AIDS and Behavior

, 13:615 | Cite as

Running in Place: Implications of HIV Incidence Estimates among Urban Men Who Have Sex with Men in the United States and Other Industrialized Countries

  • Ron Stall
  • Luis Duran
  • Stephen R. Wisniewski
  • Mark S. Friedman
  • Michael P. Marshal
  • Willi McFarland
  • Thomas E. Guadamuz
  • Thomas C. Mills
Original Paper

Abstract

Attempts to document changing HIV incidence rates among MSM are compromised by issues of generalizability and statistical power. To address these issues, this paper reports annualized mean HIV incidence rates from the entire published incidence literature on MSM from Europe, North America and Australia for the period 1995–2005. Publications that met the entry criteria were coded for region of the world, sampling method and year of study. From these reports, we calculated a mean incidence rate with confidence intervals for these variables. Although no differences in mean incidence rates were found for MSM from 1995 to 2005, HIV incidence rates are lower in Australia than either North America or Europe. We calculated a mean incidence rate of 2.39% for MSM in the United States, which if sustained within a cohort of MSM, would yield HIV prevalence rate of approximately 40% at age 40. These extrapolations overlap published HIV prevalence rates for MSM younger than age 40 in the United States. HIV incidence rates in the 2–3% range will adversely affect the health of gay male communities for decades to come. This analysis suggests that greater attention should be devoted to the question of how best to design prevention interventions that will lower HIV incidence rates among gay men.

Keywords

Men who have sex with men HIV/AIDS Epidemiology Prevention 

References

  1. Bartholow, B. N., Goli, V., Ackers, M., McLellan, E., Gurwith, M., Durham, M., et al. (2006). Demographic and behavioral contextual risk groups among men who have sex with men participating in a Phase 3 HIV vaccine efficacy trial: Implications for HIV prevention and behavioral/biomedical intervention trials. Journal of Acquired Immune Deficiency Syndromes, 43, 594–602.PubMedGoogle Scholar
  2. Branson, B. (2007). State of the art for diagnosis of HIV infection. Clinical Infectious Diseases, 45, S221–S225. doi:10.1086/522541.PubMedCrossRefGoogle Scholar
  3. Buchacz, K., McFarland, W., Kellogg, T. A., Loeb, L., Holmberg, S. D., Dilley, J., et al. (2005). Amphetamine use is associated with increased HIV incidence among men who have sex with men in San Francisco. AIDS (London, England), 19, 1423–1424. doi:10.1097/01.aids.0000180794.27896.fb.Google Scholar
  4. Buchbinder, S., Douglas, J., McKirnan, D., Judson, F., Katz, M., & MacQueen, K. (1996). Feasibility of Human Immunodeficiency Virus vaccine trials in homosexual men in the United States: Risk behavior seroincidence and willingness to participate. The Journal of Infectious Diseases, 174, 954–961.PubMedGoogle Scholar
  5. Buchbinder, S., Vittinghoff, E., Heagerty, P. J., Celum, C. L., Seage, G. R., Judson, F. N., et al. (2005). Sexual risk, nitrite inhalant use, and lack of circumcision associated with HIV seroconversion in men who have sex with men in the United States. Journal of Acquired Immune Deficiency Syndromes, 39, 82–89. doi:10.1097/01.qai.0000134740.41585.f4.PubMedCrossRefGoogle Scholar
  6. Calzavara, L., Burchell, A. N., Major, C., Remis, R. S., Corey, P., Myers, T., Millson, P., Wallace, E., & Polaris Study Team. (2002). Increases in HIV incidence among men who have sex with men undergoing repeat diagnostic HIV testing in Ontario, Canada. AIDS (London, England), 16, 1655–1661. doi:10.1097/00002030-200208160-00011.
  7. Centers for Disease Control. (2001). HIV incidence among young men who have sex with men—seven US cities, 1994–2000. MMWR, 50, 440–444.Google Scholar
  8. Centers for Disease Control. (2004). Trends in primary and secondary syphilis and HIV infections in men who have sex with men—San Francisco and Los Angeles, California, 1998–2002. MMWR, 53, 575–578.Google Scholar
  9. Centers for Disease Control. (2005). HIV prevalence, unrecognized infection, and HIV testing among men who have sex with men—five US cities, June 2004–April 2005. MMWR, 54, 597–601.Google Scholar
  10. Centers for Disease Control. (2006). Primary and secondary syphilis—United States, 2003–2004. MMWR, 55(10), 269–273.Google Scholar
  11. Choi, K., McFarland, W., Neilands, T. B., Nguyen, S., Louie, B., Secura, G. M., et al. (2004). An opportunity for prevention: Prevalence, incidence, and sexual risk for HIV among young Asian and Pacific Islander men who have sex with men, San Francisco. Sexually Transmitted Diseases, 31, 475–480. doi:10.1097/01.olq.0000135988.19969.62.PubMedCrossRefGoogle Scholar
  12. Craib, K., Weber, A., Cornelisse, P., Martindale, S., Miller, J., Schecter, M., et al. (2000). Comparison of sexual behaviors, unprotected sex and substance use between two independent cohorts of gay and bisexual men. AIDS (London, England), 14, 303–311. doi:10.1097/00002030-200002180-00013.Google Scholar
  13. del Romero, J., Castilla, J., Garcia, S., Clavo, P., Ballesteros, J., & Rodriguez, C. (2001). Time trend in incidence of HIV seroconversion among homosexual men repeatedly tested in Madrid, 1988–2000. AIDS (London, England), 15, 1319–1321. doi:10.1097/00002030-200107060-00019.Google Scholar
  14. Dougan, S., Elford, J., Chadborn, T., Brown, A. E., Roy, K., Murphy, G., et al. (2007). Does the recent increase in HIV diagnoses among men who have sex with men in the United Kingdom reflect a rise in HIV incidence or increased uptake of HIV testing? Sexually Transmitted Infections, 83, 120–125. doi:10.1136/sti.2006.021428.PubMedCrossRefGoogle Scholar
  15. Dufour, A., Parent, R., Alary, M., Otis, J., Remis, R., Mâsse, B., Lavoie, R., LeClerc, R., Turmel, G., Vincelette, J., & Omega Study Group. (1998). Characteristics of young and older men who have affective and sexual relations with men (MASM) in Montreal. Canadian Journal of Infectious Diseases, 9(Suppl. A), 30A.Google Scholar
  16. Dukers, N. H. T. M., Fennema, H. S. A., van der Snoek, E. M., Krol, A., Geskus, R. B., Pospiech, M., et al. (2007). HIV incidence and HIV testing behavior in men who have sex with men: Using three incidence sources, The Netherlands, 1984–2005. AIDS (London, England), 21, 491–499. doi:10.1097/QAD.0b013e328011dade.Google Scholar
  17. Dukers, N. H. T. M., Spaargaren, J., Geskus, R. B., Beijnen, J., Coutinho, R. A., & Fennema, H. S. A. (2002). HIV incidence on the increase among homosexual men attending an Amsterdam sexually transmitted disease clinic: Using a novel approach for detecting recent infections. AIDS (London, England), 16, F19–F24. doi:10.1097/00002030-200207050-00001.Google Scholar
  18. Elford, J., Leaity, S., Lampe, F., Wells, H., Evans, A., Miller, R., et al. (2001). Incidence of HIV infection among gay men in a London HIV testing clinic, 1997–1998. AIDS (London, England), 15, 650–653. doi:10.1097/00002030-200103300-00018.Google Scholar
  19. Fernyak, S. E., Page-Shafer, K., Kellogg, T. A., McFarland, W., & Katz, M. H. (2002). Risk behaviors and HIV incidence among repeat testers at publicly funded HIV testing sites in San Francisco. Journal of Acquired Immune Deficiency Syndromes, 31, 63–70.PubMedGoogle Scholar
  20. Giuliani, M., Di Carlo, A., Palamara, G., Dorrucci, M., Latini, A., Prignano, G., et al. (2005). Increased HIV incidence among men who have sex with men in Rome. AIDS (London, England), 19, 1429–1431. doi:10.1097/01.aids.0000180808.27298.af.Google Scholar
  21. Hogg, R. S., Weber, A. E., Chan, K., Martindale, S., Cook, D., Miller, M. L., et al. (2001). Increasing incidence of HIV infections among young gay and bisexual men in Vancouver. AIDS (London, England), 15, 1321–1322. doi:10.1097/00002030-200107060-00020.Google Scholar
  22. Hoover, D., Muñoz, A., Carey, V., Chmiel, J., Taylor, J., Margolick, J., et al. (1991). Estimating the 1978–1990 and future spread of HIV type 1 in subgroups of homosexual men. American Journal of Epidmiology, 134(10), 1190–1205.Google Scholar
  23. Hurtado, I., Alastrue, I., Ferreros, I., del Amo, J., Santos, C., Tasa, T., et al. (2007). Trends in HIV testing, serial HIV prevalence and HIV incidence among people attending a Center for AIDS Prevention from 1988 to 2003. Sexually Transmitted Infections, 83, 23–28. doi:10.1136/sti.2005.019299.PubMedCrossRefGoogle Scholar
  24. Jaffe, H., Valdiserri, R., & DeCock, K. (2007). The reemerging HIV/AIDS epidemic in men who have sex with men. Journal of the American Medical Association, 298(20), 2412–2414. doi:10.1001/jama.298.20.2412.PubMedCrossRefGoogle Scholar
  25. Janssen, R., Satten, G., Stramer, S., Rawal, B., O’Brien, T., Weiblen, B., et al. (1998). New testing strategy to detect early HIV-1 infection for use in incidence estimates and for clinical and prevention purposes. Journal of the American Medical Association, 280(1), 42–48. doi:10.1001/jama.280.1.42.PubMedCrossRefGoogle Scholar
  26. Jin, F., Prestage, G. P., McDonald, A., Ramacciotti, T., Imrie, J. C., Kippax, S. C., et al. (2008). Trend in HIV incidence in a cohort of homosexual men in Sydney: Data from the Health in Men Study. Sexual Health, 5, 109–112.PubMedCrossRefGoogle Scholar
  27. Katz, M. H., Schwarcz, S. K., Kellogg, T. A., Klausner, J. D., Dilley, J. W., Gibson, S., et al. (2002). Impact of highly active antiretroviral treatment on HIV seroincidence among men who have sex with men: San Francisco. American Journal of Public Health, 92, 388–394. doi:10.2105/AJPH.92.3.388.PubMedCrossRefGoogle Scholar
  28. Kellogg, T., Clements-Nolle, K., Dilley, J., Katz, M., & McFarland, W. (2001a). Incidence of human immunodeficiency virus among male-to-female transgenderered persons in San Francisco. Journal of Acquired Immune Deficiency Syndromes, 28(4), 380–384.PubMedGoogle Scholar
  29. Kellogg, T. A., McFarland, W., Perlman, J. L., Weinstock, H., Bock, S., Katz, M. H., et al. (2001b). HIV incidence among repeat HIV testers at a county hospital, San Francisco, California, USA. Journal of Acquired Immune Deficiency Syndromes, 28, 59–64.PubMedGoogle Scholar
  30. Koblin, B., Husnik, M., Colfax, G., Huang, Y., Madison, M., Mayer, K., et al. (2006). Risk factors for HIV infection among men who have sex with men. AIDS (London, England), 20, 731–739. doi:10.1097/01.aids.0000216374.61442.55.Google Scholar
  31. Kral, A. H., Lorvick, J., Gee, L., Bacchetti, P., Rawal, B., Busch, M., et al. (2003). Trends in human immunodeficiency virus seroincidence among street-recruited injection drug users in San Francisco, 1987–1998. American Journal of Epidemiology, 157, 915–922.PubMedCrossRefGoogle Scholar
  32. Lampinen, T. M., Ogilvie, G., Chan, K., Miller, M. L., Cook, D., Schechter, M. T., et al. (2005). Sustained increase in HIV-1 incidence since 2000 among men who have sex with men in British Columbia, Canada. Journal of Acquired Immune Deficiency Syndromes, 40, 242–244.PubMedCrossRefGoogle Scholar
  33. Lavoie, E., Alary, M., Remis, R., Otis, J., Vincelette, J., Turmel, B., et al. (2008). Determinants of HIV seroconversion among men who have sex with men living in a low HIV incidence population in the era of highly active antiretroviral therapies. Sexually Transmitted Diseases, 35(1), 25–29.PubMedCrossRefGoogle Scholar
  34. Macdonald, N., Dougan, S., MacGarrigle, C., Baster, K., Rice, G., Evans, G., et al. (2004). Recent trends in diagnosis of HIV and other sexually transmitted infections in England and Wales among men who have sex with men. Sexually Transmitted Infections, 80, 492–497. doi:10.1136/sti.2004.011197.PubMedCrossRefGoogle Scholar
  35. Mackellar, D., Valleroy, L., Anderson, J., Behel, S., Secura, G., Bingham, T., et al. (2006). Recent HIV testing among you men who have sex with men: Correlates, contexts and HIV seroconversion. Sexually Transmitted Diseases, 33(3), 183–192. doi:10.1097/01.olq.0000204507.21902.b3.PubMedCrossRefGoogle Scholar
  36. Major, C., Remis, R., Galli, R., Wu, K., Degazio, R., & Fearon, M. (1998). Towards real-time HIV surveillance using HIV testing data. Canadian Journal of Infectious Diseases, 9(Suppl. A), 40A.Google Scholar
  37. McFarland, W., Busch, M. P., Kellogg, T. A., Rawal, B. D., Satten, G. A., Katz, M. H., et al. (1999). Detection of early HIV infection and estimation of incidence using a sensitive/less-sensitive enzyme immunoassay testing strategy at anonymous counseling and testing sites in San Francisco. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 22, 484–489.Google Scholar
  38. McFarland, W., Kellogg, T. A., Dilley, J., & Katz, M. H. (1997). Estimation of human immunodeficiency virus (HIV) seroincidence among repeat anonymous testers in San Francisco. American Journal of Epidemiology, 146, 662–664.PubMedGoogle Scholar
  39. Mehta, S. D., Ghanem, K. G., Rompalo, A. M., & Erbelding, E. J. (2006). HIV seroconversion among public sexually transmitted disease clinic patients: Analysis of risks to facilitate early identification. Journal of Acquired Immune Deficiency Syndromes, 42, 116–122. doi:10.1097/01.qai.0000200662.40215.34.PubMedCrossRefGoogle Scholar
  40. Murphy, G., Charlett, A., Jordan, L. F., Osner, N., Gill, O. N., & Parry, J. V. (2004). HIV incidence appears constant in men who have sex with men despite widespread use of effective antiretroviral therapy. AIDS (London, England), 18, 265–272. doi:10.1097/00002030-200401230-00016.Google Scholar
  41. Nascimento, C. M. R., Casado, M. J., Casabona, J., Ros, R., Sierra, E., Zaragoza, K., et al. (2004). Estimation of HIV incidence among repeat anonymous testers in Catalonia, Spain. AIDS Research and Human Retroviruses, 20, 1145–1147. doi:10.1089/0889222042544956.PubMedCrossRefGoogle Scholar
  42. Nash, D., Bennani, Y., Ramaswamy, C., & Torian, L. (2005). Estimates of HIV incidence among persons testing for HIV using the sensitive/less sensitive enzyme immunoassay, New York City, 2001. Journal of Acquired Immune Deficiency Syndromes, 39, 102–111. doi:10.1097/01.qai.0000144446.52141.4c.PubMedCrossRefGoogle Scholar
  43. New York Times. (2008). Editorial: HIV rises among young gay men. New York Times: Jan 14.Google Scholar
  44. Osmond, D., Pollack, L., Pual, J., & Catania, J. (2007). Changes in prevalence of HIV infection and sexual risk behavior in men who have sex with men in San Francisco: 1997–2002. American Journal of Public Health, 97(9), 1677–1683. doi:10.2105/AJPH.2005.062851.PubMedCrossRefGoogle Scholar
  45. Pilcher, C. D., Fiscus, S. A., Nguyen, T. Q., Foust, E., Wolf, L., Williams, D., et al. (2005). Detection of acute infections during HIV testing in North Carolina. The New England Journal of Medicine, 352, 1873–1883. doi:10.1056/NEJMoa042291.PubMedCrossRefGoogle Scholar
  46. Public Health—Seattle & King County. Healthy People, Healthy Communities. (2005). HIV/AIDS Epidemiology Program. Facts about HIV/AIDS in Men who have Sex with Men (MSM). http://www.metrokc.gov/health/apu/epi (accessed October 25, 2006).
  47. Remis, R. S., Alary, M., Otis, J., Masse, B., Demers, E., Vincelette, J., Turmel, B., LeClerc, R., Lavoie, R., Parent, R., George, C., & Omega Study Group. (2002). No increase in HIV incidence observed in a cohort of men who have sex with other men in Montreal. AIDS (London, England), 16, 1183–1185. doi:10.1097/00002030-200205240-00014.
  48. Remis, R. S., Major, C., Calzavara, L., Myers, T., Burchell, A., & Whittingham, E. P. (2000). The HIV Epidemic Among Men Who Have Sex with Other Men: The Situation in Ontario in the Year 2000. Report, Department of Public Health Sciences, University of Toronto, Toronto Ontario, November 2000.Google Scholar
  49. Scheer, S., Douglas, J. M., Vittinghoff, E., Bartholow, B. N., McKirnan, D., Judson, F. N., et al. (1999). Feasibility and suitability of targeting young gay men for HIV vaccine efficacy trials. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 20, 172–178.PubMedGoogle Scholar
  50. Schwarcz, S., Kellogg, T., McFarland, W., Louie, B., Kohn, R., Busch, M., et al. (2001). Differences in the temporal trends of HIV seroincidence and seroprevalence among sexually transmitted disease clinic patients, 1989–1998: Application of the serologic testing algorithm for recent HIV seroconversion. American Journal of Epidemiology, 153, 925–934. doi:10.1093/aje/153.10.925.PubMedCrossRefGoogle Scholar
  51. Seage, G. R., Holte, S. E., Metzger, D., Koblin, B., Gross, M., Celum, C., et al. (2001). Are US populations appropriate for trials of human immunodeficiency virus vaccine?: The HIVNET vaccine preparedness study. American Journal of Epidemiology, 153, 619–627. doi:10.1093/aje/153.7.619.PubMedCrossRefGoogle Scholar
  52. SMASH study team. (1999). HIV/AIDS, Hepatitis C & Sexually Transmissible Infections in Australia. Annual Surveillance Report. Edited by the National Centre in HIV Social Research, The University of New South Wales, Sydney, Australia. http://web.med.unsw.edu.au/nchecr/Downloads/99ansurvrpt.pdf. (accessed 11/20/06).
  53. Strathdee, S. A., Martindale, S. L., Cornelisse, P. G. A., Miller, M. L., Craib, K. J. P., Schechter, M. T., et al. (2000). HIV infection and risk behaviours among young gay and bisexual men in Vancouver. Journal of the Canadian Medical Association, 162, 21–25.Google Scholar
  54. Suligoi, B., Giuliani, M., Galai, N., Balducci, M., & the STD Surveillance Working Group. (1999). HIV incidence among repeat HIV testers with sexually transmitted diseases in Italy. AIDS, 13, 845–850.Google Scholar
  55. Tabet, S. R., Krone, M. R., Paradise, M. A., Corey, L., Stamm, W. E., & Celum, C. L. (1998). Incidence of HIV and sexually transmitted diseases (STD) in a cohort of HIV-negative men who have sex with men (MSM). AIDS, 12, 2041–2048.PubMedCrossRefGoogle Scholar
  56. Taylor, M., Hawkins, K., Gonzalez, A., Buchacz, K., Aynalem, G., Smith, L., et al. (2005). User of the serologic testing algorithm for recent HIV seroconversion (STARHS) to identify recently acquired HIV infections in men with early syphilis in Los Angeles county. Journal of Acquired Immune Deficiency Syndromes, 38(5), 505–508.PubMedCrossRefGoogle Scholar
  57. The EXPLORE study team. (2004). Effects of a behavioral intervention to reduce acquisition of HIV infection among men who have sex with men: The EXPLORE randomized controlled study. Lancet, 364, 41–50.CrossRefGoogle Scholar
  58. Truong, H. H. M., Kellogg, T., Klausner, J. D., Katz, M. H., Dilley, J., Knapper, K., et al. (2006). Increases in sexually transmitted infections and sexual risk behavior without a concurrent increase in HIV incidence among men who have sex with men in San Francisco: A suggestion of HIV serosorting? Sexually Transmitted Infections, 82, 461–466.PubMedCrossRefGoogle Scholar
  59. UNAIDS. (2007). AIDS epidemic update: December 2007. UNAIDS.Google Scholar
  60. van den Noortgate W, Onghena P. (2005). Meta-analysis. In B. S. Everitt & D. C. Howell (Eds.), Encyclopedia of statistics in behavioral science. London: Wiley.Google Scholar
  61. van der Snoek, E. M., Dewit, J. B. F., Gotz, H. M., Mulder, P. G. H., Neumann, M. H. A., & Van der Meijden, W. I. (2006). Incidence of sexually transmitted diseases and HIV infection in men who have sex with men related to knowledge, perceived susceptibility, and perceived severity of sexually transmitted diseases and HIV infection: Dutch MSM—cohort study. Sexually Transmitted Diseases, 33, 193–198.PubMedCrossRefGoogle Scholar
  62. Weinstock, H., Dale, M., Gwinn, M., Satten, G. A., Kothe, D., Mei, J., et al. (2002). HIV seroincidence among patients at clinics for sexually transmitted diseases in nine cities in the United States. Journal of Acquired Immune Deficiency Syndromes, 29, 478–483.PubMedGoogle Scholar
  63. Weinstock, H., Sweeney, S., Satten, G. A., Gwinn, M., for the STD Clinic HIV Seroincidence Study Group. (1998). HIV seroincidence and risk factors among patients repeatedly tested for HIV attending sexually transmitted disease clinics in the United States, 1991 to 1996. Journal of Acquired Immune Deficiency Syndromes & Human Retrovirology, 19, 506–512.Google Scholar
  64. Winkelstein, W., Lyman, D., Padian, N., Grant, R., Samuel, M., Wiley, J., et al. (1987). Sexual practices and risk of infection by the human immunodeficiency virus: The San Francisco Men’s Health Study. Journal of the American Medical Association, 257(3), 321–324.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Ron Stall
    • 1
  • Luis Duran
    • 1
  • Stephen R. Wisniewski
    • 2
  • Mark S. Friedman
    • 1
  • Michael P. Marshal
    • 1
    • 3
  • Willi McFarland
    • 4
  • Thomas E. Guadamuz
    • 1
  • Thomas C. Mills
    • 3
  1. 1.Department of Behavioral and Community Health SciencesUniversity of Pittsburgh Graduate School of Public HealthPittsburghUSA
  2. 2.Department of EpidemiologyUniversity of Pittsburgh Graduate School of Public HealthPittsburghUSA
  3. 3.Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghUSA
  4. 4.AIDS OfficeDepartment of Public Health, City and County of San FranciscoSan FranciscoUSA

Personalised recommendations