November 30, 2012
The results of this analysis indicate that the majority of HIV infections in newly diagnosed persons aged ≥13 years in 2010 were attributed to male-to-male sexual contact. The percentages of HIV infections attributable to male-to-male sexual contact were higher in MSAs, compared with smaller metropolitan areas and nonmetropolitan areas. Among the MSAs examined, seven accounted for 48.4% of the persons with HIV infection attributable to male-to-male sexual contact. The four MSAs with the largest percentages of HIV infections attributed to male-to-male sexual contact were located in California. These results highlight the disproportionate burden of HIV infection among MSM, who were estimated to comprise approximately 3.9% of the male population aged ≥13 years in 2008 in the United States.8
The geographic concentration of HIV infection reflects the higher risk for HIV transmission in areas with larger populations, greater prevalence of HIV infection attributed to male-to-male contact (e.g., MSAs compared with smaller areas), and possibly a greater prevalence of MSM living in the community. Effective interventions that could reduce the number of HIV infections in MSAs include HIV testing, HIV care and treatment, and risk-reduction counseling.
The findings in this report are subject to at least three limitations. First, HIV infection surveillance locations in five areas were excluded because they had not had confidential name-based reporting in place by January 2007 or had not reported these data to CDC since at least June 2007. The effect of this limitation is unknown. Second, comparisons were made based on estimated percentages of diagnoses instead of HIV diagnosis rates. To evaluate disparities in HIV risk between groups, HIV diagnosis rates should be calculated by applying population denominators for persons within each transmission category; however, such population estimates currently are unavailable for MSAs, smaller metropolitan areas, and nonmetropolitan areas. Finally, transmission category estimates were adjusted for missing risk factor information. Whether these adjustments introduce any bias in overestimation or underestimation of percentages of HIV infection attributed to specific categories is unknown. Adjusted estimates should be interpreted with caution, particularly when numbers are small (i.e., less than 12).
CDC's High-Impact HIV Prevention¶ program relies on geographic targeting of resources and proven, cost-effective interventions to achieve the goals of the National HIV/AIDS Strategy, which include reducing the number of persons who become infected with HIV, increasing access to care and optimizing health outcomes for persons living with HIV, and reducing HIV-related health disparities.** The results of this analysis underscore the uneven geographic distribution of the burden of HIV infection in MSAs in the United States and Puerto Rico. The geographic disparity in HIV burden also indicates a need to target MSM who bear a large percentage of the burden of infection in areas where persons are at greatest risk for HIV transmission. Health departments, community-based organizations, and other agencies can use these results in planning interventions in their areas to reduce HIV infection and transmission.
* MSAs have populations ≥500,000; smaller metropolitan areas have populations of 50,000-499,999, and nonmetropolitan areas are those with populations <50,000. Additional information available at www.whitehouse.gov/sites/default/files/omb/assets/bulletins/b10-02.pdf.
¶ Additional information available at www.cdc.gov/hiv/strategy/hihp/pdf/dhap_policy_maker.pdf.
** Additional information available at www.whitehouse.gov/administration/eop/onap/nhas.
What is already known on this topic?
In 2009, an estimated 64% of new human immunodeficiency virus (HIV) infections were attributed to male-to-male sexual contact.
What is added by this report?
Of the estimated 28,851 infections in 2010 attributed to male-to-male sexual contact, 23,559 (81.7%) were in metropolitan statistical areas (MSAs) with populations of 500,000 or more in the United States and Puerto Rico, and 11,410 (48.4%) of those infections were in seven of the MSAs assessed. The four MSAs with the greatest percentages of HIV infections attributed to male-to-male sexual contact were in California.
What are the implications for public health practice?
Effective interventions that could reduce the number of HIV infections in areas where men who have sex with men are at greater risk for HIV infection and transmission by male-to-male contact include HIV testing, HIV care and treatment, and risk-reduction counseling.
TABLE 1. Estimated Number and Percentage* of Diagnoses of HIV Infection†Among Persons Aged ≥13 Years, by Transmission Category and Size of Location of Residence -- National HIV Surveillance System, United States and Puerto Rico, 2010
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