. In 2014, 81% of diagnoses of HIV infection were among adult and adolescent males, and among these, 83% of infections were attributable to male-to-male sexual contact (1). Since 2006, CDC has recommended HIV testing at least annually for sexually active MSM to foster early detection of HIV infection and prevent HIV transmission (2,3). Several initiatives and strategies during the past decade have aimed to expand HIV testing among MSM to increase early diagnosis and treatment and reduce transmission. To better understand HIV testing patterns among MSM with diagnosed HIV infection, CDC analyzed data for 2007–2013 from jurisdictions conducting HIV incidence surveillance as part of CDC’s National HIV Surveillance System (NHSS). Findings from this analysis suggest that increasing percentages of MSM have had a negative HIV test during the 12 months before diagnosis (48% in 2007, 56% in 2013, among those with a known date of previous negative HIV test), indicating a trend toward increased HIV testing and earlier HIV diagnosis among persons most at risk for HIV.

Data from the NHSS were used to assess trends in HIV testing patterns among MSM with HIV infection diagnosed during 2007–2013. HIV case surveillance data and supplemental information, including testing history data from patient and provider reports, were collected by 21 jurisdictions participating in HIV incidence surveillance (18 states, two cities, and the District of Columbia)* and reported to NHSS through December 31, 2015 (4). This analysis included males aged =13 years with HIV infection attributed to male-to-male sexual contact. Testing history data indicative of a negative HIV test, a date of most recent negative HIV test, or the number of negative HIV tests during the 2 years before diagnosis were used to categorize MSM as having a previous negative HIV test before diagnosis. The date of most recent negative HIV test was used to establish the number of months between the last negative HIV test and HIV infection diagnosis. The estimated annual percent change (EAPC) and the associated 95% confidence interval (CI) were used to assess trends from 2007 to 2013 in the proportion of MSM with a previous negative HIV test among those with a testing history, and the proportion of MSM with a negative HIV test =12 months before HIV diagnosis among those who had information on the date of last negative HIV test, by age group and race/ethnicity (black/African American [black], Hispanic/Latino [regardless of race], white, or other race).

In the 21 jurisdictions, the number of MSM aged =13 years with diagnosed HIV infection attributed to male-to-male sexual contact was 16,788 in 2007 and 15,951 in 2013 (Table 1). The percentage of these MSM who had any testing history data was 51% in 2007 and 69% in 2013. Overall, among MSM with testing history data, the percentage who had a previous negative HIV test increased significantly from 70% in 2007 to 74% in 2013 (EAPC = 1.15, 95% CI = 0.92–1.38). By race/ethnicity, significant increases from 2007 to 2013 occurred for black MSM (from 64% to 73%; EAPC = 2.67, 95% CI = 2.24–3.11), for white MSM (from 75% to 77%; EAPC = 0.68, 95% CI = 0.32–1.05), and MSM of other races (from 73% to 77%; EAPC = 1.34, 95% CI = 0.45–2.24). By age group, significant increases from 2007 to 2013 occurred among MSM of all age groups except those aged =55 years. Although the trend from 2007 to 2013 in the percentage with a previous negative HIV test among Hispanic/Latino MSM was not significant overall, there was a significant increase among Hispanic/Latino MSM aged 25–34 years. Among black MSM, significant increases were observed for all age groups. Among white MSM, significant increases were observed among those aged 35–44 and 45–54 years.

Among MSM with a known date of negative HIV test before HIV diagnosis (30% of all MSM in 2007 and 47% in 2013), the trend in the percentage of those with a negative test =12 months before diagnosis increased overall from 48% in 2007 to 56% in 2013 (EAPC = 2.34, 95% CI = 1.89–2.78) (Table 2). By race/ethnicity, from 2007 to 2013 the percentage of MSM with a negative test =12 months before HIV diagnosis increased among blacks (from 48% to 57%; EAPC = 2.49, 95% CI = 1.73–3.26), Hispanics/Latinos (from 51% to 57%; EAPC = 1.87, 95% CI = 1.03–2.72), and whites (from 46% to 54%; EAPC = 2.69, 95% CI = 1.88–3.51). By age group, the percentage with a negative test =12 months before HIV diagnosis increased significantly for MSM among all age groups except for those aged =55 years (Figure). Among black MSM, significant increases were observed among those aged 13–24, 25–34, and 35–44 years; among Hispanics/Latinos, increases were only observed among those aged 25–34 and 45–54 years; among whites, increases were observed among those aged 25–34, 35–44, and 45–54 years (Table 2).

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Corresponding author: Laurie Linley, LLinley@cdc.gov, 404-639-2086.

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¹Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC.

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References

1. CDC. HIV surveillance report, 2014; vol. 26. Atlanta, GA: US Department of Health and Human Services, CDC; 2015. http://www.cdc.gov/hiv/library/reports/surveillance/
2. Branson BM, Handsfield HH, Lampe MA, et al. . Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 2006;55(No. RR-14). PubMed
3. Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010;59(No. RR-12). PubMed
4. CDC. Estimated HIV incidence in the United States, 2007–2010. HIV surveillance supplemental report 2012;17(No. 4). Atlanta, GA: US Department of Health and Human Services, CDC; 2012. http://www.cdc.gov/hiv/library/reports/surveillance/index.html
5. Cooley LA, Oster AM, Rose CE, Wejnert C, Le BC, Paz-Bailey G; NHBS Study Group. Increases in HIV testing among men who have sex with men—National HIV Behavioral Surveillance System, 20 U.S. Metropolitan Statistical Areas, 2008 and 2011. PLoS One 2014;9:e104162. CrossRef PubMed
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8. Office of National AIDS Policy. National HIV/AIDS strategy. Washington, DC: Office of National AIDS Policy; 2010. https://www.whitehouse.gov/administration/eop/onap/nhas
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TABLE 1. Testing history availability and evidence of previous negative HIV test among MSM* with diagnosed HIV infections, by year of diagnosis and selected characteristics — 21 U.S. jurisdictions, 2007–2013

Abbreviations: EAPC = estimated annual percent change; HIV = human immunodeficiency virus; L95 = lower bound of 95% confidence interval; MSM = men who have sex with men; U95 = upper bound of 95% confidence interval.
* MSM in this analysis were males aged =13 years with HIV infection attributable to male-to-male sexual contact.
^† Percentage of reported diagnoses.
^§ Percentage of cases with testing history information.
^¶ Hispanics/Latinos can be of any race.

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TABLE 2. Number and percentage of MSM* with a negative HIV test in 12 months before diagnosis among those with a known date of negative test,^† by year of diagnosis and selected characteristics — 21 U.S. jurisdictions, 2007–2013

Abbreviations: EAPC = estimated annual percent change; HIV = human immunodeficiency virus; L95 = lower bound of 95% confidence interval; MSM = men who have sex with men; U95 = upper bound of 95% confidence interval.
* MSM in this analysis were males aged =13 years with HIV infection attributable to male-to-male sexual contact.
^† Refer to figure for graph of trends from 2007–2013 in percentage of HIV-diagnosed MSM with a negative HIV test in 12 months before diagnosis.
^§ Percentage of MSM with a known date of previous negative HIV test.
^¶ Hispanics/Latinos can be of any race.

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FIGURE. Percentage of MSM* with a negative HIV test =12 months before HIV diagnosis, by age at diagnosis and race/ethnicity^† — 21 U.S. jurisdictions, 2007–2013

Abbreviations: HIV = human immunodeficiency virus; MSM = men who have sex with men.

* MSM in this analysis were males aged =13 years with HIV infection attributable to male-to-male sexual contact.

^† Hispanics/Latinos can be of any race.

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Suggested citation for this article: Linley L, An Q, Song R, et al. HIV Testing Experience Before HIV Diagnosis Among Men Who Have Sex with Men — 21 Jurisdictions, United States, 2007–2013. MMWR Morb Mortal Wkly Rep 2016;65:999–1003. DOI: http://dx.doi.org/10.15585/mmwr.mm6537a3.

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