Last week, the CDC published the supplemental report, “Diagnosed HIV Infection among Adults and Adolescents in Metropolitan Statistical Areas –United States and Puerto Rico, 2013.” The report supplements the 2013 HIV Surveillance Report and presents data based on people living with diagnosed HIV infection residing in metropolitan statistical areas (MSAs; population of 500,000 or more) in the United States and Puerto Rico.
Overall, the report highlights that the southern region continues to shoulder the greatest burden of HIV in the country. Although the number of new diagnoses in the United States has remained stable, the data from the latest MSA supplemental report show that people living in MSAs, especially MSAs in the South, have higher rates of HIV diagnoses and prevalence.
Among large MSAs, five MSAs (Miami-Fort Lauderdale-West Palm Beach, FL; New York-Newark-Jersey City, NY-NJ-PA; Baltimore-Columbia-Towson, MD; New Orleans-Metairie, LA; and Jackson, MS) had the highest HIV prevalence rates accounting for 30% of the number of persons living with diagnosed HIV infection in large MSAs. Compared to data from the last MSA Supplemental Report in 2011, the overall results for the newest report were similar. By race/ethnicity, rates of diagnoses of HIV infection and prevalence were highest in MSAs in the South for Blacks/African Americans, the Northeast and South for Hispanics/Latinos, and MSAs in Florida for whites. Diagnosis and prevalence rates overall, by sex and by sex and age were highest in MSAs in the South with Miami-Fort Lauderdale-West Palm Beach, FL having the highest diagnosis and prevalence rates, overall. For all large MSAs, male-to-male sexual contact was the leading transmission category. Death rates for male and females adults and adolescents were often highest in the South with the highest being Baltimore-Columbia-Towson, MD.
Targeted testing, linkage to care, and other prevention initiatives may explain the changes seen among certain regions, populations, and subgroups. Activities such as expanded HIV testing in severely affected populations and regions align with the National HIV Strategy by increasing the number of individuals aware of their HIV infection. The data also indicates areas where there are inequities and work to be done to decrease new infections and death rates.
Surveillance data will continue to help guide resources to ensure resources are used in the most effective way possible. Consistent with CDC’s High-Impact Prevention approach, federal, state, and local health officials may use this data to target prevention and treatment services to regions, populations, and communities at greatest need.
In addition to the “Diagnosed HIV Infection among Adults and Adolescents in Metropolitan Statistical Areas –United States and Puerto Rico, 2013” supplemental report, the CDC recently published two HIV Surveillance: Special Reports. These reports highlight the latest findings from the National Behavioral Surveillance (NHBS) program that monitors behaviors among at risk populations and the Medical Monitoring Project (MMP) that assesses clinical and behavioral characteristic of HIV-infected adults who are receiving outpatient treatment.
The most recent data from the National HIV Behavioral Surveillance show that heterosexuals of low socioeconomic status in urban areas are still at increased risk of HIV infection and would benefit from increased receipt of HIV testing and prevention resources.
Past data from the first two cycles among heterosexuals at increased risk for HIV infection indicate that heterosexual men and women of low socioeconomic status in urban areas have higher HIV prevalence compared to the general population. In the third heterosexual cycle of NHBS in 2013, 2% of respondents had a positive result for HIV infection; of these, 56% reported being aware of their infection. Data from 2013 show that 19% of respondents had never been tested for HIV and 62% had not been tested in the 12 months before interview. Condomless vaginal and anal sex was reported least often by individuals aware of their infection compared with those unaware of their infection and those who are HIV-negative. The receipt of free condoms was reported by 41% of participants and 13% reported participating in an HIV behavioral intervention. Among self-reported HIV positive-aware participants, 95% reported having ever visiting a health care provider for HIV care and 91% reported a visit within the six months before the interview; 72% were linked to HIV care within three months of diagnosis. Of the 8,104 participants in 2013, the majority (77%) identified as Black, 53% were female, and 86% had incomes at or below the federal poverty level.
The results from the latest NHBS cycle underscore the importance of increased HIV testing, prevention, and linkage to care services for at-risk heterosexuals in urban areas. The National HIV/AIDS Strategy emphasizes the importance of increasing the number of people who know their serostatus and linking them to care, if needed. Data from NHBS provide a beneficial national snapshot of HIV risk behaviors among at-risk populations and provide data from state and local health departments to monitor selected health behaviors in areas with high HIV prevalence.
Medical Monitoring Project Report Details Clinical and Behavioral Characteristics of HIV-Infected Individuals Receiving Care in the United States and Puerto Rico
The latest Medical Monitoring Project (MMP) report shows the benefit of HIV treatment with over three-quarters (77%) of respondents having an undetectable viral load at their most recent measurement. Of all respondents, an estimated 98% had health insurance or coverage for antiretroviral therapy (ART) with only 31% having private health insurance. The MMP report details data collected in 2012. MMP is a representative, cross-sectional survey of HIV-infected individuals receiving care in the United States and Puerto Rico. Compared to the previous data collection in 2011, the data showed similar results.
The results from the latest MMP report highlight the need for tailored HIV prevention strategies for HIV-infected individuals with only 41% of all respondents reporting receiving counseling about how to prevent transmission of HIV. Approximately 63% of patients reported being sexually active with the highest percentage of sex without a condom with a partner of negative or unknown status being reported by men who have sex with men. The representative sample was 74% male, almost half (49%) identified as heterosexual, 42% were black, and more than three-quarters (77%) were at least 40 years old. Among patients currently taking ART, self-reported dose, schedule, and special instructions adherence was 89%, 76%, and 74%, respectively.
Through ongoing data collection, CDC will continue to use MMP data to monitor clinical and health characteristics along with met and unmet needs for HIV care and prevention services for HIV-infected individuals receiving care in the United States and Puerto Rico.