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Engagement in HIV Care Among HIV-Positive Men Who Have Sex with Men From 21 Cities in the United States

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Abstract

We assessed factors associated with HIV care among HIV-infected men who have sex with men (MSM). We used 2008 data on MSM from the National HIV Behavioral Surveillance System (NHBS). Venue-based, time–space sampling was used to recruit and interview men in 21 U.S. cities with high AIDS prevalence. Among self-reported HIV-positive MSM, we used generalized estimating equations (clustered on city of interview) to evaluate factors associated with delayed linkage to care (care entry >3 months after diagnosis), not currently receiving care (no visit for HIV care during the 6 months before the study interview), and not being on antiretroviral therapy (ART). Among 8,153 MSM, 882 (11 %) were self-reported HIV-positive. 25 % had delayed linkage, 12 % were not currently receiving care and among those with at least one heath care visit 30 % were not on ART. In multivariate analysis, lower income and testing positive at their first HIV test were associated with delayed linkage. Age 18–29 years, and not having health insurance were associated with not currently receiving care. Among those with at least one health care visit, being age 18–39 years, having private or no health insurance, and stimulant use were associated with not being on ART. These findings can inform efforts to improve engagement in care.

Resumen

Analizamos factores relacionados con la atención médica del VIH entre hombres que tienen relaciones sexuales con hombres (HSH). Usamos datos del 2008 sobre HSH del Sistema Nacional de Vigilancia del Comportamiento Relacionado con el VIH (NHBS, por sus siglas en ingles). Se utilizó un muestreo en tiempo y lugar (VBS, por sus siglas en ingles) para reclutar y entrevistar a hombres en 21 ciudades de los EE. UU. con alta prevalencia del sida. Entre los HSH que autorreportaron ser VIH positivos utilizamos ecuaciones de estimación generalizada (agrupadas por ciudad de la entrevista) para analizar los factores relacionados con la vinculación tardía a la atención médica (comienzo de la atención > 3 meses después del diagnóstico), no estar recibiendo atención médica en ese momento (falta de citas para recibir atención médica por el VIH durante los 6 meses previos a la entrevista del estudio) y la falta de terapia antiretroviral (TAR). De 8,153 HSH, 882 (11 %) autorreportaron ser VIH positivos. El veinticinco por ciento tuvo vinculación tardía a la atención médica; el 12 % no estaba recibiendo atención médica en ese momento; y entre aquellos que habían ido a por lo menos una cita médica, el 30 % no estaba recibiendo TAR. En análisis multivariados, los ingresos más bajos y el haber tenido un resultado positivo en la primera prueba del VIH se relacionaron con una vinculación tardía a la atención médica. Tener entre 18 y 29 años y no tener un seguro médico se relacionaron con no estar recibiendo atención médica en ese momento. Entre aquellos que habían ido a por lo menos una cita médica, tener entre 18 y 39 años, tener seguro médico privado o no tener seguro y el uso de drogas estimulantes se relacionaron con la falta de TAR. Estos hallazgos pueden proporcionar información para los esfuerzos destinados a mejorar la participación en la atención médica.

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Acknowledgments

We would like to thank Dr. Binh Le for his invaluable assistance with data analysis.

Conflict of interest

The authors declare no conflicts of interest.

Funding

Funding was provided by the Centers for Disease Control and Prevention.

Author information

Authors and Affiliations

  1. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA

    Gabriela Paz-Bailey, Alexandra M. Oster, Amy Lansky, Ryan E. Wiegand, Elizabeth DiNenno, Jacek Skarbinski & James D. Heffelfinger

  2. ICF International, Atlanta, GA, USA

    Huong Pham

  3. Department of Public Health, Los Angeles, CA, USA

    Trista Bingham

Authors
  1. Gabriela Paz-Bailey
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  2. Huong Pham
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  3. Alexandra M. Oster
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  4. Amy Lansky
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  6. Ryan E. Wiegand
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  7. Elizabeth DiNenno
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  9. James D. Heffelfinger
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Corresponding author

Correspondence to Gabriela Paz-Bailey.

Appendix

Appendix

Atlanta, GA: Jennifer Taussig, Robert Gern, Tamika Hoyte, Laura Salazar; Baltimore, MD: Colin Flynn, Frangiscos Sifakis; Boston, MA: Debbie Isenberg, Maura Driscoll, Elizabeth Hurwitz; Chicago, IL: Nikhil Prachand, Nanette Benbow; Dallas, TX: Sharon Melville, Praveen Pannala, Richard Yeager, Aaron Sayegh, Jim Dyer, Alicia Novoa; Denver, CO: Mark Thrun, Alia Al-Tayyib, Ralph Wilmoth; Detroit, MI: Emily Higgins, Vivian Griffin, Eve Mokotoff; Houston, TX: Marcia Wolverton, Jan Risser, Hafeez Rehman; Los Angeles, CA: Trista Bingham, Ekow Kwa Sey; Miami, FL: Marlene LaLota, Lisa Metsch, David Forrest, Dano Beck, Gabriel Cardenas; Nassau-Suffolk, NY: Chris Nemeth, Carol-Ann Watson, Lou Smith; New Orleans, LA: William T. Robinson, DeAnn Gruber; New York City, NY: Chris Murrill, Alan Neaigus, Samuel Jenness, Holly Hagan, Travis Wendel; Newark, NJ: Helene Cross, Barbara Bolden, Sally D’Errico; Philadelphia, PA: Kathleen A. Brady, Althea Kirkland; San Diego, CA: Vanessa Miguelino, Al Velasco; San Francisco, CA: H. Fisher Raymond; San Juan, PR: Sandra Miranda De León, Yadira Rolón-Colón; Seattle, WA: Hanne Thiede, Richard Burt; St Louis, MO: Michael Herbert, Yelena Friedberg, Dale Wrigley, Jacob Fisher; Washington, DC: Paul Cunningham, Marie Sansone, Tiffany West-Ojo, Manya Magnus, Irene Kuo; Behavioral Surveillance Team.

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Paz-Bailey, G., Pham, H., Oster, A.M. et al. Engagement in HIV Care Among HIV-Positive Men Who Have Sex with Men From 21 Cities in the United States. AIDS Behav 18 (Suppl 3), 348–358 (2014). https://doi.org/10.1007/s10461-013-0605-y

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