Running in Place: Implications of HIV Incidence Estimates among Urban Men Who Have Sex with Men in the United States and Other Industrialized Countries
- 374 Downloads
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.
KeywordsMen who have sex with men HIV/AIDS Epidemiology Prevention
This research was supported in part by grants MH080648, “Longitudinal Internet Research Investigating Health Outcomes in Adolescence” (Dr. Friedman), DA022936 “Long Term Health Effects of Methamphetamine Use in the MACS” (Drs. Stall and Guadamuz), AA015100 “Parent Alcoholism Among ADHD Youth: A Longitudinal Study” (Dr. Marshal). This paper is dedicated to the memory of Mr. Hank Wilson, a long-time AIDS activist in San Francisco whose life work was devoted to improving health and well-being among gay men.
- 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
- 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
- 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
- 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
- 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.
- 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
- 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
- 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
- Centers for Disease Control. (2006). Primary and secondary syphilis—United States, 2003–2004. MMWR, 55(10), 269–273.Google Scholar
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- New York Times. (2008). Editorial: HIV rises among young gay men. New York Times: Jan 14.Google Scholar
- 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).
- 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.
- 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
- 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
- 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
- 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
- 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).
- 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
- 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
- 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
- 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
- UNAIDS. (2007). AIDS epidemic update: December 2007. UNAIDS.Google Scholar
- 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
- 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
- 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