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One in 5 gay and bisexual men in major cities in the United States is infected with HIV, and nearly half — 44% — do not know their status. Most unaware are young and minority men who have sex with men (MSM), according to a new analysis published in the September 24 issue of the Morbidity and Mortality Weekly Report.

“[MSM] are at increased risk for infection with [HIV],” write A. Smith, MPH, and colleagues from the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention (CDC). “In 2006, 57% of new HIV infections in the United States occurred among MSM.”

The CDC uses the National HIV Surveillance system (NHBS) to monitor prevalence and trends in HIV-related risk behaviors, HIV testing, and use of HIV prevention services among high-risk populations. In the current report, the authors summarize NHBS data from 2008.

From January to December 2008, 8153 MSM from 21 cities were interviewed and tested for HIV. The study found that the overall prevalence of HIV was 19%.

Non-Hispanic blacks had the highest prevalence (28%), followed by Hispanics (18%), non-Hispanic whites (16%), and persons who were multiracial or of other race (17%).

Forty-four percent of those infected with HIV were unaware of their status. Black MSM with HIV were least likely to be aware of their infection (59%), followed by Hispanic MSM (46%) and white MSM (26%).

The study also found that although young men, aged 30 years or younger, had a lower HIV prevalence than older men, they were much more likely to be unaware of their HIV infection. Among men aged 18 to 29 years who had HIV, 63% were unaware vs 37% of men aged 30 years and older.

Also among young men, MSM of color were less likely than their white counterparts to know they were infected with HIV. Among blacks aged 30 years or younger, 71% were unaware of their status compared with 63% of young Hispanic MSM and 40% of young white MSM.

The study also found a strong link between socioeconomic status and HIV infection in MSM. The prevalence of HIV infection increased as education and income decreased, as did awareness. These findings are similar to those found in recent NHBS research among homosexuals, the authors report.

Men who know their current HIV infection status can be referred to appropriate medical care and prevention services. Once they are linked to prevention services, they can learn ways to avoid transmitting HIV to others, the authors note, adding that efforts to reach out to young and minority MSM should be increased to promote testing for HIV.

The authors also note limitations of their report. Because interviewers conducted the surveys, positive HIV status might have been underreported. Also, because the findings are limited to men who frequented bars, dance clubs, and other MSM venues, they may not be representative of results for all MSM.

The high proportion of MSM unaware of their HIV infection continues to be a serious public health concern, because these MSM account for the majority of estimated new HIV transmissions in the United States,” the author write in their concluding remarks. “The 2008 NHBS data show that MSM remain a key target of strategies to reduce HIV incidence and decrease racial and socioeconomic disparities in the United States.

This study’s message is clear: HIV exacts a devastating toll on [MSM] in America’s major cities, and yet far too many of those who are infected don’t know it,” Kevin Fenton, MD, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said in a statement. “We need to increase access to HIV testing so that more MSM know their status, and we all must bring new energy, new approaches, and new champions to the fight against HIV among [MSM].

The authors have disclosed no relevant financial relationships.

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