Unmet HIV Service Needs Among Hispanic Men who Have Sex with Men in the United States

Delayed Diagnosis of Human Immunodeficiency Virus in the Latino Population at a Federally Qualified Community Health Center in New Jersey

Late diagnosis of human immunodeficiency virus (HIV) is associated with early progression to acquired immunodeficiency syndrome (AIDS). We examined racial/ethnic differences in presentation with advanced HIV/AIDS at a community health center in New Jersey. Records of patients diagnosed with HIV between 1990 and 2018 were reviewed. Odds ratios (OR) of presenting with AIDS at HIV diagnosis were computed in unadjusted and adjusted models. There were 182 (48.3%) Latino, 48 (12.7%) non-Latino White (NLW), 130 (34.5%) non-Latino Black, and 17 (4.5%) non-Latino of other race/ethnicity included in the analysis. Over 75% of the Latinos were foreign-born. Latino patients had higher odds of presentation with AIDS at time of HIV diagnosis than NLW in unadjusted (OR = 4.85, 95% confidence interval (95% CI): 2.28-10.31) and adjusted models (OR = 3.71, 95%CI: 1.60-8.59). Latino patients, particularly foreign-born and bisexual, had higher odds of being diagnosed with AIDS at presentation with HIV in this cohort.

Social Support and Other Factors Associated with HIV Testing by Hispanic/Latino Gay, Bisexual, and Other Men Who Have Sex with Men in the U.S. South

Cognitive-psychosocial and other factors may affect participation in HIV testing, particularly by Hispanic/Latino gay, bisexual, and other men who have sex with men (MSM) in the U.S. South, a region hard-hit by HIV. We used univariate and multivariable logistic regression analyses to examine the association between social support and other cognitive-psychosocial factors; sociodemographic characteristics; risk behaviors; and self-reported HIV testing in a sample of 304 Hispanic/Latino MSM in North Carolina. In the multivariable logistic regression analysis, general and HIV-related social support and HIV-related knowledge were associated with greater odds of testing; speaking only Spanish was associated with reduced odds of testing. Social support and aspects of social connectedness may constitute community-based resources for use in HIV prevention efforts with Hispanic/Latino MSM. However, harnessing these resources for HIV prevention will require a better understanding of how social support relationships and processes shape HIV risks and protective actions by these vulnerable MSM.

Rates of prevalent and new HIV diagnoses by race and ethnicity among men who have sex with men, U.S. states, 2013-2014

PURPOSE

Men who have sex with men (MSM) bear a disproportionate burden of new and existing HIV infections in the United States, with black and Hispanic MSM facing the highest rates. A lack of data on MSM population sizes has precluded the understanding of state-level variations in these rates.

METHODS

Using a recently developed model for estimating state-level population sizes of MSM by race that synthesizes data from the American Community Survey and the National Health and Nutrition Examination Survey, in conjunction with Centers for Disease Control and Prevention-based HIV diagnosis data, we estimated rates of living with an HIV diagnosis (2013) and new diagnosis among MSM (2014) by state and race.

RESULTS

Nationally, state-level median prevalence of living with an HIV diagnosis was 10.6%. White MSM had lower prevalence in all but five states; black MSM were higher in all but three. Hispanic MSM had highest concentrations in Northeast and Mississippi Delta states. Patterns were similar for new diagnoses rates.

CONCLUSIONS

Results suggest that racial disparities in HIV infection among MSM are more prominent than geographic ones. Interventions should be differentially tailored to areas of high proportionate and absolute burden. Continued efforts to understand and address racial differences in HIV infection are needed.

Promoting Pre-exposure Prophylaxis to Prevent HIV Infections Among Sexual and Gender Minority Hispanics/Latinxs

Sexual and gender minority Hispanics/Latinxs (henceforth: Latinxs) continue to be disproportionately impacted by HIV/AIDS in the U.S. Pre-exposure prophylaxis (PrEP) is a biomedical prevention approach which holds significant promise for at risk and vulnerable populations. We discuss barriers and facilitators to uptake of PrEP among sexual and gender minority Latinxs living in the U.S. through an ecosocial lens that takes into account structural, community, and individual contexts. The impact of immigration status on PrEP uptake emerges as a major and recurrent theme that must be understood and addressed by HIV prevention programs aiming to promote an inclusive strategy for sexual and gender minority Latinxs living in the U.S.

U.S. HIV Incidence and Transmission Goals, 2020 and 2025

INTRODUCTION

The recently updated U.S. National HIV/AIDS Strategy sets key HIV prevention and care targets for 2020, but the trajectory of the epidemic remains unclear. Authors modeled HIV incidence, prevalence, and mortality for the U.S. over 10 years to determine whether an ambitious trajectory toward "ending AIDS" by 2025 would be achievable.

METHODS

Authors utilized recently published 2010-2013 Centers for Disease Control and Prevention surveillance data to model HIV incidence, prevalence, and mortality. Authors applied a 90/90/90 framework (90% awareness of serostatus, 90% of diagnosed individuals in care, and 90% of individuals on antiretroviral therapy virally suppressed) by 2020 and 95/95/95 by 2025 to assess the feasibility of meeting epidemiologic targets. Analyses were conducted in 2016.

RESULTS

With a goal of reducing infections to 21,000 new HIV infections in 2020, authors project a transmission rate of 1.74, 12,571 deaths, and a total of 1,205,515 people living with HIV. By 2025, with a target of 12,000 new HIV infections (a 69% decrease in HIV incidence), authors project a transmission rate of 0.98, 12,522 deaths, and a total of 1,220,615 people living with HIV. With a 90/90/90 framework by 2020 and a 95/95/95 framework by 2025, these epidemiologic targets would be feasible.

CONCLUSIONS

Key programmatic milestones provide an ambitious, but important, pathway to reduce U.S. HIV incidence below 12,000 new infections by 2025. HIV incidence would decrease below mortality in 2025, marking a transition toward ending the HIV/AIDS epidemic. Such goals will require a sustained and intensified national commitment over the next decade.

Small-Group Randomized Controlled Trial to Increase Condom Use and HIV Testing Among Hispanic/Latino Gay, Bisexual, and Other Men Who Have Sex With Men

OBJECTIVES

To evaluate the HOLA en Grupos intervention, a Spanish-language small-group behavioral HIV prevention intervention designed to increase condom use and HIV testing among Hispanic/Latino gay, bisexual, and other men who have sex with men.

METHODS

In 2012 to 2015, we recruited and randomized 304 Hispanic/Latino men who have sex with men, aged 18 to 55 years in North Carolina, to the 4-session HOLA en Grupos intervention or an attention-equivalent general health education comparison intervention. Participants completed structured assessments at baseline and 6-month follow-up. Follow-up retention was 100%.

RESULTS

At follow-up, relative to comparison participants, HOLA en Grupos participants reported increased consistent condom use during the past 3 months (adjusted odds ratio [AOR] = 4.1; 95% confidence interval [CI] = 2.2, 7.9; P < .001) and HIV testing during the past 6 months (AOR = 13.8; 95% CI = 7.6, 25.3; P < .001). HOLA en Grupos participants also reported increased knowledge of HIV (P < .001) and sexually transmitted infections (P < .001); condom use skills (P < .001), self-efficacy (P < .001), expectancies (P < .001), and intentions (P < .001); sexual communication skills (P < .01); and decreased fatalism (P < .001).

CONCLUSIONS

The HOLA en Grupos intervention is efficacious for reducing HIV risk behaviors among Hispanic/Latino men who have sex with men.

Demographic Trends in New HIV Diagnoses in the U.S., 2009-2013

INTRODUCTION

HIV testing is key to achieving the National HIV/AIDS Strategy goals. A new diagnosis metric evaluated whether testing services are reaching the remaining undiagnosed people living with HIV (PLWH), by subpopulation.

METHODS

Centers for Disease Control and Prevention surveillance data from 2008 to 2013 were obtained for: (1) new HIV diagnoses; (2) HIV prevalence; and (3) percentage of PLWH aware of serostatus. The number of new HIV diagnoses in a given year divided by the number of undiagnosed PLWH in the previous year was determined. Trends were evaluated by calculating net percentage change in this measure from 2009 to 2013 for all new diagnoses and stratified by subpopulation. Analyses were conducted during 2015-2016.

RESULTS

The proportion of all undiagnosed PLWH who achieve serostatus awareness was 26.0%, 25.9%, 26.1%, 27.7%, and 30.4% from 2009 to 2013, respectively. The absolute net change was 4.3% (5.2% for men and 0.5% for women). There was an absolute net change of 5.0%, 3.1%, and 5.5% for the black, Hispanic, and men who have sex with men communities, respectively. An absolute net change >10% was observed only for those aged 13-24 years (10.9%) and ≥65 years (17.8%), and for men who inject drugs (11.7%).

CONCLUSIONS

The proportion of undiagnosed PLWH who achieve serostatus awareness increased minimally from 2009 to 2013, especially for blacks, Hispanics, and men who have sex with men. Redirecting HIV testing efforts and funds to disproportionately affected communities is essential.

Evaluating the Impact of the US National HIV/AIDS Strategy, 2010-2015

The 2010 US National HIV/AIDS Strategy (NHAS) set key targets for the reduction of HIV incidence (25 %) and the transmission rate (30 %) by 2015. We utilized published CDC data on HIV prevalence and mortality for 2007-2012, and literature-based incidence estimates for 2008-2012, along with mathematical modeling to evaluate whether the original NHAS incidence and transmission rate goals were achieved. From 2010 to 2015, a decrease was estimated from about 37,366 to 33,218 (11.1 % net decrease) for HIV incidence, and from 3.16 to 2.61 (17.4 % net decrease) for the HIV transmission rate. Over the same period, estimated all-cause mortality decreased from 17,866 to 16,085, while HIV prevalence increased from 1,181,300 to 1,270,755 persons living with HIV. At the conclusion of the original NHAS time period, important incremental but ultimately insufficient progress was made in attempting to reach key incidence and transmission rate targets for the NHAS. HIV prevention efforts must be reinvigorated in the NHAS's second era.