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More gay, bi men with HIV receiving care, disparities remain
Posted 14 Apr 2017 05:55
(Reuters Health) - Gay and bisexual men in the United States who are diagnosed with HIV are promptly receiving the necessary treatments more often than in the past, according to a new report from the Centers for Disease Control and Prevention (CDC).
Still, black gay and bisexual men are less likely than their white counterparts to receive antiretroviral therapy (ART) to keep the human immunodeficiency virus in check, the researchers found.
They write in the Journal of Infectious Diseases that one goal of the National HIV/AIDS Strategy was to get 85 percent of people to a healthcare facility within three months of being diagnosed with HIV by 2015. By 2020, the goal is to get 85 percent of people diagnosed with HIV to care within one month.
The study team previously published 2008 and 2011 results from the CDC's National HIV Behavioral Surveillance, which includes data from 20 cities on adult HIV-positive men who have sex with men - a group at particular risk for HIV infection. The new study adds data from 2014.
Altogether, 1,144 men provided data in 2008, 1,338 in 2011 and 1,716 in 2014. The proportion of white men taking the survey fell 14 percentage points between 2008 and 2014, but the proportion of black men participating increased by 13 percentage points during the same period.
The average age of the men dropped over the study period, too. Insurance coverage increased from 75 percent in 2008 to 86 percent in 2014, which was the first year of coverage expansion under the Affordable Care Act.
In 2008, 79 percent of the men were seen at a healthcare facility within three months of their diagnosis. That measure - known as linkage to care - increased to 87 percent by 2014.
With the 2020 goal in mind, the researchers analyzed how many men were seen at a healthcare facility within one month of their HIV diagnosis. In 2014, 78 percent of men were linked to care within one month, which the researchers say suggests the 2020 goal is feasible.
When the researchers looked at how many of the men were receiving ART, they found the rate increased from 69 percent in 2008 to 88 percent in 2014.
People with insurance or with higher levels of education or income were more likely to be linked to care within a short amount of time and be on ART.
In all years, a higher percentage of ARV treatment was observed among whites, according to the researchers - and this disparity persisted in 2014. The proportion of white men on ART were 9 percentage points higher than the proportion of black men.
"We’re moving in the right direction, but the fact that the disparities are persisting in 2014 when we’ve had access to antiretroviral therapy for so long is troubling," said Jennifer Kates, who is vice president and director of global health and HIV policy at the Kaiser Family Foundation in Washington, D.C.
The findings suggest black men are being linked to care at roughly the same rate as white men, but they're not getting equal access to ART, said Kates, who wasn't involved in the new study.
"There are some systemic issues on the healthcare system side – from providers to insurance – that this study wasn’t designed to look at," she told Reuters Health.
For example, it could be that doctors are writing the prescriptions for ART, but lack of insurance or other social services is creating a barrier.
In an editorial accompanying the new study, Sten Vermund of the Vanderbilt University School of Medicine in Nashville, Tennessee, writes that many organizations are working to find better and more effective outreach methods for HIV testing and care.
"Still, jurisdictions struggle with only limited success to solve their black-Hispanic-white disparities in HIV risk and access to care," Vermund writes.
The authors caution that the results are not nationally representative. Additionally, they relied on face-to-face interviews that may lead men to report higher levels of linkage to care and ART use since those would be the more socially desired answers.
Lead author Brooke Hoots, of the CDC's division of HIV/AIDS Prevention in Atlanta, was not available for comment by press time.
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