HIV Care Continuum Among Men Who Have Sex with Men (MSM) in Georgia, 2012 - CANCELLED (June 21)

BACKGROUND:   Recording behavioral risk factors associated with HIV infection helped identify the mode of HIV transmission (e.g., blood and bodily fluids) and continues to be crucial in identifying populations at increased risk for HIV infection.  Although a person can have multiple risk factors, CDC recommends categorizing the risk factor information on each surveillance record according to a hierarchy. In descending order of priority, these hierarchical categories are:

• Male-to-male sexual contact (MSM)
• Injection drug use (IDU)
• MSM and IDU (MSM/IDU)
• Heterosexual contact or HET
• Other

 New HIV infections in Georgia occurred disproportionately among MSM and people of color. Anti-retroviral therapy (ART) use resulting in viral suppression (a viral load <200 copies/ml) decreases the transmission of the virus to others. It has been hypothesized that the increased rate of new HIV diagnoses among black MSM compared to white or Hispanic/Latino MSM relates to lower levels of viral suppression.  Such lower levels of suppression may be a function of poorer access to care, limited retention in care, less ART adherence, and other factors relating to the social determinants of health

METHODS:   Using data from Georgia’s Enhanced HIV/AIDS Reporting System (eHARS), the Georgia Department of Public Health (DPH) analyzed HIV Care Continuum for MSM with a current address in Georgia stratified by race/ethnicity and age for the prevalent population of persons living with HIV and for persons newly diagnosed in 2011. Multiple imputation, a statistical approach in which missing transmission categories for each person are replaced with plausible values that represent the uncertainty regarding the actual, but missing, values, was used to assign transmission category where missing

RESULTS:   Among MSM living with HIV in 2012, viral suppression (VL <200) is found for 36% of blacks, 38% of Hispanic/Latinos and 47% of Whites. Of the 1050 Black MSM diagnosed with HIV infection in 2011 in Georgia, stratified by age viral suppression was lowest (26%) among those aged 13-24 years and highest (47%) among ages 45-54 years.  Even among those retained in care, black MSM had lower levels of viral suppression than white and Hispanic/Latino MSM at every age group.

CONCLUSIONS:   The HIV Care Continuum can be used to identify disparities in care and outcomes with multilevel stratification.