Understanding of the extent of disparity in HIV infection rates between men who have sex with men (MSM) and other groups has been limited by an inability to approximate the size of the MSM population. Defining MSM as ever engaged in same-sex behavior, Lieb et al. estimated that 7.1%, 5.5% and 6.5% of White, Black and Hispanic/Latino men in Georgia were MSM. Defining MSM as same-sex behavior within the past five years, Grey et al. estimated Georgia’s proportion of MSM as 3.7%; race/ethnicity estimates were not provided. These estimates allow the calculation of rates that are important to understanding the dynamics of Georgia’s HIV epidemic.
METHODS:
We used Georgia population estimates for 2013, and applied the proportions from the above-referenced studies to calculate the number of MSM in Georgia. Prevalence of diagnosed HIV infection as of 2013 was obtained from the Georgia HIV Surveillance System. We calculated rates for diagnosed HIV infection for males, females, MSM and other males, aged 15 and older, stratified by race/ethnicity. Transmission categories for other males included injection drug use (IDU), combined MSM/IDU, heterosexual and unknown. We calculated rate ratios to compare rates between different groups by dividing the rate for MSM by the rate for other men and women.
RESULTS:
There were 39,097 men and 12,724 women living with HIV in Georgia during 2013. HIV prevalence was approximately 1% for males and 0.3% for females overall. For Whites, Hispanic/Latinos and Blacks, HIV prevalence was 5%, 8%, and 32% respectively for MSM defined as ever engaged in same-sex behavior (method 1 using Lieb’s estimates), and 9%, 15%, and 48% for MSM defined as same-sex behavior in the past five years (method 2 using Grey’s estimate). Compared to males with other transmission risk, rate ratios using method 1 and method 2 were 47.3 and 85.5 for MSM overall, 59.7 and 90.3 for Black MSM, 58.1 and 105.1 for Hispanic/Latino MSM, and 83 and 168.7 for White MSM.
CONCLUSIONS:
Use of prevalence rates for MSM allows for quantifying the impact of HIV on this population and highlights the degree to which MSM are disproportionately affected. Rate ratios demonstrate substantial HIV disparity by race and transmission category in Georgia during 2013. Estimated HIV prevalence rates of 32% and 48%, depending on MSM definition, among Black MSM underscore the importance of HIV prevention in this group.